[Secondary data analysis of the prevalence of alcohol dependence (F10.2) in Germany]. / Sekundärdatenanalyse der Prävalenz der Alkoholabhängigkeit (F10.2) in Deutschland.

BACKGROUND AND AIM: Compared to other European countries, alcohol consumption and abuse in Germany is on a high level. Even in smaller quantities, frequent alcohol consumption can generate organic damages and thus lead to secondary diseases that have a significant societal relevance regarding direct and indirect costs for the healthcare system. After several publications have already addressed the prevalence of acute alcohol intoxication and alcohol abuse in adolescents, the question arises how the prevalence of alcohol abuse develops on the basis of the accounting data of outpatient and inpatient care providers in the population of adults aged 18 and over and what tendency can be observed within a multi-year period. Within this study, the coding of alcohol abuse (F10.2 diagnosis) was analyzed separately for outpatient and inpatient sector in the insured population ≥ 18 years and presented over time. PATIENTS AND METHODS: The development of the prevalence of alcohol abuse was analyzed on the basis of secondary random sample data from one nation-wide working statutory health insurance with a total population of more than 3 million insurants in the 5-year period from 2006 to 2010. For the presentation of the prevalences, insurant numbers were used. For the identification of the relevant insurants, only confirmed outpatient F10.2 diagnoses or inpatient F10.2 diagnoses were used. The age and sex distributions of the dataset were adjusted to the distribution in the statutory health insurance to ensure representativeness. The analyses of each single year only allude to insured persons aged ≥ 18 years. With the help of the statistics of the insured of statutory health insurance, for each calendar year, projections of the detected prevalence rates were determined to estimate the number of cases on the statutory health insurance level and their development over time. RESULTS: The results show a tendency of slightly increasing prevalence of alcohol dependence from 2006 to 2010. For insured persons with at least one inpatient or outpatient F10.2 diagnosis, the prevalence continuously rises from 1,04% in 2006 to 1.14% in 2010; the prevalence of insured persons who received an alcohol dependence diagnosis only in the outpatient sector, increased from 0,67% to 0,79% in that time scale. In all analyzes, there was a ratio of 30% affected women to 70% affected men. From 2006 to 2010, the proportion of insured persons with hospitalization caused by alcohol dependence decreased steadily from 14,51% to 12,24%. CONCLUSION: For the analyzed group of persons aged ≥ 18 years, the present analysis results show a tendency of slightly increasing prevalences of alcohol abuse, however at the same time combined with a decreasing proportion of hospitalized patients. Similar nationwide studies from 2010 on the basis of secondary data of a health insurance company and inclusion of outpatient and inpatient diagnoses also indicate prevalences of alcohol dependence of about 1.18%, but they base on the age range of 15- to 64-year-old insurants.

[Nutritional therapy in gastrointestinal diseases. Diets--necessary or superfluous?]. / Ernährungstherapie bei Magen-Darm-Erkrankungen. Diäten--nützlich oder überflüssig?

Diets form a part of the treatment concept in numerous gastrointestinal diseases. Their effectiveness, however, varies considerably from one disease to another. Thus, for example, diet is of decisive importance in celiac disease and lactose intolerance. In contrast, dietary measures are ineffective in the treatment of gallstones, and uncertain as a prophylactic measure against biliary colic. While dietetic measures are an important temporary measure in acute pancreatitis, in chronic pancreatitis such an approach is often not complied with, since it includes abstinence from alcohol. In chronic inflammatory bowel disease, diet can ameliorate a number of complications, although it leaves the pathological process itself unaffected. High-fiber diet is, for the most part, ineffective in patients with irritable bowel syndrome. The present article discusses the benefits of dietary measures in a number of gastroenterological disorders.

[Diverticulosis and diverticulitis in the elderly]. / Divertikulose und Divertikulitis beim alten Menschen.

Diverticulosis of the colon is a disease that mainly affects the elderly, presenting in 10 to 20% of this age group. The most common complication--painful diverticular disease, is usually treated conservatively with a high-fiber diet, intermittent use of antispasmodics and possibly regulation of the stools. Diagnostic differentiation is best performed using ultrasonography of the bowel wall, supplemented where necessary by computer tomography and colonoscopy (sigmoidoscopy) or, where this latter is not possible, barium enema using Gastrografin. Conservative treatment of diverticulitis with antibiotics, bowel rest, possibly including parenteral alimentation, is usually applied for three to ten days. In the absence of a response to this treatment, frequent recurrence, immunosuppression or complications (perforation, peritonitis, enterovesicular fistula), surgery is indicated.

Acupuncture inhibits vagal gastric acid secretion stimulated by sham feeding in healthy subjects.

In a prospective randomised study, the effect of acupuncture on sham feeding stimulated gastric acid secretion was investigated. In eight healthy volunteers (five men, three women, mean (SEM) age 26.3 (4.7) years) various methods of acupuncture were performed. Apart from the sham procedure, the acupuncture was performed at the classic acupuncture points. Electroacupuncture reduced gastric acid secretion expressed as median (range) significantly during the first 30 minute period to 1.6 (0-5.2) mmol compared with 3.8 (2.3-14.5) mmol (p < 0.05) during control period (sham feeding without acupuncture). Inhibition of gastric acid secretion by electroacupuncture was also significant during the second 30 minute period (0.2 (0-5.6) v 3.6 (0.3-9.1) mmol; p < 0.05) and for peak acid output (0.8 (0.2-5.1) v 7.6 (3.4-12.1) mmol; p < 0.05). Transcutaneous electrical nerve stimulation also resulted in significant reduction of gastric acid secretion during the first 30 minute period (1.0 (0-3.6) mmol v 3.8 (2.3-14.5) mmol; p < 0.05), and peak acid output (3.6 (1.2-12.0) v 7.6 (3.4-12.1) mmol; p < 0.05). The classic needle acupuncture, laser acupuncture, and sham acupuncture had no significant effect on gastric acid secretion. This study shows firstly that in healthy volunteers, only the versions of acupuncture using more pronounced stimulation (electroacupuncture, transcutaneous electrical nerve stimulation), but not those with only mild stimulation of the nerves (classic needle acupuncture, laser acupuncture), and secondly only acupuncture performed at defined points lead to significant reduction in gastric acid secretion.

Tumor stenoses of the upper gastrointestinal tract--therapeutic alternatives to laser therapy.

Alternatives to laser treatment of tumor stenoses of upper gastrointestinal tract include dilatation, implantation of bridging tubes, radiation therapy and chemotherapy. Based on the experience of 170 bridging tubes implanted and laser therapy in 70 patients with tumor stenoses (presented elsewhere) "tubes and laser" are compared. Complication rate, applicability in very proximal and distal stenoses are in favour of laser therapy, costs, hospitalisation time, possibility to occlude fistulae and short recurrence time after laser therapy are facts speaking for oesophageal bridging tubes. The question "tubes or laser" has to be answered by "tubes and laser" already.

[Long-term effect of calcium carbonate containing antacids on basally and peptone-stimulated hydrochloric acid secretion]. / Langzeiteffekt Kalziumkarbonat-haltiger Antazida auf die basale und die Peptone-stimulierte Magensäure-Sekretion.

Basal and meal-stimulated gastric acid secretion was measured before and after a 3-week-period of regular consumption of a calcium carbonate-containing antacid with 6 therapeutic doses per day in normal healthy volunteers. Furthermore the effect of a single large dose of 2000 mg calcium ions was studied on meal-stimulated gastric acid secretion before and after this period. The results suggest that (1) even a large single dose of calcium ions seems to have no major effect on meal-stimulated gastric acid secretion and (2) chronic consumption of calcium carbonate containing antacids over a 3-week-period does not change basal- and meal-stimulated gastric acid secretion in healthy volunteers nor does it increase the response to 2 g calcium ions.