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Abstract: Functional dyspepsia (FD) and irritable bowel syndrome (IBS), two common gastrointestinal entities with overlapping symptoms, should be diagnosed according to Rome IV criteria. This includes one or more of the following symptoms: in FD, postprandial fullness, early satiation, epigastric pain or burning; in IBS, recurrent abdominal pain associated with defecation, change in frequency of stool or form of stool. To exclude structural diseases, attention should be paid to alarm symptoms. As far as treatment is concerned, a stepwise scheme proves to be effective for both diseases. Step 1: doctor-patient discussion with explanation of diagnosis and prognosis as well as clarification of therapy goals; lifestyle adaptations; use of phytotherapeutics; step 2: symptom-oriented medication: for FD, PPIs or prokinetics; for IBS, antispasmodics, secretagogues, laxatives, bile acid sequestrants, antidiarrheals, antibiotics, probiotics; step 3: visceral analgesics (antidepressants). [ABSTRACT FROM AUTHOR]

Inflammatory breast diseases caused by bacterial infections represent the main cause for mastitis in breastfeeding and non-breastfeeding women. The clinical appearance and a standardized evaluation can indicate rare inflammatory breast diseases. An underlying comorbidity or the evidence of rare pathogens could be suggestive. However, core needle biopsy is the main step in diagnostics. Malignancy, e.g. an inflammatory breast cancer must consistently be excluded. This mini review outlines a few rare inflammatory breast diseases, their initial presentation, and how to diagnose them accurately. [ABSTRACT FROM AUTHOR]

Bruxism, the grinding or clenching of teeth, is common in the population. Stress, anxiety syndromes and genetic disposition seem to be dominant factors that lead to increased muscle tension. A distinction is made between two circadian manifestations, sleep and wake bruxism. Bruxism is a major risk factor for tooth structure and dentures. The diagnosis is based on a targeted medical history and examination. Sleep bruxism can be demonstrated by electromyography and video recording in the sleep laboratory. The treatment aims to protect the hard tooth substance and preserve the denture using occlusal splints. Relaxation exercises can improve bruxism. Specialized physiotherapy can improve tension, pain and restricted movement. Botulinum toxin treatment reduces the subjective complaints during the period of action. [ABSTRACT FROM AUTHOR]

This overview describes the various applications of sonography in family practice. After an outline of the requirements for examiners and equipment, the individual areas of examination are discussed, in part with the most important diagnostic criteria, and illustrated with case studies using images and videos. Readers should be encouraged to make broad use of sonography and to attend regular further training and education courses in this field. [ABSTRACT FROM AUTHOR]

Body dysmorphic disorder (point prevalence: 1.7–2.4 %) is characterized by excessive preoccupation with one or more subjectively perceived blemishes of the appearance, as a result of which those affected show a high burden of disease due to avoidance behavior and time-consuming rituals, and often secondary problems (including depression, suicidal tendencies). The disorder is often accompanied by pronounced shame and is therefore associated with challenges in diagnostics, which is why the indication and specialist treatment (first-line treatment: cognitive-behavioural therapy) are usually only carried out with great latency. Family doctors can play a key role in diagnosis and treatment because of the often long-standing relationship of trust with their patients. Targeted screening, active and at the same time prudent discussion, as well as knowledge of treatment options and special features of the disease pattern (e.g. fluctuating understanding of the disease, desire for plastic surgery measures) are necessary. Against this background, the article provides an overview of the clinic, diagnostics and therapy and concludes with specific challenges and practical recommendations for family practice. [ABSTRACT FROM AUTHOR]

Changes in the urogenital microbiome of the bladder, urethra, vagina and cervix can cause recurrent infections. We distinguish between obligate and facultative pathogens. In the case of facultative pathogens, treatment with antibiotic, antiviral or antifungal drugs should only be considered in cases with attributable symptoms. Sexually transmitted diseases (STD) manifest either urogenitally alone or in association with an ascending infection of the adnexa as a pelvic inflammatory disease. STD may be asymptomatic, as in cases of chlamydia, or may cause a high burden of symptoms, impairment of quality of life or infertility. The aim of this minireview is to give an overview of the pathogenicity of the different germs and their treatment. [ABSTRACT FROM AUTHOR]

Obesity in childhood and adolescence presents a complex challenge. Early recognition by general practitioners is now important. In Switzerland, the comprehensive forms of care (individual or group therapy) have been eligible for reimbursement since January 2014. However, in order to curb the global overweight epidemic, comprehensive health-promoting and primarily preventive measures are needed worldwide. [ABSTRACT FROM AUTHOR]

Good interdisciplinary cooperation is crucial in the treatment of patients with breast cancer or gynecological-oncological tumors. Usually, regular consultations are held with the general practitioner and with gynecologists in parallel with oncological treatment. The recognition and early treatment of potential side effects of targeted oncological therapies is therefore very important in general practice. This article aims to provide an overview of the most important side effects of targeted oncological therapies in gynecological oncology and breast cancer treatment, and their adequate management. [ABSTRACT FROM AUTHOR]

Heart failure is a clinical syndrome characterized by typical symptoms, frequently accompanied by typical signs in association with structural or functional cardiac abnormalities. Heart failure with reduced, preserved and as new entity «mid-range» ejection fraction are differentiated. A new diagnostic algorithm based on the clinical probability of the presence of heart failure with non-acute onset is presented. Established medical treatment for heart failure with reduced ejection fraction includes ACE-inhibitors, betablockers and mineralocorticoidreceptor-antagonists complemented by diuretics in case of fluid retention. The angiotensinreceptor-neprilysin-inhibitor Valsartan/Sacubitril represents a new therapeutic option. Device therapy, in particular cardiac resynchronisation therapy (CRT), plays an important role in addition to drug treatment. Indications for defibrillators and cardiac resynchronisation are the responsibility of cardiologists. No evidence-based treatment is available for heart failure with preserved ejection fraction. Diuretics improve symptoms of congestion. Triggering factors as well as cardiac and noncardiac comorbidities need to be investigated and treated. [ABSTRACT FROM AUTHOR]

Status epilepticus, especially generalized convulsive status epilepticus is a serious neurologic emergency that requires immediate treatment. Early aggressive treatment with the use of standardized treatment protocols is more effective than late treatment. To prevent seizure recurrence after first-line therapy with Benzodiazepines, a second-line therapy with anticonvulsive drugs (Levetiracetam, Valproate or Phenytoin) should be given as soon as possible even if the seizures have stopped. Third-line therapy fcr the refractory status epilepticus comprises of Propofol or Midazolam (or Thiopental), and should be given ideally under continuous EEG monitoring, achieving a burst- suppression pattern. In addition to the treatment, an intensive d agnostic approach is warranted to treat the underlying cause of seizures. In the case of refractory status epilepticus, the diagnosis should be checked again to prevent missing non epileptic Pseudoseizures. [ABSTRACT FROM AUTHOR]

Frequent Gastro-Intestinal Disorders: Management of Functional Dyspepsia and Irritable Bowel Syndrome in Clinical Practice Abstract: Functional dyspepsia (FD) and irritable bowel syndrome (IBS), two common gastrointestinal entities with overlapping symptoms, should be diagnosed according to Rome IV criteria. This includes one or more of the following symptoms: in FD, postprandial fullness, early satiation, epigastric pain or burning; in IBS, recurrent abdominal pain associated with defecation, change in frequency of stool or form of stool. To exclude structural diseases, attention should be paid to alarm symptoms. As far as treatment is concerned, a stepwise scheme proves to be effective for both diseases. Step 1: doctor-patient discussion with explanation of diagnosis and prognosis as well as clarification of therapy goals; lifestyle adaptations; use of phytotherapeutics; step 2: symptom-oriented medication: for FD, PPIs or prokinetics; for IBS, antispasmodics, secretagogues, laxatives, bile acid sequestrants, antidiarrheals, antibiotics, probiotics; step 3: visceral analgesics (antidepressants).

The recognition, diagnosis, and interpretation of pain is an absolute requirement for potent therapy. The nature, form, and anatomical correspondence of pain to its source, modulation, and transmission has to be taken into consideration for a treatment strategy. In most cases, treatment of chronic pain disorders is not only freedom from pain, but rather for quality of life and activity. By understanding the nature of pain mechanisms, it should theoretically be possible to avoid a «pain career». [ABSTRACT FROM AUTHOR]

Male breast cancer is a rare disease. Symptoms and signs resemble breast cancer in women: A palpable mass, enlarged lymph nodes or skin changes (ulceration, secretion, peau d'orange) mandate mammography, ultrasound to assess the regional lymph nodes. The definitive diagnosis is made by biopsy. Men with breast cancer are treated along the same principles as women: resection followed by systemic and radiation therapy. Tamoxifen, not aromatase inhibitors, is the adjuvant therapy of choice for estrogen receptor positive tumors. Therapy of men with m etastatic breast cancer follows the same principles as therapy of women. [ABSTRACT FROM AUTHOR]

The catheter-based mitral valve repair is a novel technology for the treatment of severe mitral regurgitation (MR). This technique is suitable for elderly patients with pronounced co-morbidities who are deemed to be high risk for conventional heart surgery. A meaningful reduction of mitral regurgitation leads to improvement of symptoms and quality of life. Studies also demonstrate reverse remodeling of the left ventricle. In heart failure patients with severe MR percutaneous repair reduces re-hospitalization rates >50% in comparison to optimal medical treatment. For degenerative MR conventional surgery is the gold standard, whereas for high-surgical risk patients and for severe functional MR percutaneous repair is an alternative. [ABSTRACT FROM AUTHOR]

Epistaxis is one of the most common ENT emergencies and highly prevalent in the general population. Most cases are self-limiting and patients do not usually seek medical attention. However, some cases can be severe and life-threatening. While most anterior bleeds can be effectively managed by simple measures, including pressure application, vasoconstrictive agents and cautery, some will require additional measures such as nasal packing. Posterior epistaxis can be difficult to control. Latest studies showed that surgical ligation of the sphenopalatine and/or anterior ethmoidal arteries is the most effective treatment and less painful and distressing than nasal packing. But packing is the therapeutic option that is readily available. [ABSTRACT FROM AUTHOR]

Cerebral cavernomatous malformations (CCM) are a subgroup of low-pressure cerebral vascular malformation. They have an estimated prevalence of 0,1-4% of the population and account for 8-15% of all cerebral vascular malformations. Depending on their size and localization (supratentorial or infratentorial, brain stem), CCM may present with focal bleedings with or without neurological deficits, as epileptic seizures, or are diagnosed incidentally by MRI performed for unspecific symptoms (e.g. headache, vertigo), especially in younger patients (mostly in 2nd or 3rd decade). The decision-making in patients with CCM can be classified into four categories: surgical or conservative treatment of symptomatic or incidental lesions. The decision regarding the optimal therapy in the individual patient must be made in the knowledge of the natural history (risk for bleeding or epilepsy) on the one hand, and the surgical possibilities (accessibility of the lesion) including their estimated outcome on the other hand. Therefore, careful patient selection and appropriate experience of the centre is warranted in the management of CCM. [ABSTRACT FROM AUTHOR]

Fecal incontinence is defined as an accidental loss of stool or the inability to control defecation. There are three subtypes of fecal incontinence: passive incontinence, urge incontinence and soiling. About 8% of the adult population suffer from fecal incontinence, but only 1/3 consults a doctor. Beside the individual handicap, fecal incontinence has a huge socio-economic impact. Causes of fecal incontinence are changes in the quantity or quality of the stool and structural or functional disorders. Diagnostics encompass the medical history, clinical examination including the digital rectal examination, imaging (particularly endoanal ultrasound) as well as functional diagnostics (anal manometry and defecography). Nowadays, the most promising conservative treatment option consists of loperamide and biofeedback therapy. The most successful invasive method is the sacral neuromodulation. [ABSTRACT FROM AUTHOR]

Treatment options for prostate cancer are currently widely discussed in the media and by urologic associations. International studies showed that current treatment options may significantly affect the quality of life (including incontinence and erectile dysfunction) while only offering marginal survival benefits. Low to medium risk patients in particular don't seem to be ideal candidates for radical treatment by surgery of radio therapy. For this large group of patients focal therapy offers additional valuable treatment option. Malignant prostate tissue can be specifically ablated by High-Intensity Focused Ultrasound (HIFU). Thus, the cancer can be controlled without removing the whole prostate and with minimal side effects. Multimodal magnetic resonance tomography, specific biopsies and monitoring contribute to the safety of this new treatment Strategy. [ABSTRACT FROM AUTHOR]

Positional plagiocephaly in the newborn corresponds to a posterior flattening and asymetry of the head. Its incidence has significantly increased since the "back to sleep" campain in the nineteen nineties to prevent sudden infant death syndrome. The posterior deformation usually worsens during the first six months of life when the skull is susceptible to posterior constant pressure which induces the deformation. Spontaneous outcome can be favorable. Treatment is always conservative and consists in positionnai exercise, physiotherapy and osteopathy. In some cases treatment with a helmet is recommended for a period of three months usually. Posterior positionnai plagiocephaly has no consequences on the brain's developement an is considered as an esthetic issue. In most cases good results are obtained after management with a custom fitted helmet when needed. [ABSTRACT FROM AUTHOR]

Inflammatory bowel diseases (IBD) show an increase of prevalence in Switzerland. Industrialization and urbanisation correlate with an increase of incidence. IBD are the result of a continuum of interactions between genetic factors, the intestinal microbial flora, the immune system as well as environmental factors. Treatment for active Crohn's disease includes primarily systemically acting steroids for induction of remission, whereas azathioprine, methotrexate and TNF antibodies are used for maintenance of remission. Treatment for ulcerative colitis includes mostly systemic acting steroids for induction of remission and topically and systemically acting 5-ASA products and TNF antibodies for maintenance of remission. For mild active disease 5-ASA drugs are effective. [ABSTRACT FROM AUTHOR]

In diabetes mellitus, it is expected to see a common, mainly sensitive, distal symmetrical polyneuropathy (DPN) involving a large proportion of diabetic patients according to known risk factors. Several other diabetic peripheral neuropathies are recognized, such as dysautonomia and multifocal neuropathies including lumbosacral radiculoplexus and oculomotor palsies. In this review, general aspects of DPN and other diabetic neuropathies are examined, and it is discussed why and how the general practionner has to perform a yearly examination. At the present time, some consensuses emerge to ask help from neurologist when faced to other forms of peripheral neuropathies than distal symmetrical DPN. [ABSTRACT FROM AUTHOR]

Estimates assume approximately 100 000 occasional and 11 000 addicted cocaine consumers in Switzerland. Although there is no established «standard Treatment», helpful pharmacological and psychotherapeutic treatment strategies for cocaine addiction and its consequences exist. A selection of the most relevant treatment options is presented in this review. Their application should be embedded within an individualized treatment plan, which usually includes several of the therapeutic elements presented hereafter, depending on the patient's current situation. The treatment of patients with cocaine dependence might encompass longer periods and multiple sequences of treatment in out- or inpatient setting, yet it is promising. [ABSTRACT FROM AUTHOR]

Patients with a transient ischemic attack and an acute stroke need urgent investigations and therapy in a stroke unit. Immediate investigation of the etiology and early secondary prevention measures reduce the likelihood of recurrent and other vascular events. In selected stroke patients intravenous thrombolysis and/or endovascular therapies lead to a significant reduction of long term disabilities. [ABSTRACT FROM AUTHOR]

Goal of this article is to select three molecules from all the candidates currently under clincial development and to present and comapre their characteristics. Dabigatran is a direct thrombin (FIIa) inhibitor, whereas Rivaroxaban and Apixaban are direct factor Xa (FXa) inhibitors. All three represent small molecules that reversibly, rapidly and directly bind to their target, the active center of the respective activated coagulation factor. Phase III data have been published for venous thromboembolism prophylaxis for each of these three drugs. Interestingly, VTE prophylaxis is initiated postoperatively with these products. Rivaroxaban currently holds the only accepted indication in Switzerland. For the indications VTE, atrial fibrillation and acute coronary syndrome promising phase III data have been or are in the process of being published. Monitoring is not necessary for any of these three new anticoagulants. [ABSTRACT FROM AUTHOR]

We present a patient with an aortic aneurysm and the epidemiology, etiology, screening, symptoms and therapeutic options of abdominal aortic aneurysms are discussed. A widening of the abdominal aorta >3 cm is termed aortic aneurysm. As patients with aortic aneurysm are mostly oligosymptomatic until rupture occurs and an estimated 30'000 patients annually die from ruptured aortic aneurysm in the US a screening of the population at greatest risk (smokers, familial predisposition) is recommended. Screening is best done by ultrasound. Noninvasive therapy is limited to antiplatelet therapy and optimal adjustment of risk factors. For definitive treatment endovascular aortic repair (EVAR) is considered an established alternative to open surgery with lower 30 daysmortality but higher reintervention rate. [ABSTRACT FROM AUTHOR]

Treatment of breast cancer is complex and needs multidisciplinarity. Preferably it should be performed in breast cancer units. Chemo-/endocrine treatment modalities are chosen by the targets (eg hormone receptors, Her2 receptor) and not by the risk anymore (bi-annual St. Galler Konsensus meeting). The choice of local and systemic treatment should be adapted to the patient's conditions (age, co-morbidities, sometimes preferences) and must strongly consider the risk of relapse. Treatment of breast cancer patients is demanding and requires knowledge and skills, both of which is best available in breast cancer units. [ABSTRACT FROM AUTHOR]

Wilson's disease is a rare inherited disorder of copper metabolism. If left untreated, the disorder has a fatal course within a few years after symptom onset. If discovered early, effective treatment is available, preventing further clinical deterioration and leading to a normal life expectancy. Accumulation of copper in liver and brain can lead to a variety of unspecific hepatic, neurologic and psychiatric symptoms such as jaundice, tremor, ataxia or depression. In patients under the age of 40 with unexplained hepatic, neurologic or psychiatric symptoms, Wilson's disease must be considered. Diagnosis can be made by measurement of urinary copper excretion and other tests as required. Lifelong decoppering treatment must be maintained. For the detection of deterioration of the disease or adverse effects of the medication as well as for the assessment of therapeutic compliance, regular clinical controls are necessary. [ABSTRACT FROM AUTHOR]

Background: Asthma is not adequately controlled in many patients. A new approach in asthma treatment, known as Budesonide/Formoterol Maintenance and Reliever Therapy has shown improvement in asthma control compared to conventional therapy regimens. As Switzerland was the first European country to formally approve budesonide/formoterol maintenance and reliever therapy, a patient follow-up programme was commenced in January 2006 to investigate its efficacy and safety in a «real-life» environment. Methods: A non randomised uncontrolled post-marketing survey involving 420 physicians in all language regions in Switzerland was carried out. 2035 patients with asthma were enrolled. Data on current asthma treatment, asthma control and unscheduled visits due to worsening asthma were recorded. Asthma control was assessed subjectively by both the patients and the physicians as well as by means of the validated 5-item Asthma Control Questionnaire (ACQ5). An ACQ score of 0.75 or less indicates well-controlled asthma. Results: Data from 2006 out of 2035 patients were analysed (mean age 44.9 ± 19.6 years, 50.5% female). With budesonide/formoterol maintenance and reliever therapy the mean ACQ5 score improved by more than 3-fold the defined minimal important difference (MID). The percentage of patients with an ACQ score ≤0.75 increased from 4.8% at baseline to 58.0% at the end of the follow-up programme. Patient satisfaction with budesonide/formoterol for both maintenance and relief was high. Conclusions: Budesonide/formoterol maintenance and reliever therapy improves asthma control in a non randomised real-life setting. [ABSTRACT FROM AUTHOR]

Massive ovarian edema (MOE) is a rare, benign disease of young women. Because preoperatively in most cases the differential diagnosis primarily appears to indicate the presence of a malignant tumour, there is a risk that these patients will be subjected to unnecessary overtreatment. In the case of the 18-year-old patient described here, on the basis of the preoperative data the suspected clinical diagnosis was polycystic ovarian (PCO) syndrome. In the MRI the enlarged ovary was interpreted as a mucous tumour. The laparotomy showed a smooth-walled, opalescent ovarian tumour with adnexal torsion. Histopathological examination of the adnexectomy specimen gave the diagnosis of a massive ovarian edema (MOE). Therapeutically, a wedge-shaped excision, immediate-section histology and derotation and suspension of the ovary would have been sufficient. Unnecessary overtreatment can be avoided in young women with enlarged ovaries, if MOE is included in the differential diagnosis and if the characteristic sonography, MRI and macroscopy findings are known. [ABSTRACT FROM AUTHOR]

Ascites means accumulation of fluid within the peritoneal cavity, usually in patients with cirrhosis. Diagnostic paracentesis (cell count, albumin, cell culture) is a must. Na-restriction remains the cornerstone of treatment (< 3 g NaCl/d). Spironolactone is the drug of choice, in some patients in addition with proximally acting diuretics. Minimum effective dosage is recommented to reduce side-effects. Pronounced ascites can be treated by large-volume paracentesis with concomitant albumin-infusion. Only very few patients suffer from refractory ascites. TIPS is a treatment modality for this group. However, TIPS may precipitate PSE in some patients with decompensated liver cirrhosis. [ABSTRACT FROM AUTHOR]

Body Dysmorphic Disorder: Diagnosis, Treatment and Challenges in the General Practice Abstract. Body dysmorphic disorder (point prevalence: 1.7-2.4 %) is characterized by excessive preoccupation with one or more subjectively perceived blemishes of the appearance, as a result of which those affected show a high burden of disease due to avoidance behavior and time-consuming rituals, and often secondary problems (including depression, suicidal tendencies). The disorder is often accompanied by pronounced shame and is therefore associated with challenges in diagnostics, which is why the indication and specialist treatment (first-line treatment: cognitive-behavioural therapy) are usually only carried out with great latency. Family doctors can play a key role in diagnosis and treatment because of the often long-standing relationship of trust with their patients. Targeted screening, active and at the same time prudent discussion, as well as knowledge of treatment options and special features of the disease pattern (e.g. fluctuating understanding of the disease, desire for plastic surgery measures) are necessary. Against this background, the article provides an overview of the clinic, diagnostics and therapy and concludes with specific challenges and practical recommendations for family practice.

Rare Forms of Mastitis Abstract. Inflammatory breast diseases caused by bacterial infections represent the main cause for mastitis in breastfeeding and non-breastfeeding women. The clinical appearance and a standardized evaluation can indicate rare inflammatory breast diseases. An underlying comorbidity or the evidence of rare pathogens could be suggestive. However, core needle biopsy is the main step in diagnostics. Malignancy, e.g. an inflammatory breast cancer must consistently be excluded. This mini review outlines a few rare inflammatory breast diseases, their initial presentation, and how to diagnose them accurately.

The Role of Ultrasonography in Family Medicine Abstract. This overview describes the various applications of sonography in family practice. After an outline of the requirements for examiners and equipment, the individual areas of examination are discussed, in part with the most important diagnostic criteria, and illustrated with case studies using images and videos. Readers should be encouraged to make broad use of sonography and to attend regular further training and education courses in this field.

The catheter-based mitral valve repair is a novel technology for the treatment of severe mitral regurgitation (MR). This technique is suitable for elderly patients with pronounced co-morbidities who are deemed to be high risk for conventional heart surgery. A meaningful reduction of mitral regurgitation leads to improvement of symptoms and quality of life. Studies also demonstrate reverse remodeling of the left ventricle. In heart failure patients with severe MR percutaneous repair reduces re-hospitalization rates>50% in comparison to optimal medical treatment. For degenerative MR conventional surgery is the gold standard, whereas for high surgical risk patients and for severe functional MR percutaneous repair is an alternative.

Epistaxis is one of the most common ENT emergencies and highly prevalent in the general population. Most cases are self-limiting and patients do not usually seek medical attention. However, some cases can be severe and life-threatening. While most anterior bleeds can be effectively managed by simple measures, including pressure application, vasoconstrictive agents and cautery, some will require additional measures such as nasal packing. Posterior epistaxis can be difficult to control. Latest studies showed that surgical ligation of the sphenopalatine and/or anterior ethmoidal arteries is the most effective treatment and less painful and distressing than nasal packing. But packing is the therapeutic option that is readily available.

Cerebral cavernomatous malformations (CCM) are a subgroup of low-pressure cerebral vascular malformation. They have an estimated prevalence of 0,1-4% of the population and account for 8-15% of all cerebral vascular malformations. Depending on their size and localization (supratentorial or infratentorial, brain stem), CCM may present with focal bleedings with or without neurological deficits, as epileptic seizures, or are diagnosed incidentally by MRI performed for unspecific symptoms (e.g. headache, vertigo), especially in younger patients (mostly in 2nd or 3rd decade). The decision-making in patients with CCM can be classified into four categories: surgical or conservative treatment of symptomatic or incidental lesions. The decision regarding the optimal therapy in the individual patient must be made in the knowledge of the natural history (risk for bleeding or epilepsy) on the one hand, and the surgical possibilities (accessibility of the lesion) including their estimated outcome on the other hand. Therefore, careful patient selection and appropriate experience of the centre is warranted in the management of CCM.

Fecal incontinence is defined as an accidental loss of stool or the inability to control defecation. There are three subtypes of fecal incontinence: passive incontinence, urge incontinence and soiling. About 8% of the adult population suffer from fecal incontinence, but only 1/3 consults a doctor. Beside the individual handicap, fecal incontinence has a huge socio-economic impact. Causes of fecal incontinence are changes in the quantity or quality of the stool and structural or functional disorders. Diagnostics encompass the medical history, clinical examination including the digital rectal examination, imaging (particularly endoanal ultrasound) as well as functional diagnostics (anal manometry and defecography). Nowadays, the most promising conservative treatment option consists of loperamide and biofeedback therapy. The most successful invasive method is the sacral neuromodulation.