Der Internist
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Most imported diseases can be well treated-provided the diagnosis is made in due time. For example, only the rapid and correctly performed treatment of falciparum malaria can impede severe complications and save the patient's life. ⋯ However, it has to be mentioned that evidence from clinical trials is often insufficient. Accordingly only few international guidelines for imported diseases exist.
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Crohn's disease and ulcerative colitis are the most common forms of chronic inflammatory bowel disease. The therapeutic algorithm is complex and individualized especially in complicated courses of the disease. ⋯ Furthermore, ongoing controversies will be highlighted including early immunosuppression and immunomodulation as well as new therapeutic goals, such as mucosal healing. Finally, a perspective on future therapeutic options is given focusing especially on vedolizumab, the new antibody against the bowel-specific α4β7-integrin.
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Despite a decreasing frequency gastric cancer is the fifth or sixth most common cancer in Germany. Usually the cancer is discovered in an advanced stage. This article is based primarily on the current S3 guidelines for gastric cancer published 2011. ⋯ Furthermore, this article focuses on treatment of local advanced disease. Especially in recent years, many studies have dealt with the concept of perioperative treatment. However, a worldwide standard of care could not be reached for this indication.
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The complex microbiome of the human gut contains an excessive amount of genetic information that is more than 100-fold larger than the human genome. In patients with inflammatory bowel disease diversity of the gut microbiome is significantly reduced and moreover specific phyla are overrepresented or underrepresented. ⋯ Modern pharmacological approaches target the functional capacity and constitution of the microbiome. An important strategy is the development of controlled release formulations that deliver defined lipid, carbohydrate or amino acid products derived from nutritional components targeting gut areas distal to the absorption zones of the upper gastrointestinal tract.