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Diagnostic procedures in inflammatory bowel diseases (IBD) serve to secure the diagnosis and to optimize treatment. Upon initial diagnosis endoscopy up to the terminal ileum is mandatory including multiple step biopsies. When diagnostic guidelines are followed and adequate clinical information is available, IBD will be correctly classified in about 80 to 90% of cases upon first examination. In contrast endoscopic studies are only of limited value in monitoring treatment. The decision if and when to perform endoscopy during exacerbation of disease must be an individual one. When disease activity is evaluated, a distinction must be made between degree of activity as reflected by laboratory parameters and severity of illness as reflected by the clinical presentation with abdominal complaints, fistulas, abscesses, etc. Distinct activity indices are useful in clinical studies to obtain an objective evaluation of activity and severity of disease. At clinical routine visits questions should not only concern the basic illness but also ask for quality of life and psychosocial status. Only a small number of laboratory tests are needed for basic diagnosis and follow-up. A small bowel enteroclysis should always be performed upon primary diagnosis of Crohn's disease and during the course of disease when there is suspicion of small-bowel involvement. Double contrast barium enema should be limited to special indications as incomplete colonoscopy e.g. due to stenosis or suspected fistula. Sonography is the primary investigation when complications are suspected. CT is useful as an adjunct or when the afore mentioned methods do not show clear findings. NMR is the procedure of choice for detection of pararectal fistulas and abscesses. Transrectal endosonography is comparably good but limited to the experience of the investigators and by patient's tolerability.

In this open trial, 25 patients with identified duodenal ulcers were given long-term therapy of a single evening dose of 20 mg famotidine. 18 patients completed the study, 7 were withdrawn because of compliance difficulties. The patients included in this study had a long history of ulcer disease; ulcers were identified by endoscopy and they were healed after 4 or 8 weeks of H2-blocker therapy. Under long-term therapy with famotidine (Ulcusan), ulcers recurred in 3 patients after 3 months, a further 3 recurred after 6 months, and another 2 after 12 months. The recurrence of ulcers occurred in many patients without symptoms. Tolerance of the drug was good in all patients. No change in biochemical parameters was observed. Undesired side effects were not seen. Low dose famotidine therapy (20 mg Ulcusan tablets) is suitable in long-term treatment of peptic ulcer disease; frequent endoscopy would be advisable to detect recurrency of asymptomatically ulcers.

Sonography of the kidneys can be regarded not only as supplementary examination to intravenous pyelograms but as first step investigation for evaluation of hypertension, micro-hematuria and other acute processes. Since no contrast medium and no ionizing radiation is used it can be applied to pregnant women and also in cases of acute renal failure. Together with needle biopsy its diagnostic value is immense and it can be repeated as often as wanted even as a bed-side method. Therefore it can be used routinely for follow-ups.

On the basis of 900 laparoscopies it is attempted to define the indications of laparoscopy in abdominal diseases. 6 groups of indications could be differentiated. The diagnostic accuracy of laparoscopy allows in many cases to replace exploratory laparotomy by laparoscopy.

Sonography of the spleen allows exact measurements of this organ. There are typical pictures in cysts or hematomas. Diffuse changes of the spleen however are hardly distinguishable in regard to differential diagnosis. Retroperitoneal masses can easily be recognized. Lymph-nodes can be identified and the results of therapeutic interventions can be judged. Hematomas or abscesses can be seen easily. Guided needle biopsy offers the possibility for histologic examinations.

Ultrasonically guided fine-needle biopsy with cytologic evaluation (UGF) was performed in 347 patients with suspected tumors mostly of the abdomen. With an accuracy rate of more than 90% UGF proved to be a safe investigation of high diagnostic value.

253 patients were treated for 3 years with 400 mg cimetidine at night to prevent relapses of recently healed duodenal ulcers. The efficacy of maintenance treatment was evaluated on a life table basis. In contrast to previous studies not the first but the third symptomatic relapse was taken as the major criterium of treatment failure, an assumption, that better represents the everyday practical situation. Further endpoints for the life table calculation were: the wish of the patient to stop treatment after the first or second recurrence, the failure of a first or second recurrence to heal within 12 weeks and side effects. At 1, 2 and 3 years 5 +/- 2.4%, 16 +/- 4.6% and 20 +/- 5.2% respectively had to be considered as treatment failures. 4 patients presented with a bleeding relapse, none of which necessitated emergency operation. There were no irreversible side effects. This study demonstrates that treatment of recurrent duodenal ulcers with 400 mg cimetidine at night for 3 years is safe and improves considerably the quality of life of the majority of patients. The authors suggest that drug maintenance treatment should be offered before surgery is recommended.

Ultrasound examination contributes essentially to the assessment of nephrological disorders. This investigation provides accurate information about form, size and mobility of the organ. Circumscript painful areas can be localized in combination with palpation. Pathological changes such as hydronephrosis, cysts, solid tumors or inherited diseases (polycystic diseases, hypoplasia or renal agenesia) can easily be diagnosed. Therefore this harmless method is the investigation of choice in the screening of families for inherited renal diseases. To differentiate between acute and chronic renal failure, this diagnostic technique is preferentially employed. Furthermore, it provides valuable information for the long-term-management of patients on haemodialysis, patients with hydronephrosis or impaired renal function. However, for the diagnosis of minor defects in renal calces, the vasculature and for the detection of small stones, this technique needs still to be improved.