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Conventional therapy for Crohn's disease

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World Journal of Gastroenterology 2006年第30期12卷 4794-4806页

作者： Carsten Büning herbert lochs Department of Gastroenterology Hepatology & Endocrinology Charité Campus Mitte Universittsmedizin Berlin Berlin Germany

Crohn＇s disease （CD） is a multifactorial disorder of unknown cause. Outstanding progress regarding the pathophysiology of CD has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD over the last years. However, many drugs have not been approved by regulatory authorities due to lack of efficacy or severe side effects. Therefore, well-known drugs, including 5-ASA, systemic or topical corticosteroids, and immunosuppressants such as azathioprine, are still the mainstay of CD therapy. Importantly, biologicals such as infliximab have shown to be efficacious in problematic settings such as fistulizing or steroid-dependent CD. This review is intended to give practical guidelines to clinicians for the conventional treatment of CD. We concentrated on the results of randomized, placebo-controlled trials and meta-analyses, when available, that provide the highest degree of evidence. We provide evidence-based treatment algorithms whenever possible. However, many clinical situations have not been answered by controlled clinical trials and it is important to fill these gaps through expert opinions. We hope that this review offers a useful tool for clinicians in the challenging treatment of CD.

关键词： Crohn's disease Conventional treatment Review Therapy

Malnutrition affects quality of life in gastroenterology patients

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World Journal of Gastroenterology 2006年第21期12卷 3380-3385页

作者： Kristina Norman Henriette Kirchner herbert lochs Matthias Pirlich Klinik mil Schwerpunkt Gastroenterologie Hepatologie und Endokrinologie Charité-Universit(a|¨)tsmedizin Berlin Campus MitteGermany

AIM： To investigate the association between malnutrition and quality of life in patients with benign gastrointestinal ***： Two hundred patients （104 wellnourished and 96 malnourished） were assessed according to the Subjective Global Assessment, anthropometric measurements and bioelectrical impedance analysis. Quality of life was determined with the validated Medical Outcomes Study 36-item Short-Form General Health Survey （SF 36）. Muscle function was assessed by hand grip strength and peak ***： Body mass index, body cell mass, arm muscle area and hand grip strength were significantly lower in the malnourished patients. Quality of life was generally lower when compared to norm values. Seven out of eight quality of life scales （excluding bodily pain） were significantly reduced in the malnourished patients. Comparing patients with liver cirrhosis and inflammatory bowel disease （IBD）, patients with IBD experienced significantly lower values in the perception of bodily pain, social functioning and rnenta/health. Malnourished liver cirrhotics suffered reductions in more scales （six out of eight） than malnourished IBD patients did （four out of eight）.CONCLUSION： Quality of life is generally low in benign gastrointestinal disease and is further reduced in patients who are classified as malnourished. It appears that liver cirrhosis patients experience a higher quality of life than IBD patients do, but the impact of malnutrition seems to be greater in liver cirrhosis than in IBD.

关键词： Quality of life Malnutrition Gastrointestinal disease Liver cirrhosis Inflammatory bowel disease

Spatial organization of bacterial flora in normal and inflamed intestine: A fluorescence in situ hybridization study in mice

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World Journal of Gastroenterology 2005年第8期11卷 1131-1140页

作者： Alexander Swidsinski Vera Loening-Baucke herbert lochs Laura P.Hale Innere Klinik Department of Pathology

AIM: To studythe role of intestinal flora in inflammatory bowel disease (IBD).METHODS: The spatial organization of intestinal flora was investigated in normal mice and in two models of murine colitis using fluorescence in situ ***: The murine small intestine was nearly bacteriafree. The normal colonic flora was organized in three distinct compartments (crypt, interlaced, and fecal), each with different bacterial compositions. Crypt bacteria were present in the cecum and proximal colon. The fecal compartment was composed of homogeneously mixed bacterial groups that directly contacted the colonic wall in the cecum but were separated from the proximal colonic wall by a dense interlaced layer. Beginning in the middle colon, a mucus gap of growing thickness physically separated all intestinal bacteria from contact with the epithelium. Colonic inflammation was accompanied with a depletion of bacteria within the fecal compartment, a reduced surface area in which feces had direct contact with the colonic wall, increased thickness and spread of the mucus gap, and massive increases of bacterial concentrations in the crypt and interlaced compartments. Adhesive and infiltrative bacteria were observed in inflamed colon only, with dominant Bacteroides ***: The proximal and distal colons are functionally different organs with respect to the intestinal flora, representing a bioreactor and a Segregation *** highly organized structure of the colonic flora, its specific arrangement in different colonic segments, and its specialized response to inflammatory stimuli indicate that the intestinal flora is an innate part of host immunity that is under complex control.

关键词： Intestinal flora IBD

NOD2/CARD15 gene polymorphism in patients with inflammatory bowel disease: Is Hungary different?

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World Journal of Gastroenterology 2005年第3期11卷 407-411页

作者： Carsten Büning Tomas Molnar Ferenc Nagy Janos Lonovics Renita Weltrich Bettina Bochow Janine Genschel Hartmut Schmidt herbert lochs Department of Gastroenterology Department of Medicine

AIM: To analyse the impact of NOD2/CARD15 mutations on the clinical course of Crohn 's disease patients from an eastern European country (Hungary). METHODS: We investigated the prevalence of the three common NOD2/CARD15 mutations (Arg702Trp, Gly908Arg, 1007finsC) in 148 patients with Crohn's disease, 128 patients with ulcerative colitis and 208 controls recruited from the University of Szeged, Hungary. In patients with Crohn 's disease, the prevalence of NOD2/CARD15 mutations was correlated to the demographical and clinical parameters. RESULTS: In total, 32.4% of Crohn's disease patients carried at least one mutant allele within NOD2/CARD15 compared to 13.2% of patients with ulcerative colitis (P = 0.0002) and to 11.5% of controls (P

关键词： Crohn's disease NOD2/CARD15 gene Mutation