ABSTRACT
INTRODUCTION: Environmental factors may play an important role in the pathogenesis of IBD. The history of patients of the German IBD twin study was analyzed by questionnaires and interviews. METHODS: Randomly selected German monozygotic (MZ) and dizygotic (DZ) twins with at least one sibling suffering from IBD (n=512) were characterized in detail including demography, medical history and concomitant medications. Controls comprised of non-twin IBD patients (n=392) and healthy subjects (n=207). RESULTS: The most significant variables that were associated with Crohn's disease (CD) or ulcerative colitis (UC) included living abroad before time of diagnosis (OR, 4.32; 95% CI, 1.57-13.69), high frequency of antibiotic use (MZ CD OR, 5.03; 95% CI 1.61-17.74, DZ CD OR, 7.66; 95% CI, 3.63-16.82, MZ UC OR, 3.82; 95% CI, 1.45-10.56, DZ UC OR, 3.08; CI, 1.63-5.92), high consumption of processed meat including sausage (MZ CD OR, 7.9; 95% CI, 2.15-38.12, DZ CD OR, 10.75; 95% CI, 4.82-25.55, MZ UC OR, 5.69; 95% CI, 1.89-19.48, DZ UC OR, 18.11; 95% CI, 7.34-50.85), and recall of bacterial gastrointestinal infections (MZ CD OR, 15.9; 95% CI, 4.33-77.14, DZ CD OR, 17.21; 95% CI, 4.47-112.5, MZ UC OR, 5.87; 95% CI, 1.61-28.0, DZ UC OR, 11.34; 95% CI, 4.81-29.67). CONCLUSIONS: This study reinforced the association of life style events, in particular a specific dietary and infections history, with IBD. Alteration of gut flora or alterations of the mucosal immune system in reactivity to the flora could be an important factor to explain the relationship between life-style and disease.
Subject(s)
Colitis, Ulcerative/etiology , Crohn Disease/etiology , Diseases in Twins/etiology , Adolescent , Adult , Aged , Child , Communicable Diseases/complications , Comorbidity , Diet , Female , Germany , Humans , Life Style , Male , Middle Aged , Risk Factors , Surveys and Questionnaires , Twins, Dizygotic , Twins, Monozygotic , Young AdultABSTRACT
A prospective, controlled, randomised trial was performed to compare the effect of high-energy extracorporeal shock wave therapy (ESWT) versus low-energy ESWT in treatment of rotator cuff tendinopathy. Forty adult patients were included in the study. Patients in the intervention group received 6000 impulses of high-energy (ED+ 0.78 mJ/mm2) in 3 sessions under local anaesthesia. Patients in the control group received 6000 impulses of a low-energy ESWT (ED+ 0.33 mJ/mm2) under local anaesthesia. Follow-up examinations were performed 12 weeks and one year after treatment by an independent observer. An increase in function and a reduction of pain were found in both groups (p < 0.001). Although the improvement in Constant score was greater in the high-energy group compared to the low-energy group, statistical analyses showed no significant difference between the groups with respect to all parameters studied (Constant score/pain/subjective improvement) after 12 weeks and one year follow-up. No statistically significant differences were found between the results of high-energy and low-energy ESWT of rotator cuff tendinopathy.