Med Klin (Munich)

[Nutritional deficiencies and complications in chronic inflammatory bowel diseases]

Year 1998
Rath HC. Caesar I. Roth M. Scholmerich J.
Klinik und Poliklinik fur Innere Medizin I, Klinikum, Universitat Regensburg. herath@t-online.de
BACKGROUND: Deficiencies of vitamins and trace elements are frequent in inflammatory bowel disease. Aim of this study was to evaluate retrospectively the prevalence of these deficiencies and of liver complications in a large population. PATIENTS AND METHODS: The records from 392 out-patients, 279 with Crohn's disease (160 female, 119 male) and 113 with ulcerative colitis (56 female, 57 male) were analyzed. RESULTS: Deficiencies were found in 85% of patients with Crohn's disease vs 68% with ulcerative colitis during the course of the disease, predominantly a deficiency of iron and of calcium. Less frequently deficiencies of zinc, protein, cyanocobalamin, and folic acid were found. Elevated liver enzymes were seen in 38% of patients with Crohn's disease vs 27% with ulcerative colitis. In order of frequency: gamma-glutamyl-transferase, ALAT, AP, ASAT, and bilirubin. Gallstones were present in 12% of patients with Crohn's disease and 4% with ulcerative colitis. 6% of patients with Crohn's disease and 4% with ulcerative colitis had kidney stones. CONCLUSIONS: In view of the high frequency of deficiencies in patients with inflammatory bowel disease it seems to be important to check frequently for extraintestinal complications.

[Acute abdomen in endemic sprue--a rare complication]

Year 1998
Koberstein B. Wedell J. Balzer K.
Medizinische Klinik I, Klinikums Kreis Herford.
BACKGROUND: The celiac sprue, a small intestinal disease usually becoming apparent by a malabsorption syndrome, is caused by gluten respectively gliadin intolerance which leads to intestinal mucosal damage finally resulting in complete villous atrophy. CASE REPORT: A propos of the case of a 60-year old woman with an uneventful course of celiac sprue of many years we report about a rare complication of this disease. Investigating recurrent attacks of abdominal pain a barium contrast examination revealed an intestinal stenosis which clinically resulted in an acute abdomen finally requiring surgery. Histologically a chronic ulcerative jejunoileitis was found. The main differential diagnosis is a malignant intestinal lymphoma, this however couldn't be found. Regarding this differential diagnosis surgical removal of the diseased parts of the bowel is the therapy of choice. Because of the possible transition from ulcerative jejunoileitis to intestinal lymphoma a postoperative close follow-up is recommended.

[Short-term triple therapy with pantoprazole, amoxicillin and metronidazole in Helicobacter pylori infection]

Year 1998
Glaser J. Hein J. Daikeler R. Weithofer G. Vieth M. Schmidt M. Stolte M.
Medizinische Klinik, Herz-Jesu-Krankenhaus Fulda.
BACKGROUND: The present study was conducted to investigate the efficacy and tolerability of a 7-day treatment with pantoprazole, amoxicillin and metronidazole for the eradication of Helicobacter pylori (H. pylori) infection. PATIENTS AND METHODS: Fifty patients (26 male, 24 female, age 18 to 86, mean 54 years) with an active duodenal (n = 25) or gastric ulcer (n = 25) were recruited into the study, 48 patients being H. pylori positive at the study start. Patients were treated with pantoprazole (40 mg bid), amoxicillin (1 g bid) and metronidazole (500 mg bid) for 7 days and for another 21 days with pantoprazole (40 mg/od). Four weeks after the end of study medications the patients were re-examined endoscopically and their H. pylori status was re-assessed using urease test, histology and 13C-urea-breath test. RESULTS: In 39 of 48 intention to treat patients, H. pylori infection was cured, according to 81% (95%-CI = 67 to 91%). In the per protocol population in 35 of 41 patients H. pylori was eradicated, which results in an eradication rate of 85% (95%-CI = 71 to 94%). Ulcer healing was endoscopically confirmed in 45 of 48 patients (94%; 95%-CI = 83 to 99%) after 8 weeks. Six of 50 patients (12%) reported mild to moderate probable side-effects of the study medication. Cure of the infection was associated with a distinct reduction of the gastritis grade and activity. CONCLUSION: A 7-day triple therapy using pantoprazole, amoxicillin and metronidazole is an effective and cost-effective alternative to regimens including clarithromycin for the treatment of H. pylori infection.

[Coccidioidomycosis as the cause of granulomatous hepatitis]

Year 1998
Zangerl B. Edel G. von Manitius J. Schmidt-Wilcke HA.
II. Medizinische Klinik, St.-Franziskus-Hospitals Munster.
The case of 36-year-old man is reported who fell ill with a febrile infection, shortly after returning from several weeks to Mexico. EXAMINATION: Chest X-ray revealed a pulmonary infiltration. Also, the levels of liver function tests (gamma-GT, alkaline phosphatase, SGOT, SGPT) were clearly increased. As there were no signs of extended bile ducts in ultrasonics, a liver biopsy was indicated. The histology showed a granulomatous hepatitis. DIAGNOSIS: The exposure during the Mexico-trip, the pulmonary infiltration, the histology and the significant raised titers in specific serological tests led to the diagnosis of a general infection by the fungus coccidioides immitis. In addition to pathogenetic aspects of coccidioidomycosis the diagnostic approaches and relevant therapeutic strategies are discussed.

[A young patient with multiple arterial occlusions]

Year 1998
Panzere C. Brieke A. Brauer B. Eggemann F. Becker HM. Dieterle P.
Medizinische Abteilung fur Endokrinologie, Stoffwechsel Und Angiologie, Stadtisches Krankenhaus Munchen-neuperlach.
BACKGROUND: Mild hyperhomocysteinemia due to genetic causes and nutrition factors is well known as an independent strong risk factor for premature arterial occlusive disease. CASE REPORT: A 27-year-old female with a history of two episodes of small bowel ileus due to vascular causes presented with subacute pain in the left lower extremity. Angiography revealed a short segmental occlusion in the P III segment of the popliteal artery with small vessel collateralization and proximal occlusion of the superior mesenteric artery und the coeliac trunk. Vascular risk factors in this patient included smoking over a duration of 10 years, use of oral contraceptives (estrogen and gestagen combination) and elevated levels of homocysteine in the fasting state and after methionin loading. The patient was treated conservatively with intravenous application of prostaglandins, additionally she underwent training to improve her walking capability. After 4 weeks of the fasting state as well as after methionin loading were normalized by an oral substitution with folate and B vitamins. So far it was not possible to prove a genetic defect of the enzymes participating in the metabolism of homocysteine. CONCLUSION: This clinical conference of a young female patient with occlusion of several arteries illustrates the differential diagnosis of premature occlusive vascular disease with special regard to mild hyperhomocysteinemia as an independent risk factor.