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Environmental and lifestyle factors play an important role in the natural history of Crohn's disease and ulcerative colitis. A group of international experts from the International Organization for the Study of Inflammatory Bowel Diseases voted on a series of consensus statements to inform the management of inflammatory bowel disease (IBD). The recommendations include avoiding traditional cigarette smoking in patients with Crohn's disease or ulcerative colitis, screening for symptoms of depression, anxiety, and psychosocial stressors at diagnosis and during flares (with referral to mental health professionals when appropriate), and encouraging regular physical activity as tolerated. Patients using dietary approaches for treatment of their IBD should be encouraged to adopt diets that are best supported by evidence and involve monitoring for the objective resolution of inflammation. We recommend formal assessment for obesity and nutritional deficiencies, and patients should be encouraged to maintain a normal body-mass index. A shared decision-making approach to contraception should include the consideration of IBD-related factors, and risk factors for venous thromboembolism. Long-term or frequent use of high-dose non-steroidal anti-inflammatory drugs should be avoided. For primary prevention of disease in the offspring of patients with IBD, we recommend avoiding passive exposure to tobacco, using antibiotics judiciously, and considering breastfeeding when able.

ZusammenfassungDie COVID-19-Pandemie ist ein weltweiter Ausbruch von neu aufgetretenen Infektionen mit dem SARS-CoV-2-Virus, von denen weltweit derzeit mehr als 10.670.000 Menschen erkrankt sind bzw. waren. In Deutschland leiden ca. 450.000 Patienten an einer chronisch entzündlichen Darmerkrankung; diese Patienten benötigen in der Regel eine kontinuierliche und kompetente Betreuung. Vor dem Hintergrund eines rasch zunehmenden Wissenszuwachses haben 68 Experten, die die derzeit gültigen Leitlinien der DGVS zum Morbus Crohn und zur Colitis ulcerosa erstellt haben, im Rahmen einer virtuellen Konferenz aktuelle und praxisnahe Empfehlungen formuliert, um die Versorgung von CED-Patienten zu verbessern. Diese adressieren das Infektionsrisiko einschließlich des Risikos für besondere Gruppen, den möglichen Verlauf der Erkrankung und die Konsequenzen für die medikamentöse und die operative Therapie der Grunderkrankung sowie allgemeine Maßnahmen zur Infektionsprävention und adjuvante Präventions- und Therapiemöglichkeiten.

Increasing interest in diverticular disease by the scientific community in the last 10-15 years has resulted in an increased number of publications. Among other things, nonevidence-based therapeutic paradigms were tested in randomized, controlled therapy studies. The importance of surgery in the therapy of diverticulitis has diminished in recent years; in particular, it has no role in the treatment of diverticulitis types 1a, 1b, and 2a according to the Classification of Diverticular Disease (CDD) treated successfully by conservative means. Surgery has only a subordinate role in recurrent type 3b diverticulitis according to the CDD. Diverticulitis is therefore increasingly treated using conservative or drug therapy. However, only the classic, established antibiotics are currently available as effective drugs for the treatment of diverticular disease. However, these are also decreasing in significance. Over 90% of patients with type 1a/1b diverticulitis can be safely treated according to current data without the use of antibiotics. It is possible that type 2a diverticulitis will also be successfully treated without antibiotics in the future. Substances such as rifaximin, mesalazine, or probiotics, which were tested above all in patients with chronic recurrent forms (CDD type 3a/3b), have not yet been established.

Recent observational studies document that non-adherence to mesalamine therapy during remission is frequent. We aimed to investigate patient impact of patient education using objective assessments of adherence.A 14-month randomised, prospective clinical trial of adherence to mesalamine was conducted in 248 patients with ulcerative colitis [UC], Colitis Activity Index [CAI] ≤ 9, receiving standard care [n = 122] versus a standardised patient education programme [n = 126]. Primary endpoint was adherence at all visits (5-aminosalicylic acid [5-ASA] urine levels). Secondary endpoints included quality of life (inflammatory bowel disease questionnaise [IBDQ]), disease activity, partial adherence, and self-assessment of adherence.Patient allocation was well balanced. Baseline non-adherence was high in quiescent/mildly active UC [52.4%] without difference between the groups (52.4% of patients in the education group versus 52.5% in the standard care group [p = 0.99]). No difference between the intervention group and standard care was seen in IBDQ, partial adherence, self-assessment of adherence, or therapy satisfaction at all visits. We suggest a model in which individual risks for non-adherence are driven by patients with young age, short disease duration, and low education levels.Non-adherence is frequent in a population with quiescent/mildly active UC. Although more than 25% of the population was not in remission at the various time points, no relationship between disease activity and adherence was seen over the 14-month observation period. Physicians should maximise their efforts to motivate high-risk patients for adherence. Future trials should use objective exposure assessments to examine the impact of continuous education and consultations on the background of individual risks to develop non-adherence.

Increasing interest in diverticular disease by the scientific community in the last 10-15 years has resulted in an increased number of publications. Among other things, nonevidence-based therapeutic paradigms were tested in randomized, controlled therapy studies. The importance of surgery in the therapy of diverticulitis has diminished in recent years; in particular, it has no role in the treatment of diverticulitis types 1a, 1b, and 2a according to the Classification of Diverticular Disease (CDD) treated successfully by conservative means. Surgery has only a subordinate role in recurrent type 3b diverticulitis according to the CDD. Diverticulitis is therefore increasingly treated using conservative or drug therapy. However, only the classic, established antibiotics are currently available as effective drugs for the treatment of diverticular disease. However, these are also decreasing in significance. Over 90% of patients with type 1a/1b diverticulitis can be safely treated according to current data without the use of antibiotics. It is possible that type 2a diverticulitis will also be successfully treated without antibiotics in the future. Substances such as rifaximin, mesalazine, or probiotics, which were tested above all in patients with chronic recurrent forms (CDD type 3a/3b), have not yet been established.

Summary Background Robust evidence regarding medical intervention for symptomatic uncomplicated colonic diverticular disease (DD) is sparse. Aim To investigate mesalazine (Salofalk granules) in this setting. Methods In a double-blind, placebo-controlled, multicentre, 6-week trial, patients were randomised to mesalazine 1000 mg three times daily or placebo. Primary efficacy endpoint was change in lower abdominal pain to week 4 (baseline defined using pain score from 7 days pre-treatment). Results Median change in lower abdominal pain with mesalazine vs. placebo was −37 (n = 56) vs. −33 (n = 61) [P = 0.374; 95% CI (−11; 4)] in the intent-to-treat (ITT) population, and −41 (n = 40) vs. −33 (n = 51) [P = 0.053; 95% CI (−18; 0)] in the per-protocol (PP) population, i.e. the primary endpoint was not significantly different. Post hoc adjustment for confounding factors (‘baseline pain intensity’, ‘baseline symptom score (Brodribb)’, and ‘localisation of diverticula in the descending colon’) resulted in P = 0.111 [ITT, 95% CI (−15.4; 1.6)] and P = 0.005 [PP, 95% CI (−19.7; −3.5)]. Between-group differences increased using pain score on day 1 as baseline, and reached significance for the PP population [mesalazine −42, placebo −26, P = 0.010; 95% CI (−25; −3)]. Median change in combined symptom score from baseline to week 4 was 257 mm with mesalazine vs. 198 mm with placebo [P = 0.064; 95% CI (−3; 105)]. More placebo-treated patients received analgesic/spasmolytic concomitant medication (34.4% vs. mesalazine 21.4%), indicating improved pain relief with mesalazine (P = 0.119). Safety was comparable. Conclusions A daily dose of 3.0 g mesalazine may relieve pain during a symptomatic flare of uncomplicated DD. In this, the first placebo-controlled double-blind trial in acute uncomplicated DD, mesalazine showed promising therapeutic efficacy.

After the expiry date of the patent protection for Infliximab in 2013, the biosimilar CT‑P13 was approved for indications in Crohn's disease and ulcerative colitis in adults as well as in children. The approval has been based on two randomized clinical studies indicating equivalence for the biosimilar with regard to pharmacokinetics, efficacy, as well as side-effects. The clinical experience since, in addition to multiple non-randomized studies, indicate a comparable efficacy and immunogenicity of the Infliximab biosimilar CT-P13 in inflammatory bowel disease. Thus, the introduction of the biosimilar as primary therapy seems to be justified. Tight monitoring of the safety of biosimilars with regard to efficacy and side effects has to be ensured.

Das toxische Megakolon ist eine seltene lebensbedrohliche Komplikation einer schwersten Kolitis, kenntlich an einer Aufweitung des Kolons > 6 cm bei fehlender Obstruktion und Vorhandensein einer „systemischen Toxizitat“ (Hauptkriterien: Fieber, Tachykardie, Leukozytose, Anamie). Verschiedenste Ausloser sind bekannt, die wichtigsten sind die Colitis ulcerosa, die mittlerweile seltener bis zum toxischen Megakolon exazerbiert und zunehmend eine Clostridium-difficile-assoziierte Kolitis. Die Diagnose kann mit einfachen klinischen und laborchemischen Untersuchungen und der Rontgen-Ubersichtsaufnahme des Abdomens gestellt werden. Die interdisziplinare Abwagung einer adaquaten intensivmedizinischen konservativen Therapie vs. eines operativen Vorgehens (meist als subtotale Kolektomie mit endstandigem Ileostoma) ist im Einzelfall hingegen sehr schwierig. Allgemeinmasnahmen sind die Balance der Elektrolyte und des Volumens, potente Breitspektrumantibiotika unter Einschluss von Metronidazol und Lagerungsmasnahmen sowie evtl. eine vorsichtige intermittierende Dekompression. Bei Colitis ulcerosa ist eine Immunsuppression mit Kortikoiden und bei gesicherten Fallen evtl. mit Calcineurininhibitoren einzuleiten, bei der pseudomembranosen Kolitis eine antibiotische Therapie mit Vancomycin oral sowie Metronidazol intravenos. Nach Moglichkeit ist eine Verlegung in ein erfahrenes Zentrum anzustreben.

New concepts are developed in the therapy of diverticular disease. 5-aminosalicylates can be administered in patients with slight forms of diverticulitis. In moderate diverticulitis antibiotics should be applied alternatively or additionally. In cases of severe diverticulitis patients should be kept fasting with parenteral nutrition and intravenous broad spectrum antibiotics. Small abscesses can be treated conservatively while abscesses larger than 4 cm should be drained in a first step and than treated surgically. A free perforation is still an absolute indication for emergency operation. In recurring diverticulitis indication for resection of the affected segment of the bowel should be considered depending on the extent of former attacks.

Background: Adequate bowel preparation is essential for accurate colonoscopy. Both oral sodium phosphate (NaP) and polyethylene glycol-based lavage (PEG-ELS) are used predominantly as bowel cleansing modalities. NaP has gained popularity due to low drinking volume and lower costs. The purpose of this randomized multicenter observer blinded study was to compare three groups of cleansing (NaP, NaP + sennosides, PEG-ELS + sennosides) in reference to tolerability, acceptance, and cleanliness. Patient and Methods: 355 outpatients between 18 and 75 years were randomized into three groups (A, B, C) receiving NaP = A, NaP, and sennosides = B or PEG-ELS and sennosides = C. Gastroenterologists performing colonoscopies were blinded to the type of preparation. All patients documented tolerance and adverse events. Vital signs, premedication, completeness, discomfort, and complications were recorded. A quality score (0–4) of cleanliness was generated. Results: The three groups were similar with regard to age, sex, BMI, indication for colonoscopy, and comorbidity. Drinking volumes (L) (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP (P = .005). Discomfort from ingested fluid was recorded in A = 39.8% (versus C: P = .015), B = 46.6% (versus C: P = .147), and C = 54.6%. Differences in tolerability and acceptance between the three groups were statistically not significant. No differences in adverse events and the cleanliness effects occurred in the three groups (P = .113). The cleanliness quality scores 0–2 were calculated in A: 77.7%, B: 86.7%, and C: 85.2%. Conclusions: These data fail to demonstrate significant differences in tolerability, acceptance, and preparation quality between the three types of bowel preparation for colonoscopy. Cleansing with NaP was not superior to PEG-ELS.

Vedolizumab, the first drug in the class of anti-integrin molecules, is newly approved for ulcerative colitis and Crohn's disease and can be prescribed in Germany since mid-2014. By a specific receptor binding a relatively gut-selective mode of action was achieved without the known side effects of the systemic immunosuppression of the anti-TNF-alpha antibodies. According to the present data the safety profile of Vedolizumab appears to be more favorable than that of the anti-TNF- alpha therapy. Vedolizumab is suitable for induction therapy in patients with ulcerative colitis and Crohn's disease, however the kinetic of response compared with the anti-TNF-alpha antibodies seems to be slower. For maintenance therapy the Vedolizumab data show a deep and sustained remission in patients initially responding to induction therapy with a lower loss of efficacy in the long-term treatment known from the anti-TNF-alpha therapy. On the basis of currently available data the efficacy of Vedolizumab in ulcerative colitis appears to be slightly better than in Crohn's disease.

Das therapeutische Vorgehen bei Morbus Crohn richtet sich nach bestimmten Vorbedingungen, wobei Krankheitsverlauf, individuelle Krankheitssituation und Behandlungsziel von besonderer Bedeutung sind. Die Betreuung von Patienten erfordert ein interdisziplinäres Zusammenarbeiten zwischen konservativer Medizin und Chirurgie. Für die Behandlung des Schubs leichterer Art stehen Aminosalizylate und Budesonid zur Verfügung, bei Versagen dieser Therapie oder schweren Schüben kommt Prednison zum Einsatz. Alle Formen eines komplizierten Krankheitszustandes stellen eine Indikation zur immunsuppressiven Therapie dar, in erster Linie für Azathioprin bzw. 6-Mercaptopurin. Methotrexat, Infliximab, Mycophenolatmofetil und weitere Substanzen können bei Versagen der Standardtherapie diskutiert werden. Für die Remissionserhaltung gibt es keine regelhafte Empfehlung, vielmehr sollte im Einzelfall die Indikation nach klinischen Kriterien gestellt werden. Risiken sind gegen mögliche Vorteile kritisch abzuwägen. Lebensqualität für die Patienten ist das wichtigste Ziel der Behandlung.

Alterations in the colon wall, motility disorders, and certain nutritional habits are the essential factors in the development of colon diverticula. Thus, with advancing age this results in a high incidence in Western industrialized countries. The clinical picture is usually one of symptom-free diverticulosis. Diverticular disease can be associated with minor symptoms, but in complicated cases with diverticulitis and diverticular hemorrhage, it is potentially fatal. Further complications include abscess formation, fistula development, and obstruction. Barium double-contrast imaging exhibits the highest diagnostic sensitivity in diverticulosis but is contraindicated in cases of suspected complicated diverticular disease due to the danger of perforation. In these instances, sonography, computed tomography, or magnetic resonance imaging are performed. For diverticular hemorrhage, coloscopy not only represents a possible diagnostic tool but also a therapeutic option for various techniques of hemostasis. Treatment of diverticulitis and its complications requires careful consideration of conservative and surgical approaches and close interdisciplinary cooperation.

In den letzten Jahren konnten viele neue Erkenntnisse uber die Pathogenese der chronisch entzundlichen Darmerkrankungen gewonnen werden. So gilt als unstrittig, dass die Interaktion von 4 Faktoren dabei die entscheidende Rolle spielt [1, 2, 3, 4]: genetische Suszeptibilitat, Umweltfaktoren, immunvermittelte Gewebedestruktion, enterische Mikroflora. Therapeutische Moglichkeiten hinsichtlich der auf genetischer Ebene erreichten Erkenntnisse fehlen bislang. Abgesehen von der eindrucksvollen Verbesserung des Krankheitsverlaufs bei M. Crohn durch Nikotinabstinenz lassen sich die epidemiologischen Ergebnisse der untersuchten Umweltfaktoren schwer in die Therapie umsetzen [5]. Die gegenwartig eingesetzten Medikamente zielen uberwiegend auf eine Beeinflussung der Immun- bzw. Entzundungsreaktion. Dabei wurden, wie das Beispiel der Antizytokintherapie (Infliximab) zeigt, grose Fortschritte erzielt. Dennoch ist es unwahrscheinlich, dass angesichts einer auf der Verknupfung vieler Faktoren beruhenden Pathogenese allein durch eine Beeinflussung der Immunantwort fur alle Patienten eine dauerhafte Remission des Entzundungsgeschehens erreicht werden kann. Als weiterer therapeutischer Ansatz wird daher die Beeinflussung der enterischen Mikroflora durch Probiotika und Prabiotika untersucht.

Fur das Krankheitsbild des Reizdarmsyndroms (RDS) besteht auch auf Grund der noch nicht vollstandig erforschten Pathogenese keine kausale und damit kurative Therapie. Aufgrund methodischer Probleme sowie wegen der bei den einzelnen Patienten sehr unterschiedlichen und fluktuierenden Symptome sind die bisher erschienenen Studien zum Problem des RDS haufig wenig aussagekraftig. Der vorliegende Beitrag beschreibt die gegenwartige Studienlage, aktuelle therapeutische Moglichkeiten mit besonderer Betonung der die Motilitat beeinflussenden Medikamente und gibt einen Ausblick auf zukunftig einsetzbare Substanzen. Aktuelle Falle zeigen, dass besonders hohe Anforderungen an das Sicherheitsprofil der eingesetzten Medikamente zu stellen sind. Abschliesend gibt ein Uberblick zur Bewertung der verschiedenen eingesetzten Pharmaka eine Entscheidungshilfe bei der individuellen Therapie.

Background and Study Aims: Data concerning potential clinically relevant arterial oxygen desaturation (SaO 2

Background: With the aim of resolving the current controversy over the diagnosis and treatment of diverticular disease, this consensus development conference set out to summarize the actual state of the art. Methods: A multidisciplinary panel of international experts (n= 16) was selected to take part in the consensus process. Prior to the conference, all experts were asked to answer a series of questions on diverticular disease. The consensus statement compiled out of these evaluations was modified during a joint meeting of the panel members, then presented for discussion in a public session, and finally revised by the expert panel. The finalized statement was mailed to all panel members for approval (Delphi method). Results: Asymptomatic diverticulosis, diverticular disease (with actual or recurrent symptoms), and complicated diverticular disease were defined separately. No agreement was reached on whether barium enema or colonoscopy is the better choice as an initial diagnostic tool in uncomplicated cases. In complicated cases, computed tomography is recommended for diagnosis. After two attacks of diverticular disease, elective resection should be considered. For patients in whom a concomitant carcinoma cannot be excluded and those with chronic complications (fistula, stenosis, or bleeding) surgery is also indicated. Laparoscopic sigmoid colectomy is recommended only for uncomplicated and, after percutaneous drainage of abscesses, Hinchey stage I and II cases. Conclusions: Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.

Als chronisch entzundliche Darmerkrankungen gelten im allgemeinen Kolitis ulzerosa und Morbus Crohn. Daneben findet sich aber noch eine andere chronisch entzundliche Darmerkrankung, die mikroskopische Kolitis, fur die es 2 Formen gibt, die kollagene und die lymphozytare Kolitis. Es wird noch diskutiert, ob es sich um 2 verschiedene Erkrankungen oder nur um unterschiedliche Auspragung einer Krankheit handelt. Charakteristisch fur die mikroskopische Kolitis ist die Diskrepanz zwischen dem unauffalligen makro- und dem auffalligen mikroskopischen Befund der Darmschleimhaut. Des weiteren fehlen im wesentlichen typische Laborbefunde. Bei kollagener Kolitis finden sich folgende Veranderungen: ·*diffuse, meist diskontinuierliche Verdickung einer unter der Basalmembran gelegenen subepithelialen Kollagenschicht, ·*entzundliches Infiltrat in der Lamina propria, meist Lymphozyten und Plasmazellen, ·*epitheliale Lasionen in Form von Abflachung, Vakuolisierung und Ablosung von Epithelzellen, ·*Befall aller, bevorzugt aber proximaler Kolonabschnitte, seltener Befall des Intestinum. Bei der lymphozytaren Kolitis fehlt lediglich die verbreiterte Kollagenschicht, das entzundliche Infiltrat ist aber dichter als bei der kollagenen Kolitis und enthalt eine etwas andere Zellzusammensetzung, besonders auch Mastzellen. Nachfolgend wird uber Epidemiologie, Klinik, Diagnostik, Atiologie, Pathogenese und Therapie der kollagenen und lymphozytaren Kolitis referiert.

Background and Study Aims: A prerequisite for successful laparoscopic cholecystectomy is the exclusion of potential risks such as cholangiolithiasis or anatomical malformations. As there is no general agreement regarding the appropriate preoperative diagnostic work-up, a comparative study of different diagnostic methods was carried out. Patients and Methods: In 180 consecutive patients admitted to a community hospital for cholecystectomy due to symptomatic cholecystolithiasis, a prospective comparison was carried out of the diagnostic accuracy of patient history, physical examination, laboratory tests, upper gastrointestinal endoscopy, intravenous cholan-giography, ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP). Results: Measurement of the diameter of the common bile duct was found to be a reliable method as a single noninvasive parameter for diagnosing cholangiolithiasis (sensitivity 100%, specificity 93%), with good predictive power (positive predictive value 0.7, negative predictive value 1.0). The best accuracy achieved noninvasively and without sonography was with a combination of positive patient history and y-glutamyl transferase findings (sensitivity 58%, specificity 84%, positive predictive value 0.37, negative predictive value 0.93). ERCP detected additional cholangiolithiasis in 19 of 139 patients (13.7%) and anatomical malformations in three patients. In all 19 patients, the bile ducts were cleared of stones endoscopically within 24 hours, prior to laparoscopic cholecystectomy. Among the 163 patients primarily assigned to laparoscopic cholecystectomy, the protocol diagnostic work-up, including ERCP, allocated three patients (1.8%) to open surgery. Conversion from laparoscopic cholecystectomy to open cholecystectomy occurred in a further two of 158 patients (1.3%). Conclusions : These results show that routine ultrasonography prior to laparoscopic cholecystectomy can be recommended in order to determine the diameter of the common bile duct. In patients with a ductal diameter of more than 6 mm, ERCP should be performed. Laparoscopic cholecystectomy can be carried out within 24 hours after ERCP and papillotomy.

The treatment of patients with inflammatory bowel disease has become more complex in recent years through the introduction of various immunosuppressive agents as well as the approval of monoclonal antibodies. Patients receiving such treatment must be carefully monitored. National and international guidelines define a diagnostic and therapeutic context for the practitioner, but can only partially respond to specific questions on the procedure for individual patients. Within the framework of a project initiated by Abbott entitled "IBD ahead" 34 German IBD experts have elaborated concrete proposals for the utility of clinical symptom assessment, endoscopy and the use of laboratory parameters including foecal markers of inflammation. Furthermore, we discuss the significance of conventional X-rays, computed tomography, ultrasound and magnetic resonance tomography. These recommendations are illustrated by case studies from everyday practice in the participating centres.

Treatment of diverticulitis comprises at least two options: conservative or surgical management. There is a recent trend to limit surgical treatment of acute diverticulitis and to favor conservative management. This review addresses general aspects of conservative patient care with special focus on the treatment of patients with a first attack of diverticulitis. The presentation does not include a discussion of specific drugs which is given in other sections of this issue.

Toxic megacolon is a rare and life-threatening complication of severe colitis, defined as a dilatation of the colon6 cm in the absence of distal obstruction in combination with signs of systemic toxicity (major criteria: fever, tachycardia, leukocytosis, anaemia). Various triggers are known and the most common causes are underlying ulcerative colitis and Clostridium difficile. Diagnosis can easily be made by clinical examination, routine laboratory parameters and a plain X-ray of the abdomen. Much more difficult is to decide between non-surgical treatment including intensive care treatment or surgery (mostly subtotal colectomy with terminal ileostomy). Non-surgical therapy includes balancing of electrolytes and fluid volumes, broad-spectrum antibiotics including metronidazole, positioning of patients and probably careful intermittent decompression. In case of ulcerative colitis immunosuppression should be started with corticosteroids and potentially with calcineurin inhibitors. In pseudomembranous colitis vancomycin should be given orally and metronidazole should be given intravenously. As far as possible the patient should be treated in a centre with experience in the field.

Different oral formulations of 'mesalazine (mesalamine)' may have different efficacy in distal ulcerative colitis.To evaluate the efficacy of mesalazine granules (Salofalk granules) vs. mesalazine tablets (Salofalk tablets) as induction therapy in patients with distinct extensions of ulcerative colitis.A pooled analysis of 705 patients from four prospective, randomised, double-blind phase III trials was performed. The efficacy of 8 weeks' induction with 3 g/day mesalazine granules [3 g once daily (o.d.) or 1 g three times daily (t.d.s)] vs. 3 g/day mesalazine tablets (1 g t.d.s.) was compared in terms of clinical remission (CR: CAI ≤ 4) and endoscopic remission (ER: EI ≤ 3) (both according to Rachmilewitz) in subgroups with pancolitis, left-sided colitis, or proctosigmoiditis.Mesalazine granules were equipotent to mesalazine tablets in pancolitis regarding CR (72% vs. 71%, P = 0.909) and ER (58% vs. 49%, P = 0.338). In left-sided colitis, both mesalazine formulations were equipotent regarding CR (66% vs. 67%; P = 0.843) but mesalazine granules were superior regarding ER (56% vs. 37%; P = 0.025). In proctosigmoiditis, mesalazine granules were significantly more effective than mesalazine tablets regarding CR (78% vs. 55% P0.001) and ER (67% vs. 43% P0.001). Furthermore, o.d. application of mesalazine granules was more effective than t.d.s. dosing in left-sided colitis (CR 73% vs. 62%, P = 0.181; ER 71% vs. 48% P = 0.005) and proctosigmoiditis (CR 86% vs. 73%, P = 0.020; ER 75% vs. 61%, P = 0.021), but not in pancolitis.This pooled analysis supports the hypothesis that mesalazine granules are superior to mesalazine tablets in induction of remission in distal colitis and should be taken once daily.

Objective Fibrosing colonopathy (FC) is a rare entity associated with cystic fibrosis (CF). Until now, patients with stricturing FC have usually been treated surgically. In this instance, we aimed at avoiding surgery by applying a new conservative approach. Methods Case report on an adult with CF who developed persistent abdominal pain due to a non-passable stricture in the right transverse colon. Histology confirmed fibrosing colonopathy. Results Initially we treated the patient with prednisolone pulse therapy and additive antibiotic therapy. For maintenance therapy we administered budesonide. The patient underwent clinical, laboratory and endoscopic follow-up over a three-year period. The stricture healed and was easy to pass. A relapse in the cecum at the ileocecal valve again improved under steroid and antibiotic therapy. Conclusions We present a novel therapeutic approach for advanced stricturing FC in an adult patient which successfully avoided surgery (right hemicolectomy) over a three year follow up.

The treatment of patients with inflammatory bowel disease has become more complex in recent years through the introduction of various immunosuppressive agents as well as the approval of monoclonal antibodies against TNF-α and patients receiving such treatment must be carefully monitored. National and international guidelines define a diagnostic and therapeutic context for the practitioner, but can only partially respond to specific questions on the procedure for individual patients. Within the framework of a project initiated by Abbott entitled "IBD ahead" 38 German IBD experts have elaborated concrete proposals for dealing with corticosteroids, immunosuppressants and TNF-α antibodies on the basis of the published literature and their own personal experience in order to close the gap between these guidelines and daily clinical practice. Statements were developed on the choice of correct timing of initiation, dose and duration of the individual substances and on how to proceed with patients exhibiting treatment failure. Moreover, recommendations are also made on drug combination strategies, safety monitoring and the risks regarding the development of infectious complications and malignancies. These recommendations are illustrated by case studies from everyday practice in participating centres.

Das Reizdarmsyndrom umfaβt eine oftmals wechselnde Kombination chronischer gastrointestinaler Beschwerden ohne erkennbare organische Ursachen. Die Diagnose kann aufgrund der Anamnese und des klinischen Bildes gestellt werden. Abgesehen von der korperlichen Untersuchung, einem kleinen Laborstatus und eventuell einer Koloskopie sind keine weiteren Untersuchungen notwendig. Zur Therapie ist festzustellen, daβ weder ein therapeutischer Nihilismus noch das andere Extrem eines unkritischen Polypragmatismus bei der Behandlung von Patienten mit Reizdarmsyndrom angebracht sind. Eine wichtige und erfolgversprechende Basismaβnahme ist die sogenannte «kleine Psychotherapie». Eine weitergehende Behandlung sollte sich gezielt nach den Leitsymptomen richten.

Comparative data regarding different regimens of oral mesalazine (mesalamine) for maintaining remission in ulcerative colitis are limited.To evaluate whether 3.0 g mesalazine once-daily (OD) is superior to the standard treatment of 0.5 g mesalazine three times daily (t.d.s.) and to prove the therapeutic equivalence of OD vs. t.d.s. dosing of total 1.5 g mesalazine for remission maintenance in patients with ulcerative colitis.A 1-year, multicentre, double-blind, double-dummy study was undertaken in patients with endoscopically and histologically confirmed ulcerative colitis in remission. Patients were randomised to oral mesalazine 3.0 g OD, 1.5 g OD or 0.5 g t.d.s. The primary efficacy endpoint was the proportion of patients still in clinical remission at the final visit, with clinical relapse being defined as CAI score4 and an increase of ≥3 from baseline.The primary efficacy endpoint occurred in 162/217 3.0 g OD patients (75%), 129/212 1.5 g OD patients (61%) and 150/218 0.5 g t.d.s. patients (69%) in the intention-to-treat population, and in 152/177 (86%), 121/182 (67%) and 144/185 (78%) in the per protocol population respectively; 3.0 g OD was superior to both low-dose regimens for the primary endpoint (i.e. P0.001, 3.0 g OD vs. 1.5 g OD; P = 0.024, 3.0 g OD vs. 0.5 g t.d.s.; superiority test, per protocol population). Safety analysis, including comprehensive renal monitoring, revealed no concern in any treatment group.Mesalazine 3.0 g once daily was the most effective dose for maintenance of remission in ulcerative colitis of the three regimens assessed, with no penalty in terms of safety.