Abstract:
:Portal hypertension in patients with liver cirrhosis can be improved, not only by surgical or interventional shunt placements, but also by drug-only treatment. Many recent studies addressed the question whether any of these substances can improve survival of patients with liver cirrhosis when administered continuously for months and years. Non-selective beta-blockers (NSBB), statins, antibiotics, enoxaparin and albumin have been shown to possess many beneficial effects in the pathophysiology of portal hypertension or on events leading to decompensation of liver cirrhosis. Accordingly, they represent candidate drugs for long-term treatment to improve patient survival. In contrast to NSBB, antibiotics and albumin, which have clearly defined indications in the treatment of complications related to portal hypertension, the role of statins and anticoagulants in the management of these patients remains to be further elucidated. Recent studies came to opposing results when a permanent treatment was tested to improve patient prognosis or to prevent liver decompensation. At present, there is no reason to change our everyday practice beyond established management proposals published in practice guidelines. This paper gives an overview of present and future indications for treatment with NSBB, antibiotics, statins, anticoagulants and albumin with special reference to studies aiming at improving prognosis of patients with liver cirrhosis. :Die portale Hypertension bei Patienten mit Leberzirrhose kann nicht nur durch interventionelle (TIPS: transjugulärer portosystemischer Stent-Shunt) oder operative Shuntanlagen, sondern auch medikamentös beeinflusst werden. Zahlreiche Studien beschäftigten sich mit der Frage, ob diese Substanzen bei dauerhafter Gabe zu einer Prognoseverbesserung bei Patienten mit Leberzirrhose führen können. Nicht selektive Betablocker (NSBB), Statine, Antibiotika, Enoxaparin und Albumin haben viele Angriffspunkte in der Pathogenese der portalen Hypertension oder bei Dekompensation der Leberzirrhose, sodass sie grundsätzlich als Kandidaten für eine Langzeittherapie infrage kommen. Während es für NSBB, Antibiotika und Albumin klare Indikationen in der Versorgung von Patienten mit dekompensierter Leberzirrhose gibt, ist dies weniger geklärt für den Einsatz von Statinen oder Antikoagulanzien. Neuere Untersuchungen ergaben widersprüchliche Ergebnisse, wenn der primäre Endpunkt einer Studie die Prognoseverbesserung oder die Vermeidung einer Dekompensation der Zirrhose durch eine dauerhafte medikamentöse Therapie war. Zum jetzigen Zeitpunkt ergibt sich aufgrund der aktuellen Studienlage keine Veranlassung, das bisherige, in Leitlinien abgesicherte Vorgehen im täglichen Alltag zu ändern. Diese Übersicht gibt einen Überblick zum Einsatz von NSBB, Antibiotika, Statinen, Antikoagulanzien und Albumin bei Komplikationen der portalen Hypertension insbesondere im Hinblick auf ihren dauerhaften Einsatz zur Verbesserung des Überlebens von Patienten mit Leberzirrhose.
journal_name
Z Gastroenteroljournal_title
Zeitschrift fur Gastroenterologieauthors
Holstege Adoi
10.1055/a-0958-2788subject
Has Abstractpub_date
2019-08-01 00:00:00pages
983-996issue
8eissn
0044-2771issn
1439-7803journal_volume
57pub_type
杂志文章,评审abstract::Budesonide is a locally acting steroid with a high first-pass metabolism in the liver and low systemic effects. We performed the first pilot study comparing budesonide foam (1 mg/50 ml b.i.d.) with mesalazine enemas (4 g/60 ml o.d.). 33 patients from 3 centres were enrolled in this open randomized clinical trial. 16 p...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1055/s-2000-14869
更新日期:2000-04-01 00:00:00
abstract::Langerhans cell histiocytosis is a disease with different clinical presentations and a wide spectrum of organ involvements. Rarely Langerhans cell histiocytosis can involve the gastrointestinal tract of adult patients. A case of infiltration of gastric mucosa by Langerhans cell histiocytosis is presented. The neoplast...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-0034-1399058
更新日期:2015-04-01 00:00:00
abstract::Appendico-ileal knotting is a very rare and widely unknown cause of closed loop bowel obstruction. In most cases it is discovered incidentally during surgery. We report a 59 year old female with a previous history of a total abdominal hysterectomy who presented with features of intestinal obstruction and was thought t...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0042-100916
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Little is known about the similarities and differences in the clogging process of biliary and pancreatic stents. The aim of the study was to elucidate this process using scanning electron microscopy. MATERIALS AND METHODS:Scanning electron microscopy was performed in a consecutive series of 18 biliary and 1...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2008-1027926
更新日期:2009-04-01 00:00:00
abstract:INTRODUCTION:Data about the nature and pathophysiological relevance of the target antigens reacting with perinuclear antineutrophil cytoplasmatic autoantibodies (p-ANCA) in ulcerative colitis are inconsistent and partly conflicting. In the majority of the previous studies only one singular potential target antigen was ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1998-08-01 00:00:00
abstract::Between 1986 and 1997 we treated 67 patients with 68 cystic tumors of the pancreas including 17 mucinous cystadenocarcinomas, four serous cystadenocarcinomas, 15 mucinous cystadenomas, 18 serous cystadenomas, ten intraductal papillary-mucinous tumors, three solid-pseudopapillary tumors, and one cystic neuroendocrine t...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1998-11-01 00:00:00
abstract::Anisakiasis or "herring worm disease" is one of the most important parasitic diseases of the gastrointestinal tract in Japan. In 1988 Lorenz and Warzok published 8 cases of intestinal anisakiasis in Eastern Germany. In 1988 Spehn et al. reported a case of gastric anisakiasis in an AIDS patient. Here, we describe a cas...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2001-11150
更新日期:2001-02-01 00:00:00
abstract::A 29-year-old man presented with abdominal cramps and bloody diarrhoea. Blood tests revealed elevated C-reactive protein (21.3 mg/dL; normal range 0.01 - 0. 82 mg/dL) and white blood cells (28200/μL, normal range 4000 - 10000/μL). Stool tests were negative for enteropathogenic bacteria and Clostridium difficile toxins...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0031-1299289
更新日期:2012-02-01 00:00:00
abstract::We report on the case of a 55-year-old patient suffering from progressive systemic sclerosis (PSS). The patient was sent to our department when clinical symptoms of an acute upper gastrointestinal hemorrhage occurred. Upper endoscopy showed a watermelon stomach and fresh blood in the stomach. The presence of teleangie...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1997-06-01 00:00:00
abstract::Successful application of non operative procedures for gallstone therapy are limited on cholesterol stones. Therefore reliable therapeutic analysis of stone components is mandatory for planning of an adequate therapy. Computed tomographic gallstone analysis is considered to improve selection of patients significantly....
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract::Between 1981 and 1987 5434 patients were studied by ERCP in Allgemeines Krankenhaus Hamburg-Barmbeck. 26 (i.e. 0.43%) suffered from Mirizze syndrome with the triad of cholelithiasis, cholecystitis and obstructive biliary disease. They were classified in four different types according to the variable localisation and o...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1990-04-01 00:00:00
abstract::Pancreatic secretion is involved in circadian regulation of the whole organism. This observation was obtained in animals and humans with pancreatic fistulas. We report on three patients in whom the pancreas was removed totally or subtotally because of chronic pancreatitis with severe pain. A segment of the removed gla...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1991-07-01 00:00:00
abstract::Ultrasonography has become widely accepted as a diagnostic tool for gastrointestinal diseases. It not only assesses the lumen but more importantly also the wall and the surrounding structures of the stomach and bowel. Furthermore, functional processes (peristalsis, blood flow) can be visualised and provide important i...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2007-963101
更新日期:2007-07-01 00:00:00
abstract::With regard to acute or chronic pancreatitis various complications involving the spleen can occur, hematoma of the spleen being a rare complication. We describe the case of a patient in reduced general condition with elevated pancreatic enzymes and signs of inflammation. During multiple examinations, hematoma of the s...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2004-813783
更新日期:2004-11-01 00:00:00
abstract::Transanal endoscopic microsurgery (TEM) presents a minimally invasive procedure for local removal of large rectal adenomas (>/= 2 cm) and early, so called "low-risk" carcinomas (uT1, G1 - 2) in curative as well as of advanced tumors in palliative intent. Over a 6-year period 92 TEM excisions of rectal tumors were carr...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2002-20210
更新日期:2002-02-01 00:00:00
abstract:BACKGROUND:Celiac disease (CD) is a common chronic systemic autoimmune disease in Europe. The prevalence of CD in Hungarian children is estimated at 1.2 - 1.4 %. To date, however, no data on adult CD prevalence has been published. AIMS:Analysis of the serological evidence for CD among Hungarian adults in order to esti...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0033-1335450
更新日期:2013-11-01 00:00:00
abstract::Penile and scrotal swelling considered as metastatic Crohn's disease is described in a 23 years-old-man. Clinical features and therapeutic options of this rare manifeatation are reviewed. ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0028-1109450
更新日期:2009-09-01 00:00:00
abstract::Cystic fibrosis (CF) is the most common autosomal recessive disease in the Caucasian population. The primary cellular defect, the reduced expression of the cystic fibrosis transmembrane conductance regulator (CFTR), leading to a chloride secretory defect, is present in all epithelial cells of endodermal and mesodermal...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:
更新日期:1999-08-01 00:00:00
abstract::1. In conscious rats provided with indwelling pancreatic and biliary catheters, the influence of anesthesia was investigated. 2. Ether was applied in concentrations of 4, 6 and 8 Vol % by an evaporator and Na-pentobarbital injected intravenously (30 mg/kg b. w.) 3. Flow rate, electrolytes (ion-selective electrodes and...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1982-02-01 00:00:00
abstract::Various sorbents were tested in-vitro for their ability to support hepatic excretory and detoxification functions, and their in-vivo perfusion with plasma was studied in an animal experiment. Amino acids, particularly phenylalanine and tyrosine, were strongest bound by activated charcoal, while Amberlite XAD-7 removed...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1979-02-01 00:00:00
abstract::Seventy-nine caustic burns of the upper gastrointestinal tract were divided into early and late effects. The radiological findings were analysed and discussed. The central role of radiology proved to be indisputable, particularly for demonstration of a perforation and for the control of treatment. Endoscopy is of part...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1978-11-01 00:00:00
abstract::In a randomized, endoscopically controlled double-blind trial the effectiveness of a twice daily dose of the prostaglandin E2-analogue enprostil was compared with pirenzepine given to 97 ambulatory patients with duodenal ulcers. Under 35 micrograms b.i.d. enprostil the ulcer healing rates after 2, 4 and 6 weeks averag...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1986-05-01 00:00:00
abstract:BACKGROUND: Hepatic encephalopathy (HE) is a severe complication of liver cirrhosis with impairment of quality of life and prognosis. Management patterns among physicians have not been investigated yet. METHODS: A questionnaire containing 17 questions was sent out to 1468 gastroenterologists and 120 general practition...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/a-1010-6974
更新日期:2020-01-01 00:00:00
abstract::Biopsy diagnosis of early and highly differentiated liver tumors is difficult and complex. Modern pathology has met this challenge by several different means; elaborate morphological algorithms and novel immunohistological markers support the differential diagnosis of highly differentiated HCC and a new, predictive mo...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-0028-1109088
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND: The aim of our study is to analyze viscosity characteristics of focal liver lesions (FLLs) and the diagnostic performance of shear wave dispersion (SWD) in differentiating benign and malignant FLLs. METHODS: Between January 2018 and April 2018, 58 consecutive patients (median age 57, age range 21-74 years,...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/a-1217-7465
更新日期:2020-09-01 00:00:00
abstract::12% of the rectal biopsies (19% of the patients) showed epitheloid cell granulomas in clinically definite Crohn's disease. In colonic biopsies such granulomata were visible in 14% (22% of the patients). Granulomata were scarcely seen in normal or slightly inflamed mucosa. They were mostly found together with crypt abs...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1979-05-01 00:00:00
abstract::Common causes of chronically elevated serum liver enzymes include fatty liver disease, chronic viral hepatitis, autoimmune hepatitis, or hereditary metabolic disorders. Adrenocortical insufficiency can also cause elevated liver enzymes. Since 1990 only 11 cases have been reported. We here report a 52-year-old man with...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2005-858976
更新日期:2006-02-01 00:00:00
abstract::Increasing awareness is attributed to altered sensory perception in the pathogenesis of gastrointestinal disorders. Evoked potentials (EP), which represent the brain's electrical response to peripheral stimulation, have recently been used to investigate where and how (GI) afferent information is processed along the br...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:
更新日期:1998-04-01 00:00:00
abstract::The technique spontaneously or siphoned after cholecystokinin stimulation. Our technique of cell collection within the region of the duodenum, the pancreas and the bile-ducts have been optimal performed by duodenoscopical methods. From the papilla of Vater, the cell brush abrasion is used. Pancreatic secretions are ob...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1976-07-01 00:00:00
abstract::Cholangiocarcinoma at the choledochoduodenal anastomosis site is a rare complication. Our 71-years-old female patient developed an adenocarcinoma 38 years after cholecystectomy and choledochoduodenal anastomosis. During the previous two years she suffered from recurrent episodes of cholangitis and jaundice. Multiple e...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1997-12-01 00:00:00