Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Digestive Diseases and Sciences
Erschienen in: Digestive Diseases and Sciences 5/2015

01.05.2015 | Original Article

Environmental Factors in the Relapse and Recurrence of Inflammatory Bowel Disease: A Review of the Literature

verfasst von: Thomas D. Martin, Simon S. M. Chan, Andrew R. Hart

Erschienen in: Digestive Diseases and Sciences | Ausgabe 5/2015

Einloggen, um Zugang zu erhalten

Abstract

Introduction

The causes of relapse in patients with Crohn’s disease (CD) and ulcerative colitis (UC) are largely unknown. This paper reviews the epidemiological and clinical data on how medications (non-steroidal anti-inflammatory drugs, estrogens and antibiotics), lifestyle factors (smoking, psychological stress, diet and air pollution) may precipitate clinical relapses and recurrence. Potential biological mechanisms include: increasing thrombotic tendency, imbalances in prostaglandin synthesis, alterations in the composition of gut microbiota, and mucosal damage causing increased permeability.

Results

The clinical epidemiological data consistently reports positive associations between smoking and relapses in CD, and inverse ones with UC. For NSAIDs and estrogens, the epidemiological findings are inconsistent, although general antibiotic use was associated with a reduced risk of relapse in CD. High levels of stress were positively associated with relapse, although psychological interventions did not have therapeutic benefits. The limited work on diet has reported sulphur-containing foods are positively associated with relapse in UC, but there is no work in CD. Ecological data reported positive correlations between air pollution levels and IBD hospitalisations.

Conclusions

In the future, to clarify this area, more clinical epidemiological work is required where detailed drug types and doses, and complete dietary intakes are measured, in specific forms of IBD. Such work could provide guidance to both patients and doctors to help maintain remission.
Literatur
1.
2.
Bouma G, Strober W. The immunological and genetic basis of inflammatory bowel disease. Nat Rev Immunol. 2003;3:521–533.CrossRefPubMed
3.
Cohen RD. The quality of life in patients with Crohn’s disease. Aliment Pharmacol Ther. 2002;16:1603–1609.CrossRefPubMed
4.
Casellas F, Arenas JI, Baudet JS, et al. Impairment of health-related quality of life in patients with inflammatory bowel disease: a Spanish multicenter study. Inflamm Bowel Dis. 2005;11:488–496.CrossRefPubMed
5.
Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007;369:1641–1657.CrossRefPubMed
6.
Eaden J. Review article: colorectal carcinoma and inflammatory bowel disease. Aliment Pharmacol Ther. 2004;20:24–30.CrossRefPubMed
7.
Danese S, Semeraro S, Papa A, et al. Extraintestinal manifestations in inflammatory bowel disease. World J Gastroenterol. 2005;11:7227–7236.PubMed
8.
Rothfuss KS, Stange EF, Herrlinger KR. Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol. 2006;12:4819–4831.PubMedCentralPubMed
9.
Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J. Predictors of Crohn’s disease. Gastroenterology. 2006;130:650–656.CrossRefPubMed
10.
Solberg IC, Vatn MH, Hoie O, et al. Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007;5:1430–1438.CrossRefPubMed
11.
Hovde O, Moum BA. Epidemiology and clinical course of Crohn’s disease: results from observational studies. World J Gastroenterol. 2012;18:1723–1731.CrossRefPubMedCentralPubMed
12.
Bitton A, Peppercorn MA, Antonioli DA, et al. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology. 2001;120:13–20.CrossRefPubMed
13.
Barua RS, Ambrose JA, Eales-Reynolds LJ, DeVoe MC, Zervas JG, Saha DC. Dysfunctional endothelial nitric oxide biosynthesis in healthy smokers with impaired endothelium-dependent vasodilatation. Circulation. 2001;104:1905–1910.CrossRefPubMed
14.
Severinsen MT, Kristensen SR, Johnsen SP, Dethlefsen C, Tjonneland A, Overvad K. Smoking and venous thromboembolism: a Danish follow-up study. J Thromb Haemost. 2009;7:1297–1303.CrossRefPubMed
15.
Stepien E, Miszalski-Jamka T, Kapusta P, Tylko G, Pasowicz M. Beneficial effect of cigarette smoking cessation on fibrin clot properties. J Thromb Thrombolysis. 2011;32:177–182.CrossRefPubMed
16.
Brunner H, Cockcroft JR, Deanfield J, et al. Endothelial function and dysfunction. Part II: association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. J Hypertens. 2005;23:233–246.CrossRefPubMed
17.
Thompson NP, Wakefield AJ, Pounder RE. Inherited disorders of coagulation appear to protect against inflammatory bowel disease. Gastroenterology. 1995;108:1011–1015.CrossRefPubMed
18.
Wakefield AJ, Sawyerr AM, Dhillon AP, et al. Pathogenesis of Crohn’s disease: multifocal gastrointestinal infarction. Lancet. 1989;2:1057–1062.CrossRefPubMed
19.
Dhillon AP, Anthony A, Sim R, et al. Mucosal capillary thrombi in rectal biopsies. Histopathology. 1992;21:127–133.CrossRefPubMed
20.
Lunderquist A, Knutsson H. Angiography in Crohn’s disease of the small bowel and colon. Am J Roentgenol Radium Ther Nucl Med. 1967;101:338–344.CrossRefPubMed
21.
Erikson U, Fagerberg S, Krause U, Olding L. Angiographic studies in Crohn’s disease and ulcerative colitis. Am J Roentgenol Radium Ther Nucl Med. 1970;110:385–392.CrossRefPubMed
22.
23.
Schreck R, Rieber P, Baeuerle PA. Reactive oxygen intermediates as apparently widely used messengers in the activation of the NF-kappa B transcription factor and HIV-1. Embo J. 1991;10:2247–2258.PubMedCentralPubMed
24.
Bonizzi G, Karin M. The two NF-kappaB activation pathways and their role in innate and adaptive immunity. Trends Immunol. 2004;25:280–288.CrossRefPubMed
25.
26.
Kaser A, Zeissig S, Blumberg RS. Inflammatory bowel disease. Annu Rev Immunol. 2010;28:573–621.CrossRefPubMed
27.
Grisham MB, Granger DN. Neutrophil-mediated mucosal injury. Role of reactive oxygen metabolites. Dig Dis Sci. 1988;33:6S–15S.CrossRefPubMed
28.
Reese GE, Nanidis T, Borysiewicz C, Yamamoto T, Orchard T. Tekkis PP. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis. 2008;23:1213–1221.CrossRefPubMed
29.
Cosnes J, Carbonnel F, Beaugerie L, Le Quintrec Y, Gendre JP. Effects of cigarette smoking on the long-term course of Crohn’s disease. Gastroenterology. 1996;110:424–431.CrossRefPubMed
30.
Timmer A, Sutherland LR, Martin F. Oral contraceptive use and smoking are risk factors for relapse in Crohn’s disease. The Canadian Mesalamine for Remission of Crohn’s Disease Study Group. Gastroenterology. 1998;114:1143–1150.CrossRefPubMed
31.
Cosnes J, Carbonnel F, Carrat F, Beaugerie L, Cattan S, Gendre J. Effects of current and former cigarette smoking on the clinical course of Crohn’s disease. Aliment Pharmacol Ther. 1999;13:1403–1411.CrossRefPubMed
32.
33.
Cottone M, Rosselli M, Orlando A, et al. Smoking habits and recurrence in Crohn’s disease. Gastroenterology. 1994;106:643–648.PubMed
34.
Sutherland LR, Ramcharan S, Bryant H, Fick G. Effect of cigarette smoking on recurrence of Crohn’s disease. Gastroenterology. 1990;98:1123–1128.PubMed
35.
Seksik P, Nion-Larmurier I, Sokol H, Beaugerie L, Cosnes J. Effects of light smoking consumption on the clinical course of Crohn’s disease. Inflamm Bowel Dis. 2009;15:734–741.CrossRefPubMed
36.
Beaugerie L, Massot N, Carbonnel F, Cattan S, Gendre JP, Cosnes J. Impact of cessation of smoking on the course of ulcerative colitis. Am J Gastroenterol. 2001;96:2113–2116.CrossRefPubMed
37.
Merrett MN, Mortensen N, Kettlewell M, Jewell DO. Smoking may prevent pouchitis in patients with restorative proctocolectomy for ulcerative colitis. Gut. 1996;38:362–364.CrossRefPubMedCentralPubMed
38.
Aldhous MC, Prescott RJ, Roberts S, Samuel K, Waterfall M, Satsangi J. Does nicotine influence cytokine profile and subsequent cell cycling/apoptotic responses in inflammatory bowel disease? Inflamm Bowel Dis. 2008;14:1469–1482.CrossRefPubMed
39.
Zhang S, Petro TM. The effect of nicotine on murine CD4 T cell responses. Int J Immunopharmacol. 1996;18:467–478.CrossRefPubMed
40.
Savoye G, Lerebours E. Toll-like receptor-4 signaling: a possible candidate pathway to support tobacco smoking effects in ulcerative colitis. Am J Gastroenterol. 2008;103:2947–2948.CrossRefPubMed
41.
Hecht SS. Tobacco smoke carcinogens and lung cancer. J Natl Cancer Inst. 1999;91:1194–1210.CrossRefPubMed
42.
Cipolla G, Crema F, Sacco S, Moro E, de Ponti F, Frigo G. Nonsteroidal anti-inflammatory drugs and inflammatory bowel disease: current perspectives. Pharmacol Res. 2002;46:1–6.CrossRefPubMed
43.
Mancini JA, Riendeau D, Falgueyret JP, Vickers PJ, O’Neill GP. Arginine 120 of prostaglandin G/H synthase-1 is required for the inhibition by nonsteroidal anti-inflammatory drugs containing a carboxylic acid moiety. J Biol Chem. 1995;270:29372–29377.CrossRefPubMed
44.
Luong C, Miller A, Barnett J, Chow J, Ramesha C, Browner MF. Flexibility of the NSAID binding site in the structure of human cyclooxygenase-2. Nat Struct Biol. 1996;3:927–933.CrossRefPubMed
45.
Loll PJ, Picot D, Garavito RM. The structural basis of aspirin activity inferred from the crystal structure of inactivated prostaglandin H2 synthase. Nat Struct Biol. 1995;2:637–643.CrossRefPubMed
46.
Hayashi S, Ueno N, Murase A, Nakagawa Y, Takada J. Novel acid-type cyclooxygenase-2 inhibitors: design, synthesis, and structure–activity relationship for anti-inflammatory drug. Eur J Med Chem. 2012;50:179–195.CrossRefPubMed
47.
Levy BD, Clish CB, Schmidt B, Gronert K, Serhan CN. Lipid mediator class switching during acute inflammation: signals in resolution. Nat Immunol. 2001;2:612–619.CrossRefPubMed
48.
Miles EA, Allen E, Calder PC. In vitro effects of eicosanoids derived from different 20-carbon Fatty acids on production of monocyte-derived cytokines in human whole blood cultures. Cytokine. 2002;20:215–223.CrossRefPubMed
49.
Lichtenberger LM, Wang ZM, Romero JJ, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) associate with zwitterionic phospholipids: insight into the mechanism and reversal of NSAID-induced gastrointestinal injury. Nat Med. 1995;1:154–158.CrossRefPubMed
50.
Baumgart DC, Carding SR. Inflammatory bowel disease: cause and immunobiology. Lancet. 2007;369:1627–1640.CrossRefPubMed
51.
Hatoum OA, Gauthier KM, Binion DG, et al. Novel mechanism of vasodilation in inflammatory bowel disease. Arterioscler Thromb Vasc Biol. 2005;25:2355–2361.CrossRefPubMed
52.
Meyer AM, Ramzan NN, Heigh RI, Leighton JA. Relapse of inflammatory bowel disease associated with use of nonsteroidal anti-inflammatory drugs. Dig Dis Sci. 2006;51:168–172.CrossRefPubMed
53.
Felder JB, Korelitz BI, Rajapakse R, Schwarz S, Horatagis AP, Gleim G. Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a case-control study. Am J Gastroenterol. 2000;95:1949–1954.CrossRefPubMed
54.
Evans JM, McMahon AD, Murray FE, McDevitt DG, MacDonald TM. Non-steroidal anti-inflammatory drugs are associated with emergency admission to hospital for colitis due to inflammatory bowel disease. Gut. 1997;40:619–622.CrossRefPubMedCentralPubMed
55.
Bonner GF, Walczak M, Kitchen L, Bayona M. Tolerance of nonsteroidal antiinflammatory drugs in patients with inflammatory bowel disease. Am J Gastroenterol. 2000;95:1946–1948.CrossRefPubMed
56.
Dominitz JA, Koepsell TD, Boyko EJ. Association between analgesic use and inflammatory bowel disease (IBD) flares: a retrospective cohort study (abstract). Gastroenterology. 2000;118:A581.CrossRef
57.
Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60:571–607.CrossRefPubMed
58.
Lader D, Hopkins G. Contraception and sexual health. Cardiff: Office for National Statistics; 2008.
59.
Beral V, Banks E, Reeves G, Appleby P. Use of HRT and the subsequent risk of cancer. J Epidemiol Biostat. 1999;4:191–210; discussion-5.
60.
Reid R, Leyland N, Wolfman W, et al. SOGC clinical practice guidelines: oral contraceptives and the risk of venous thromboembolism: an update: no. 252, December 2010. Int J Gynaecol Obstet. 2011;112:252–256.CrossRefPubMed
61.
Meijers JC, Tekelenburg WL, Bouma BN, Bertina RM, Rosendaal FR. High levels of coagulation factor XI as a risk factor for venous thrombosis. N Engl J Med. 2000;342:696–701.CrossRefPubMed
62.
63.
Foley EF, Jazaeri AA, Shupnik MA, Jazaeri O, Rice LW. Selective loss of estrogen receptor beta in malignant human colon. Cancer Res. 2000;60:245–248.PubMed
64.
Cosnes J, Carbonnel F, Carrat F, Beaugerie L, Gendre JP. Oral contraceptive use and the clinical course of Crohn’s disease: a prospective cohort study. Gut. 1999;45:218–222.CrossRefPubMedCentralPubMed
65.
Sutherland LR, Ramcharan S, Bryant H, Fick G. Effect of oral contraceptive use on reoperation following surgery for Crohn’s disease. Dig Dis Sci. 1992;37:1377–1382.CrossRefPubMed
66.
Kane SV, Reddy D. Hormonal replacement therapy after menopause is protective of disease activity in women with inflammatory bowel disease. Am J Gastroenterol. 2008;103:1193–1196.CrossRefPubMed
67.
Linskens RK, Huijsdens XW, Savelkoul PH, Vandenbroucke-Grauls CM, Meuwissen SG. The bacterial flora in inflammatory bowel disease: current insights in pathogenesis and the influence of antibiotics and probiotics. Scand J Gastroenterol. 2001;36:29–40.CrossRef
68.
Backhed F, Ley RE, Sonnenburg JL, Peterson DA, Gordon JI. Host-bacterial mutualism in the human intestine. Science. 2005;307:1915–1920.CrossRefPubMed
69.
Lu L, Walker WA. Pathologic and physiologic interactions of bacteria with the gastrointestinal epithelium. Am J Clin Nutr. 2001;73:1124S–1130S.PubMed
70.
Hisamatsu T, Suzuki M, Reinecker HC, Nadeau WJ, McCormick BA, Podolsky DK. CARD15/NOD2 functions as an antibacterial factor in human intestinal epithelial cells. Gastroenterology. 2003;124:993–1000.CrossRefPubMed
71.
Aberra FN, Brensinger CM, Bilker WB, Lichtenstein GR, Lewis JD. Antibiotic use and the risk of flare of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2005;3:459–465.CrossRefPubMed
72.
Khan KJ, Ullman TA, Ford AC, et al. Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2011;106:661–673.CrossRefPubMed
73.
Sternberg EM, Chrousos GP, Wilder RL, Gold PW. The stress response and the regulation of inflammatory disease. Ann Intern Med. 1992;117:854–866.CrossRefPubMed
74.
LeResche L, Dworkin SF. The role of stress in inflammatory disease, including periodontal disease: review of concepts and current findings. Periodontol. 2000;2002:91–103.
75.
Chrousos GP, Gold PW. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA. 1992;267:1244–1252.CrossRefPubMed
76.
Collins SM, McHugh K, Jacobson K, et al. Previous inflammation alters the response of the rat colon to stress. Gastroenterology. 1996;111:1509–1515.CrossRefPubMed
77.
Collins SM. Stress and the Gastrointestinal Tract IV. Modulation of intestinal inflammation by stress: basic mechanisms and clinical relevance. Am J Physiol Gastrointest Liver Physiol. 2001;280:G315–G318.PubMed
78.
Bitton A, Dobkin PL, Edwardes MD, et al. Predicting relapse in Crohn’s disease: a biopsychosocial model. Gut. 2008;57:1386–1392.CrossRefPubMed
79.
Levenstein S, Prantera C, Varvo V, et al. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol. 2000;95:1213–1220.CrossRefPubMed
80.
Bernstein CN, Singh S, Graff LA, Walker JR, Miller N, Cheang M. A prospective population-based study of triggers of symptomatic flares in IBD. Am J Gastroenterol. 2010;105:1994–2002.CrossRefPubMed
81.
North CS, Alpers DH, Helzer JE, Spitznagel EL, Clouse RE. Do life events or depression exacerbate inflammatory bowel disease? A prospective study. Ann Intern Med. 1991;114:381–386.CrossRef
82.
83.
Boye B, Lundin KE, Jantschek G, et al. INSPIRE study: does stress management improve the course of inflammatory bowel disease and disease-specific quality of life in distressed patients with ulcerative colitis or Crohn’s disease? A randomized controlled trial. Inflamm Bowel Dis. 2011;17:1863–1873.CrossRefPubMed
84.
Dignass A, Van Assche G, Lindsay JO, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: current management. J Crohns Colitis. 2010;4:28–62.CrossRefPubMed
85.
Beattie RM, Bentsen BS, MacDonald TT. Childhood Crohn’s disease and the efficacy of enteral diets. Nutrition. 1998;14:345–350.CrossRefPubMed
86.
Gorard DA, Hunt JB, Payne-James JJ, et al. Initial response and subsequent course of Crohn’s disease treated with elemental diet or prednisolone. Gut. 1993;34:1198–1202.CrossRefPubMedCentralPubMed
87.
Parcell S. Sulfur in human nutrition and applications in medicine. Altern Med Rev. 2002;7:22–44.PubMed
88.
Adams JB. Food additive-additive interactions involving sulphur dioxide and ascorbic and nitrous acids: a review. Food Chem. 1997;59:401–409.
89.
90.
Aslam M, Batten JJ, Florin THJ, Sidebotham RL, Baron JH. Hydrogen sulphide induced damage to the colonic mucosal barrier in the rat. Gut. 1992;33:S69.
91.
Christl SU, Eisner HD, Dusel G, Kasper H, Scheppach W. Antagonistic effects of sulfide and butyrate on proliferation of colonic mucosa: a potential role for these agents in the pathogenesis of ulcerative colitis. Dig Dis Sci. 1996;41:2477–2481.CrossRefPubMed
92.
Jowett SL, Seal CJ, Pearce MS, et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut. 2004;53:1479–1484.CrossRefPubMedCentralPubMed
93.
Magee EA, Richardson CJ, Hughes R, Cummings JH. Contribution of dietary protein to sulfide production in the large intestine: an in vitro and a controlled feeding study in humans. Am J Clin Nutr. 2000;72:1488–1494.PubMed
94.
Florin THJ. The sulfate content of foods and beverages. J Food Compost Anal. 1993;6:140–151.CrossRef
95.
Magee EA, Edmond LM, Tasker SM, Kong SC, Curno R, Cummings JH. Associations between diet and disease activity in ulcerative colitis patients using a novel method of data analysis. Nutr J. 2005;4:7.CrossRefPubMedCentralPubMed
96.
Guerreiro CS, Ferreira P, Tavares L, et al. Fatty acids, IL6, and TNFalpha polymorphisms: an example of nutrigenetics in Crohn’s disease. Am J Gastroenterol. 2009;104:2241–2249.CrossRefPubMed
97.
Tornqvist H, Mills NL, Gonzalez M, et al. Persistent endothelial dysfunction in humans after diesel exhaust inhalation. Am J Respir Crit Care Med. 2007;176:395–400.CrossRefPubMed
98.
Dybdahl M, Risom L, Moller P, et al. DNA adduct formation and oxidative stress in colon and liver of Big Blue rats after dietary exposure to diesel particles. Carcinogenesis. 2003;24:1759–1766.CrossRefPubMed
99.
Sigaud S, Goldsmith CA, Zhou H, et al. Air pollution particles diminish bacterial clearance in the primed lungs of mice. Toxicol Appl Pharmacol. 2007;223:1–9.CrossRefPubMedCentralPubMed
100.
Ananthakrishnan AN, McGinley EL, Binion DG, Saeian K. Ambient air pollution correlates with hospitalizations for inflammatory bowel disease: an ecologic analysis. Inflamm Bowel Dis. 2011;17:1138–1145.CrossRefPubMed
Metadaten
Titel
Environmental Factors in the Relapse and Recurrence of Inflammatory Bowel Disease: A Review of the Literature
verfasst von
Thomas D. Martin
Simon S. M. Chan
Andrew R. Hart
Publikationsdatum
01.05.2015
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 5/2015
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-014-3437-3

Weitere Artikel der Ausgabe 5/2015

Digestive Diseases and Sciences 5/2015 Zur Ausgabe

Editorial

Detection of Advanced Neoplasia with FIT Versus Flexible Sigmoidoscopy Versus Colonoscopy: More Is More

Review

Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

Stanford Multidisciplinary Seminars

Non-MalIg(G4)nant Biliary Obstruction: When the Pill Is Mightier than the Knife

Publisher’s Erratum

Erratum to: Bacterial Pathogen Helicobacter pylori: A Bad AKTor Inhibits p53 Protein Activity

Original Article

Diagnostic Performance of Fecal Immunochemical Test and Sigmoidoscopy for Advanced Right-Sided Colorectal Neoplasms

Original Article

IL-33 Promotes Gastric Cancer Cell Invasion and Migration Via ST2–ERK1/2 Pathway

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren. 

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise