[Sugar free diet: a new perspective in the treatment of Crohn disease? Randomized, control study]. / Zuckerfreie Diät: Ein neue Perspektive zur Behandlung des Morbus Crohn? Eine randomisierte, kontrollierte Studie.

Since several studies have shown that patients with Crohn's disease have an increased consumption of refined carbohydrates, the influence of a diet excluding refined sugar on the course of the disease was examined. In a randomised control trial, 20 patients (10 patients in each group) with Crohn's disease were treated for an average of 18 months with two different diets. The patients used in the study had a low or middle activity of the disease. Drug treatment was omitted 14 days before commencement of the study. The first group was treated with a low carbohydrate diet (refined sugar excluded), the second group received a high carbohydrate diet (refined sugar-rich). In patients with higher activities of the disease (activity index 100-200 points), the diet which restricted refined sugar was superior to the sugar-rich diet; in 4 out of 5 patients the disease activity decreased and remained so throughout the study-period. In contrast to this 4 patients treated with the sugar-rich diet had to be taken off the treatment because of increasing activities of the disease. In patients with quiescent disease (activity index less than 100 points), neither of the diets showed detrimental effects. The statistical analysis of clinical and laboratory dates noted during the study period resulted in no significant differences between the two groups.

[Endemic sprue]. / Die einheimische Sprue.

Coeliac disease or Gluten enteropathy is a well-defined, but in its pathogenesis poorly understood syndrome. Diarrhoea, steatoroea and malnutrition due to damage and transformation of the small intestinal mucosa are induced by cereal proteins (gliadin) in genetically predisposed children and adults. Local interactions between immunocompetent cells and structural elements of the small intestinal mucosa have been investigated by immunochemical, ultrastructural and cell biological methods. In this review we discuss the events produced by defined gliadin derivates in vivo and in vitro. They suggest a complex mucosal reaction pattern, involving inflammatory and hyperergic manifestations. The cytotoxicity of gliadin is discussed in the context of defined mediators of lymphocyte and inflammatory cell interactions. The importance of structural elements of the lamina propria and the epithelium as target tissues of the immunological attack and its impact on the local environment is elucidated. Gliadin hypersensitivity is regarded as a genetically determined disposition which can be correlated to the HLA system. The distribution of HLA class I and II antigens with respect to T- and B-lymphocyte functions is described. The diagnosis of coeliac disease and the scientific exploration of cell culture techniques have been greatly improved by modern endoscopy. However, the specificity and sensitivity of laboratory tests for coeliac disease are still controversial The value of determining autoantibodies and antigliadin antibodies is evaluated. Clinical syndromes associated with coeliac disease typically involve immunological phenomena and a comprehensive review of the relevant experiences will be presented. Finally, the general prognosis of coeliac disease and the risk of developing malignancies with respect to the necessity and feasibility of a stringent, lifelong gluten-free diet and patient compliance are discussed.

[The correlation of psychosocial stress and disease activity in patients with Crohn disease and ulcerative colitis]. / Uber den Zusammenhang von psychosozialem Stress und Krankheitsaktivität bei Patienten mit Morbus Crohn und Colitis ulcerosa.

The following study examines the correlation of psychosocial stress and disease activity in patients suffering from chronic inflammatory bowel diseases. 70 patients with Crohn's disease and 44 patients with ulcerative colitis took part in this study. Using an inventory for the registration of life-changing events, psychosocial life-events of the last 24 months were inquired. The disease activity was registered by an activity index created for this particular purpose. Due to the formulation of the question, pure subjective data were not considered. With regard to the social data, the two samples can very well be compared with other epidemiological studies. For the group of Crohn-patients, a significant correlation between psychosocial stress and a subsequent increased disease activity was demonstrated. Surprisingly, the group of patients with ulcerative colitis did not show this correlation.

[Functional and morphological studies on intestinal mucosa of the rat under chronic glucagon application (author's transl)]. / Untersuchungen zuf Funktion und Morphologie der Dünndarmschleimhaut der Ratte unter chronischem Glukagoneinfluss.

Chronic application (20 days) of glucagon in pharmacological doses induces mucosal transformation of the hyperregenerative type in the small intestine of the rat. This transformation is characterized by decreased villi, and increased crypt length. The morphological changes are accompanied by a reduction in glucose absorption in vivo as well as by decreased activities of lactase, sucrase and maltase. The findings demonstrate that hyperglucagonemia is not the cause for hyperplastic mucosal transformation, which is found in the experimental diabetes in the rat.

Fecal intestinal alkaline phosphatase: a parameter for toxic damage of the small intestinal mucosa.

An immunoprecipitation procedure is presented for the measurement of rat intestinal alkaline phosphatase (I-AP) in feces. Controls exhibit a logarithmic normal distribution of fecal I-AP. Single administration of an agent toxic for small intestinal mucosa like bleomycin or triparanol induces an increase of fecal I-AP on the 1st day and a marked reduction of I-AP activity on the following 3 days. After the 5th day, abnormal high fecal I-AP activities were observed during regeneration. In parallel, morphometry and measurements of I-AP activity in the homogenate of small intestinal mucosa were performed. Rat fecal I-AP excretion proved to be a simple, non-invasive, sensitive marker for toxic damage of the small intestinal mucosa.

[Differential diagnostic evaluation of chronic pancreatitis in relation to pancreatic cancer based on clinical, laboratory chemical and diagnostic parameters. Studies of 174 patients in 10 years]. / Die differentialdiagnostische Abgrenzung der chronischen Pankreatitis zum Pankreaskarzinom an Hand klinischer, laborchemischer und diagnostischer Parameter. Beobachtungen an 174 Patienten über einen Zeitraum von 10 Jahren.

174 patients with chronic pancreatic diseases, 30 patients with pancreatic carcinoma and 144 with chronic relapsing pancreatitis, 50 of them with calcifications, were observed in the Department of Internal Medicine of the University of Marburg/FRG between 1972 and 1982. In order to differentiate between carcinoma and relapsing pancreatitis the data of these patients were analysed retrospectively with regard to patient history, actual complaints, findings of laboratory, sonography, ERCP and X-ray investigations. The following results were obtained: Of discriminating value are steatorrhoe, local palpatory pain, alcohol ingestion, a history of earlier attacks and relapsing pain situations; however, general abdominal pain, nausea, vomiting and weight loss (if not exactly specified) are not. Within the laboratory findings bilirubin, GOT, alkaline phosphatase, gamma-GT, serum potassium, blood sugar and chymotrypsin content of the stool were significant while serum and urine amylase were similarly distributed within the groups of patients. Carcinoma and chronic relapsing pancreatitis can be identified by sonography in the majority of patients, but calcifications of the pancreas were rarely demonstrated during this observation period. The obstruction of the extrahepatic bile ducts--mostly due to a carcinoma of the pancreas head--was usually well documented by sonography. Intraabdominal air proofed to be the most disturbing factor. In carcinoma patients, the ERCP is important in demonstrating a complete obstruction of the pancreatic duct and stenosis and dilatation of the extrahepatic bile ducts. In patients with chronic relapsing pancreatitis the pancreatic duct alterations such as dilatations and partial stenosis are well documented by ERCP especially if calcifications occur. In patients without calcifications, dilatation of the branches of the main duct are less relevant in the diagnosis of pancreatic diseases. Radiological demonstration of calcification of the pancreatic area is important for the differential diagnosis. Longstanding characteristical complaints, symptoms and calcifications within the pancreatic area are the most relevant factors in discriminating carcinoma and chronic relapsing pancreatitis.