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Introduction: Clostridioides difficile infection (CDI), as a nosocomial disease, is associated with high morbidity and mortality. Even though the incidence of CDI has been declining in Germany in recent years, the individual infection may pose a medical challenge despite therapeutic advances. The aim here is to clarify which gaps practitioners consider to be particularly serious in care and in the existing evidence base., Methods: In a moderated workshop of German CDI experts the topics considered as relevant were identified. A survey already conducted in five other countries (Australia, France, Great Britain, Canada, and Italy) was adapted and processed by 27 practitioners. During the evaluation, the topics perceived as particularly important were identified, the statements of the specialist groups were compared and changes in opinion were considered., Results: 27 fully completed questionnaires were evaluated. The need for improvement was primarily seen in the prevention of CDI recurrences (74.1%) and the treatment of recurrences (55.6%). Evidence deficits were noted in the treatment of recurrences (55.6%) and identification of risk factors for recurrences (48.1%). Improving care via fecal microbiota transfer (FMT) was named by 70.4%. For guidelines, more clarity (48.1%) and more regular updates (40.7%) were desired. For patients, better education on appropriate antibiotic use (52.0%) and choice of FMT were desired (48.1%)., Summary: The German expert view and the international assessment is similar, when asked about the need for improvement in care and evidence gaps in the treatment of patients with CDI: The focus is on prevention and therapy of recurrent CDI. The problem of access to FMT is a German peculiarity that seems to need improvement., Competing Interests: MJGTV hat Forschungsmittel erhalten von 3M, Astellas Pharma, Biontech, DaVolterra, Evonik, Gilead Sciences, Glycom, Immunic, MaaT Pharma, Merck/MSD, Organobalance, Seres Therapeutics, Takeda Pharmaceutical and Tillots Pharma, sowie Vortrags- oder Beratungshonorare von Astellas Pharma, Basilea, Bio-Mérieux, DaVolterra, Farmak International Holding GmbH, Ferring, Gilead Sciences, Immunic AG, MaaT Pharma, Merck/MSD, Pfizer, Roche, Organobalance, SocraTec R&D GmbH, Tillots Pharma. SS hat persönliche Honorare von Abbvie, Arena, BMS, Biogen, Celltrion, Celgene, Eli Lilly, Falk, Ferring, Fresenius Kabi, IMAB, Galapagos, Gilead, Janssen, MSD, Mylan, Pfizer, Protagonist, Provention Bio, Sandoz, Takeda und Theravance erhalten HJE erhielt Referenten- oder Beraterhonorare von Astellas Pharma, Ferring Arzneimittel und Tillots Pharma. CFM hat Vorträge auf von Ferring gesponserten Symposien gehalten und hat eine beratende Tätigkeit in einem Advisory-Board von Abbvie. TW hat Vortrags- und Beratungshonorare erhalten von: Astra Zeneca, BioNTech, Boehringer Ingelheim, Falk Foundation, GSK, Moderna, MSD, Pfizer, Roche, Sanofi Pasteur und Seqirus. LvM, JO und SW haben keine Interessenkonflikte angegeben. AS hat Vortragstätigkeiten für AbbVie, Bristol Myers Squibb, Celltrion, CLS Behring, De Prom, Falk Foundation, Ferring, Janssen, Kompetenznetz Darmerkrankungen, MedUpdate, MSD, Recordati-Pharma, sobi rare strength, Takeda und Beratertätigkeiten für AbbVie, Amgen, Bristol Myers Squibb, Consal, Galapagos, Gilead, Janssen, Lilly, MSD, Repha GmbH, Roche, Pfizer, Pharmacosmos GmbH, Takeda, Tillots Pharma., (Thieme. All rights reserved.)

Competing Interests: Die Übersicht über die Interessenkonflikte der Autorinnen und Autoren sind im Leitlinienreport veröffentlicht.

Competing Interests: Die Übersicht über die Interessenkonflikte der Autorinnen und Autoren sind im Leitlinienreport veröffentlicht.

Background:  Patients with abdominal symptoms are frequently diagnosed with fructose malabsorption (FM). Fructose is absorbed by monosaccharide transporters located in the brush border of the human small intestine. The aim of this study was to investigate the histoanatomical distribution of the main fructose transporter GLUT5., Materials and Methods:  We studied 223 patients diagnosed with FM by a hydrogen breath test and grouped according to their response to a fructose-free diet. The control group were 42 healthy individuals and 29 patients with celiac disease (CD). The fructose breath test was done with 50 g fructose. The expression of Glut5 in duodenal biopsy specimens was studied by immunohistochemistry. The Kruskal-Wallis-test and Mann-Whitney U-test were used to carry out the statistical analysis., Results:  The histoanatomical expression pattern of GLUT5 did not differ significantly between those patients with FM who responded completely to a fructose-free diet (n = 183) and healthy individuals (n = 42); nor did it correlate to H2 production measured in fructose breath testing. In patients with FM, the GLUT5 expression pattern did not differ between those individuals responding to a fructose-free diet and those who did not. However, GLUT5 expression pattern was significantly different in patients with CD (n = 29) compared to patients with FM and to healthy individuals (p = 0.009)., Conclusion:  GLUT5 expression patterns are not be related to adult patients with FM. However, in secondary malabsorption, a decreased GLUT5 expression was found. Further investigation is needed to understand the essential factors in FM and the influence on functional gastrointestinal disorders., Competing Interests: Ulf Helwig (UH): lecture and consulting fees: AbbVie, MSD, Ferring, Falk Foundation, Takeda, Mundipharma, Hospira, Vifor PharmaJost Langhorst (JH): research support: Repha; TechLab, Steigerwald, Falk Foundation. Lectures and consulting fees: Falk; MSD; Repha; ArdeypharmStefan Schreiber (SS): honoraria from AbbVie, Celltrion, MSD; Pfizer, TakedaAnna K Koch (AK): no disclosuresPia Staubach (PS): no disclosuresChristoph Röcken (CR): no disclosures, (Thieme. All rights reserved.)

Competing Interests: T. Kucharzik hatte während der letzten 3 Jahre wirtschaftliche oder persönliche Verbindungen wie folgt: Abbvie, Biogen, Celgene, Celltrion, Gilead, Hospira, Mundipharma, Dr. Falk Pharma GmbH, Ferring Arzneimittel GmbH, Janssen, MSD Sharp & Dome GmbH, Novartis, Takeda Pharma GmbH, Roche

Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

The present review by the IBD-Dach group provides a comprehensive summary of the mode of action, clinical development, approval, efficacy and safety aspects of the novel anti-p40 antibody Ustekinumab. The review provides current data, including the large clinical trials as well as smaller case series and work outside the field of inflammatory bowel diseases for shedding more light into special situations. Together, the data indicate that Ustekinumab shows clinical efficacy as well as a good safety profile for the treatment of Crohn's disease., Competing Interests: Britta Siegmund: received a research grant from Pfizer, served as consultant for Falk, Janssen, MSD, Abbvie, Celgene, Lilly, Takeda, Pfizer, Hospira and received lecture fees from Abbvie, Falk, Ferring, Janssen, MSD, Merck, Takeda; all money went to the Charité – Universitätsmedizin Berlin, Germany. Christoph Högenauer: Beratungs- und Vortragstätigkeit für Janssen-Cilag Pharma GmbHGottfried Novacek: Advisory Board/Speaker: Janssen, MSD, Abbvie, Falk, Pfizer, ViforWolfgang Petritsch: Abbvie, Astro-Pharma, Falk, Ferring, Janssen, MSD, Takeda und ViforWalter Reinisch: has received research funding from Abbott Laboratories, Abbvie, Aesca, Centocor, Falk Pharma GmbH, Immundiagnsotik, and MSD; WR has served as a speaker for Abbott Laboratories, Abbvie, Aesca, Aptalis, Centocor, Celltrion, Danone Austria, Elan, Falk Pharma GmbH, Ferring, Immundiagnostik, Mitsubishi Tanabe Pharma Corporation, MSD, Otsuka, PDL, Pharmacosmos, Schering-Plough, Shire, Takeda, Therakos, Vifor, and Yakult; WR has served as a consultant for Abbott Laboratories, Abbvie, Aesca, Amgen, AM Pharma, Astellas, Astra Zeneca, Avaxia, Bioclinica, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Covance, Danone Austria, Elan, Falk Pharma GmbH, Ferring, Galapagos, Genentech, Gilead, Grünenthal, ICON, Index Pharma, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nestle, Novartis, Ocera, Otsuka, PDL, Pharmacosmos, Pfizer, Procter & Gamble, Prometheus, Robarts Clinical Trial, Schering-Plough, Second Genome, Setpointmedical, Takeda, Therakos, Tigenix, UCB, Vifor, Zyngenia, and 4SC; and WR has served as an advisory board member for Abbott Laboratories, Abbvie, Aesca, Amgen, AM Pharma, Astellas, Astra Zeneca, Avaxia, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Danone Austria, Elan, Ferring, Galapagos, Genentech, Grünenthal, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nestle, Novartis, Ocera, Otsuka, PDL, Pharmacosmos, Pfizer, Procter & Gamble, Prometheus, Schering-Plough, Second Genome, Setpointmedical, Takeda, Therakos, Tigenix, UCB, Zyngenia, and 4SCAlain Schoepfer: Advisory Board: Vifor, Abbvie, MSD, UCB in der SchweizStefan Schreiber received consultancy fees from AbbVie, Bristol-Myers Squibb, Boehringer, Ferring, Genentech/Roche, Pfizer, MSD/Janssen, Takeda and UCB and lecture fees from AbbVie, MSD/Janssen, Takeda and UCBStephan Vavricka: Consulting fees, payment for lectures, support for travel to meetings, advisory boards, unrestricted research grants: Abbott, Ferring, MSD, Pfizer, Takeda, Tillots, UCB, ViforBernd Bokemeyer: Consulting Fee: Abbvie, MSD, Shire, Ferring, UCB, Hospira,Takeda, Shield Therapeutics, Pfizer, Biogen, Janssen, Hexal, Cellgene; Allergan, Boehringer, Falk Speaking and Teaching: Abbvie, Ferring, MSD, Merckle, Falk, HLR, Grant/Research: Abbvie, Ferring, UCB, Janssen, Takeda, (© Georg Thieme Verlag KG Stuttgart · New York.)

The European Medicines Agency (EMA) recently approved the first anti-TNF-alpha biosimilar for infliximab (CT-P13) (trade names: Inflectra ® and Remsima ® ) in Germany. Over the past year, German gastroenterologists gained experience treating IBD-patients with infliximab biosimilars (IFX-biosimilars). To evaluate their experiences and opinions on biosimilars, we conducted a nationwide online survey among German gastroenterologists. Our results are based on the assessment of 449 questionnaires. Although 61 % of the participants had already prescribed IFX-biosimilars, about two thirds of these participating gastroenterologists with IFX-biosimilar prescription stated their experience as based on fewer than 10 IBD-patients treated with IFX-biosimilars. Only 15 % considered themselves to be very experienced with biosimilars. The lower price in comparison to the originator is seen as the most important advantage of biosimilars (71 %). More than two thirds of the survey participants requested specific gastroenterological trials and registries to increase the data available on biosimilars in IBD-patients (68 %)., (© Georg Thieme Verlag KG Stuttgart · New York.)

After the expiry date of the patent protection for Infliximab in 2013, the biosimilar CT‑P13 was approved for indications in Crohn's disease and ulcerative colitis in adults as well as in children. The approval has been based on two randomized clinical studies indicating equivalence for the biosimilar with regard to pharmacokinetics, efficacy, as well as side-effects. The clinical experience since, in addition to multiple non-randomized studies, indicate a comparable efficacy and immunogenicity of the Infliximab biosimilar CT-P13 in inflammatory bowel disease. Thus, the introduction of the biosimilar as primary therapy seems to be justified. Tight monitoring of the safety of biosimilars with regard to efficacy and side effects has to be ensured., (© Georg Thieme Verlag KG Stuttgart · New York.)

Vedolizumab, the first drug in the class of anti-integrin molecules, is newly approved for ulcerative colitis and Crohn's disease and can be prescribed in Germany since mid-2014. By a specific receptor binding a relatively gut-selective mode of action was achieved without the known side effects of the systemic immunosuppression of the anti-TNF-alpha antibodies. According to the present data the safety profile of Vedolizumab appears to be more favorable than that of the anti-TNF- alpha therapy. Vedolizumab is suitable for induction therapy in patients with ulcerative colitis and Crohn's disease, however the kinetic of response compared with the anti-TNF-alpha antibodies seems to be slower. For maintenance therapy the Vedolizumab data show a deep and sustained remission in patients initially responding to induction therapy with a lower loss of efficacy in the long-term treatment known from the anti-TNF-alpha therapy. On the basis of currently available data the efficacy of Vedolizumab in ulcerative colitis appears to be slightly better than in Crohn's disease., (© Georg Thieme Verlag KG Stuttgart · New York.)

Thiopurines (azathioprine and 6-mercaptopurine) are the most frequently used drugs in the treatment of patients with Crohn's disease. In current guidelines published by the German Society of Gastroenterology, Nutritional and Metabolic Diseases (DGVS) in 2014 and by the European Crohn´s and Colitis Organisation (ECCO) in 2010 different indications have been suggested. However, efficacy of azathioprine has been substantially questioned by recent publications in adults as well as in children examining the efficacy of early initiation of this treatment. These articles were published after release of the aforementioned guidelines. Therefore, in this survey recently published data are discussed on the background of our knowledge on the efficacy of azathioprine and 6-mercaptopurine developed in many years, and suggestions for the future use of these substances in the treatment of patients with Crohn's disease will be provided., (© Georg Thieme Verlag KG Stuttgart · New York.)