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Background: The success of colorectal cancer (CRC) screening depends mainly on screening quality, patient adherence to surveillance, and costs. Consequently, it is essential to assess the performance over time., Methods: In 2000, a closed cohort study on CRC screening in individuals aged 50 to 80 was initiated in Uri, Switzerland. Participants who chose to undergo colonoscopy were followed over 18 years. We investigated the adherence to recommended surveillance and collected baseline characteristics and colonoscopy data. Risk factors at screening for the development of advanced adenomas were analyzed. Costs for screening and follow-up were evaluated retrospectively., Results: 1278 subjects with a screening colonoscopy were included, of which 272 (21.3%; 69.5% men) had adenomas, and 83 (6.5%) had advanced adenomas. Only 59.8% participated in a follow-up colonoscopy, half of them within the recommended time interval. Individuals with advanced adenomas at screening had nearly five times the risk of developing advanced adenomas compared to individuals without adenomas (24.3% vs. 5.0%, OR 4.79 CI 2.30-9.95). Individuals without adenomas developed advanced adenomas in 4.9%, including four cases of CRC; three of them without control colonoscopy. The villous component in adenomas smaller than 10 mm was not an independent risk factor. Costs for screening and follow-up added up to CHF 1'934'521 per 1'000 persons screened, almost half of them for follow-up examinations; 60% of these costs accounted for low-risk individuals., Conclusion: Our findings suggest that follow-up of screening colonoscopy should be reconsidered in Switzerland; in particular, long-term adherence is critical. Costs for follow-up could be substantially reduced by adopting less expensive long-term screening methods for low-risk individuals., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background and Study Aims: The adenoma detection rate (ADR) is one of the quality measures in screening colonoscopy and is crucial for reducing colorectal cancer morbidity and mortality. Up to 25 % of adenomas are missed during colonoscopy. Endocuff is an easy-to-use device that is attached like a cap to the distal tip of the colonoscope in order to optimize visualization behind the folds of the colon and increase the ADR. This is the first prospective study of Endocuff-assisted colonoscopy (EC) in a screening population with follow-up to determine the ADR and adverse events of EC., Patients and Methods: We prospectively enrolled asymptomatic patients referred for screening colonoscopy during the 4-month study period. We documented the Boston Bowel Preparation Scale (BBPS) score, cecal intubation rate, polyp detection rate, ADR, number of advanced adenomas, and number of adverse events. Colonoscopies were performed by five board-certified gastroenterologists. During follow-up, the patients were called 4 to 12 weeks after EC., Results: A total of 104 EC procedures were performed. Cecal intubation was achieved in 99 % of the patients, with a median intubation time of 6 minutes. The polyp detection rate and ADR in our study were 72 % and 47 %, respectively, and 13.5 % of the lesions were advanced adenomas. A significant number of adenomas were detected in the right side of the colon. Considering all the adenomas and hyperplastic polyps above the sigmoid, we recommended that nearly 60 % of our patients repeat an endoscopic follow-up according to the existing Swiss guidelines. We noted no perforations or other serious adverse events, even in the patients with extensive diverticulosis., Conclusions: EC is feasible with the most commonly available colonoscopes without severe adverse events. EC seems to be a safe and effective device for increasing the ADR, including small adenomas in the right side of the colon. Therefore, this technique may be recommended in the future to increase the ADR in a screening population.

Background: Colonoscopy with a possible polypectomy is an efficient and preferred screening method to reduce the incidence of colorectal cancer (CRC). However, critics argue that, to date, a reduction of incidence and mortality from CRC has not been demonstrated in a population-based setting., Objective: To compare the incidence of and mortality from CRC among individuals screened by colonoscopy and non-screened individuals., Design: A closed cohort study., Setting: Population-based setting in a precisely defined area with a low level of population migration., Patients: This study involved 1912 screened and 20,774 control participants., Intervention: CRC cases in this closed cohort study were prospectively collected during the screening period of 1 year and the follow-up period of 6 years., Main Outcome Measurements: Follow-up data were corrected for negligible migration balance in the area. Tumor characteristics and risk or protective factors, age and sex, participation in general health screening examinations, history of CRC in a first-degree relative, smoking status, body mass index, frequency of sports activity, eating habits, and patients' professions were recorded., Results: Overall cancer incidence was significantly lower in the screened group compared with the non-screened group (adjusted odds ratio [OR] 0.31; 95% confidence interval [CI], 0.16-0.59; P < .001). Colon cancer-associated mortality also was clearly lower (adjusted OR 0.12; 95% CI, 0.01-0.93; P = .04). Risk factors such as lifestyle, smoking, and body mass index as well as family history were similar in both groups. Blue-collar workers had a higher incidence of CRC compared with professionals. The risk factors for CRC were a positive family history and smoking., Limitations: Number and ethnicity of the participants, non-randomized study., Conclusion: Colonoscopy with polypectomy significantly reduces CRC incidence and cancer-related mortality in the general population., (Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

Background and Study Aims: Various screening methods for colorectal cancer (CRC) are promoted by professional societies; however, few data are available about the factors that determine patient participation in screening, which is crucial to the success of population-based programs. This study aimed (i) to identify factors that determine acceptance of screening and preference of screening method, and (ii) to evaluate procedure success, detection of colorectal neoplasia, and patient satisfaction with screening colonoscopy., Patients and Methods: Following a public awareness campaign, the population aged 50 - 80 years was offered CRC screening in the form of annual fecal occult blood tests, flexible sigmoidoscopy, a combination of both, or colonoscopy., Results: 2731 asymptomatic persons (12.0 % of the target population) registered with and were eligible to take part in the screening program. Access to information and a positive attitude to screening were major determinants of participation. Colonoscopy was the method preferred by 74.8 % of participants. Advanced colorectal neoplasia was present in 8.5 %; its prevalence was higher in males and increased with age. Significant complications occurred in 0.5 % of those undergoing colonoscopy and were associated with polypectomy or sedation. Most patients were satisfied with colonoscopy and over 90 % would choose it again for CRC screening., Conclusions: In this population-based study, only a small proportion of the target population underwent CRC screening despite an extensive information campaign. Colonoscopy was the preferred method and was safe. The determinants of participation in screening and preference of screening method, together with the distribution of colorectal neoplasia in different demographic categories, provide a rationale for improving screening procedures.

Background/aims: Herbal agents are popular and perceived as safe because they are supposedly 'natural'. We report 10 cases of toxic hepatitis implicating Herbalife products., Methods: To determine the prevalence and outcome of hepatotoxicity due to Herbalife products. A questionnaire was sent to all public Swiss hospitals. Reported cases were subjected to causality assessment using the CIOMS criteria., Results: Twelve cases of toxic hepatitis implicating Herbalife preparations (1998-2004) were retrieved, 10 sufficiently documented to permit causality analysis. Median age of patients was 51 years (range 30-69) and latency to onset was 5 months (0.5-144). Liver biopsy (7/10) showed hepatic necrosis, marked lymphocytic/eosinophilic infiltration and cholestasis in five patients. One patient with fulminant liver failure was successfully transplanted; the explant showed giant cell hepatitis. Sinusoidal obstruction syndrome was observed in one case. Three patients without liver biopsy presented with hepatocellular (2) or mixed (1) liver injury. Causality assessment of adverse drug reaction was classified as certain in two, probable in seven and possible in one case(s), respectively., Conclusions: We present a case series of toxic hepatitis implicating Herbalife products. Liver toxicity may be severe. A more detailed declaration of components and pro-active role of regulatory agencies would be desirable.

Questions Under Study: The risk of colorectal cancer (CRC) starts to increase at the age of 50 years in average persons without special risk factors. The significance of clinical symptoms and frequency of endoscopies done at this age are hitherto unknown. We do not know the stage of colorectal cancers nor the distribution of advanced neoplasms in symptomatic persons above 50 years. These data are of interest to validate the necessity of screening programmes, to define the target population and to interpret results of screening studies in asymptomatic people., Methods: Endoscopies of the colon performed from 1991 to 2000 in symptomatic patients aged 50 to 80 in the well-defined area of Uri were analysed retrospectively, focusing on symptoms leading to the endoscopy and the occurrence of neoplastic lesions., Results: Sixteen percent of the population at the age of 50-80 years had a colonoscopy for workup of symptoms. A CRC was found in 5.5% of all patients (83 of 1514 patients), in 12.3% of patients with tumour suspicious symptoms, but only in 0.3% of patients with unspecific pain. Stage of tumours was often advanced (82% T3/T4, 38% N1-3, 21% M1). In 2.6% of patients a colorectal cancer was found before the age of 60, mostly in men. Advanced lesions were more frequent in men, increasing with age., Conclusions: A substantial part of the population above the age of 50 had an endoscopic workup of the colon for symptoms, what has to be considered when defining the target population and the necessary manpower of screening programmes. Tumour-suspicious symptoms were significant predictors for the presence of a CRC, but tumours were often already advanced. This underlines the importance to screen persons before developing symptoms.

Objectives: Assessment of the prevalence, health care resource use and cost of gastroesophageal reflux disease in Switzerland., Methods: A population-based telephone survey was conducted in German and French speaking Switzerland. Reflux cases were defined using a questionnaire proposed by the German Gastro League and answered additional questions on their personal characteristics and resource use., Results: 1,274 out of 7,222 participants were positively screened. The prevalence of reflux disease in Swiss adults was estimated at 17.6% (95% CI: 15.6%-19.7%) or 993,000 individuals. Regular treatment with medication was reported by 38.0% of the reflux positive sample. Reflux-induced general practitioner consultations during the last year were reported by 25.9%. On average, there were 0.84 general practitioner consultations, 0.19 specialist consultations, 0.08 gastroscopies and 0.01 hospitalisations annually. Mean direct medical costs, dominated by medication costs, were CHF 185 per patient-year (95% CI: CHF 140-230) or 0.5% of Switzerland's total health care expenditures. Total costs were CHF 234 (95% CI: CHF 185-284) per patient-year., Conclusions: The prevalence of reflux disease in Switzerland is similar to that in other industrialised countries. Reflux disease causes considerable costs, in the medical system and at the societal level.

In this audit we tried to assess the effect of the detection of Helicobacter pylori on the change of outcome and symptoms of peptic ulcer disease outside well defined prospective studies, and its influence on treatment praxis by general practitioners. The study was carried out in the canton of Uri, a geographically closed area of Switzerland. The records of all patients with peptic ulcer disease diagnosed from 1991 to 1994 were evaluated retrospectively. In addition, the patients were followed by contact through their family doctors who were asked to fill out questionnaires on the immediate and long-term treatment of acute peptic ulcer, H. pylori therapy, recurrence of ulcers in light of symptoms or endoscopy, and on any surgery performed for ulcer disease. We found 453 patients with peptic ulcer disease proven by endoscopy, 134 patients presented with signs of ulcer bleeding, 45% of these had used nonsteroidal anti-inflammatory drugs previously. Only 9 of 453 patients required surgery. In 430 patients follow-up was possible (median of 18 months). H. pylori eradication was the primary treatment in 24% of the patients in 1991 and in 79% in 1994. Long-term prophylaxis with histamine H2 antagonists had been selected in 22%. Recurrence of the ulcer disease was seen in 157 patients during the follow-up period. The recurrence rate was 8% (3/39) in patients with documented H. pylori eradication, 43% (62/145) in patients with H. pylori eradication therapy without documentation of the result, 57% (31/54) in H. pylori positive and 50% (14/28) in H. pylori negative patients on long-term treatment with histamine H2 antagonists. 33% of the patients still had substantial abdominal pain despite using long-term histamine H2 antagonists as prophylaxis against recurrence, but this was the case in only 5% (2/39) after successful H. pylori eradication. The rate of successful antibiotic treatment improved substantially during this audit. This follow-up study demonstrates that patients with successfully eradicated H. pylori remain largely free of symptoms and of ulcer recurrence. Control of the eradication result seems to be necessary outside controlled studies. In contrast, symptoms and ulcer recurrence are frequent despite long-term treatment with histamine H2 antagonists. Few patients need surgery for ulcer disease today. Audits like this are a valuable method to improve acceptance and success of a new treatment modality.

Portal hypertension is a frequent and dangerous consequence of chronic liver diseases. The most important complications are ascites and variceal bleeding. In this article new pathophysiological theories of portal hypertension are reviewed. In addition, the prophylactic and therapeutic management of variceal bleeding are discussed.

Diarrhea is still one of the most frequent causes of death and poses many diagnostic and therapeutic problems. Whereas the etiology of acute diarrhea is mainly infectious, the cause of chronic diarrhea is much more multifarious and thus more difficult to diagnose. The etiology of acute diarrhea as well as the sense and nonsense of diagnostic procedures and therapeutic possibilities are discussed. A rational and practical concept for evaluation of chronic diarrhea is presented.

Premedication for gastroscopies is still controversial. Most gastroenterologists use premedication routinely, often without control of vital signs. However, even if rarely, serious (mainly cardiorespiratory) complications still occur. In 101 patients in whom a gastroscopy had been performed, oxygen saturation before, during and after the endoscopy was investigated. A fall in saturation was seen in most of the patients but was usually minor. However, severe hypoxemia occurred in some patients, especially if premedication was used. Older patients and patients with severe anemia were particularly at risk. These results emphasize that premedication should not be used without precaution and special surveillance, especially in high risk patients. Prophylactic oxygen administration significantly diminishes the risk.

The pathogenesis of acute pancreatitis even if associated with gallstone remains unclear. This explains that the best treatment for gallstone-associated pancreatitis remains a matter of debate. However, different theoretical and clinical evaluations support the strategy to perform an endoscopic papillotomy if a common bile duct stone is suspected and the course of the disease does not improve spontaneously during the first 48 h. The discrepancies of the current data and the difficulties to give rational suggestions have been reviewed.

Intestinal side effects after antibiotic therapy are frequent. Mostly, harmless diarrhea disappears after cessation of therapy without inducing colitis; however, changing of the intestinal flora sometimes leads to colonization of the colon by toxin-producing strains of Clostridium difficile, inducing sometimes severe pseudomembranous colitis. A rapid correct diagnosis by anamnesis, clinical signs, endoscopical aspect and demonstration of toxin in the stool allows an efficient treatment. The therapeutic modalities, especially in recurrency, are delineated. In addition, the unusual and etiologically still unknown illness of penicillin-induced segmental hemorrhagic colitis will be discussed as well.

Our knowledge on chronic hepatitis B and C infection has dramatically improved. For the first time it is possible, to eliminate these hepatitis-viruses at least in some patients. In addition an excellent immuno-prophylaxis is possible in hepatitis B today. However many problems are still unsolved: we still do not have a sensitive marker for hepatitis C infection and the possibility to transfer hepatitis C by blood transfusion will remain. The recurrence-rate of chronic hepatitis C after stopping treatment with Interferon is very high and many patients with hepatitis B do not respond to Interferon-treatment. These problems are especially great in third world countries. New hope comes from the possibility to successfully immunize babies immediately after birth and from the successful production of vaccine with gene technology.

Parasites, once an exclusively tropical problem, are rare causes of diarrhea in our countries. Increasing tourism and immune deficiencies due to treatment or to Aids lead to an increase of intestinal parasites in western countries. The most frequent pathogenic parasites are Giardia lamblia and Entamoeba histolytica but other organisms like Cryptosporidia seem to be of increasing importance and have to be considered in diarrhea of unknown origin.

Survival after variceal bleeding depends greatly on the outcome of the immediate posthaemorrhagic period. This may in turn depend on the recurrence of bleeding. We therefore prospectively evaluated the influence of propranolol on the recurrence of variceal haemorrhage during the early period after the acute bleeding episode. Twenty consecutive patients with acute variceal haemorrhage and liver disease were randomly assigned to treatment either with propranolol or placebo orally for 14 days. Propranolol significantly decreased the rate of recurrence of variceal haemorrhage during this early period (p = 0.0028; 95% confidence interval in the placebo group, 90 +/- 20%; in the beta blocker group, 20 +/- 26%). Whereas a recurrence of variceal bleeding occurred in 9 of 10 patients in the placebo group, only 2 of 10 rebled during treatment with propranolol. These results suggest that propranolol may prevent rebleeding in the crucial early period after acute haemorrhage from oesophageal varices.

Factor VIII procoagulant activity, antigen concentration and von Willebrand activity as ristocetin cofactor were determined several times in 10 patients with DIC. These is a significant negative correlation between the DIC-score and the VIII:C/von Willebrand activity ratio.

The 'sump syndrome' is a rare, late complication of choledochoenterostomies. We observed 13 patients with this syndrome. The clinical features included recurrent cholangitis, liver abscesses, and recurrent pancreatitis. Five patients were treated by surgery, eight patients endoscopically. Reviewing an average follow up period of 22 months (range 6-60) after therapeutic endoscopy and 57 months (range 1-126) after different surgical procedures, we conclude that endoscopic sphincterotomy with removal of the debris is as efficient a therapy of the 'sump syndrome' as surgical sphincteroplasty and entails a smaller risk for the patient. We therefore advocate that endoscopic papillotomy should first be tried in all cases of 'sump syndrome' in the absence of suprapapillary stricture of the bile ducts.

Two women were admitted for increasing abdominal pain, vaginal discharge, and severe or moderate chronic ascites. Diffuse peritonitis without evidence of liver disease was found in both cases, and in one the ascites and vaginal discharge contained Chlamydia trachomatis. Both patients responded to doxycycline, and this and the laboratory findings pointed strongly to C trachomatis as the aetiological agent. C trachomatis may cause severe peritoneal infections with chronic ascites formation in the absence of liver disease in women with the Fitz-Hugh-Curtis syndrome. Prompt diagnosis and antibiotics lead to rapid cure.

Renal function was studied prospectively in 6 patients with rheumatoid arthritis and non-prospectively in 5 patients after bone marrow transplantation. Both groups were treated with cyclosporin A. Functionally and histologically the results suggest tubulotoxicity of cyclosporin A which seems to be dose-related and reversible. Also found in the urine of these patients were yellow, as yet undescribed crystalline bodies often included in casts.

The aim of our study was to elucidate further possible genetic influences on the incidence and progression of alcoholic liver disease. We determined HLA A, B and DR antigens in a well-controlled group of chronic alcoholics with and without liver disease, in repeated liver biopsies over period of 8.1 years (+/- 0.4 SEM). Patients with the antigen B 35 had an increased incidence of alcoholic liver cirrhosis, and especially a more rapid progression to cirrhosis (p less than 0.01). Increased susceptibility of these patients was shown by a more rapid progression of liver disease, despite the consumation of less alcohol over a shorter period. Results of this long-term study suggest that there is a sub-group of alcoholics genetically predisposed to higher susceptibility with more rapid deterioration of alcohol-induced liver disease.

Report is given on a 68-year-old man who suffered primarily from progressive weight loss and repeated episodes of fever and arthralgia. Later, liver dysfunction and renal insufficiency developed. Liver and kidney biopsies disclosed granulomatous hepatitis and nephritis. Because of the morphologic and clinical findings, the diagnosis of Boeck's disease was made. Shortly before death, diarrhea developed. Autopsy revealed a massive systemic involvement in Whipple's disease proven by light and electron microscopy and immunofluorescence. Tuberculoid and epitheloid cell granulomas and isolated giant cells were found in addition to the biopsy findings in skeleton muscles, the small intestine, lymphnodes and bronchi. At autopsy, the kidney showed chronic interstitial nephritis. The literature of kidney involvement in Whipple's disease is reviewed. This is the first case with granulomatous interstitial nephritis and chronic renal insufficiency in an inadequately treated Whipple's disease.

In a prospective study of 70 patients with epigastric pain, gastroduodenoscopy revealed gastric and/or duodenal ulcers in a total of 41 and no ulceration in the remainder. Biopsies were taken to assess the severity of gastritis and the presence of Campylobacter pylori (CP) by histology and culture. Gastritis was found in 54 patients. CP was detected in 78% of the ulcer patients and 52% of the patients without ulcer (p less than 0.05). CP was demonstrated in 83% of the histologically diagnosed cases of gastritis (all grades) but no CP was detectable in patients with normal gastric mucosa. Among the ulcer patients, CP was more frequent in those with no history of medication with nonsteroidal antiinflammatory drugs (p less than 0.01). Sera from CP-positive ulcer and gastritis patients have significantly higher levels of IgG antibodies to CP than sera from those found to be free of ulcer or gastritis. In 200 blood donors an increasing percentage of elevated CP-antibody titres were found with advancing age (50% over 60 years of age). Quantification of circulating CP antibodies, would thus seem a valuable adjunct in the diagnosis of gastritis and probably also of peptic ulcer. The data presented furnish further evidence of the high rate of association of CP and the gastritis-peptic ulcer complex.

Studies were undertaken to determine if cholestasis in alcoholic or viral hepatitis is related to immunologic hyperreactivity as suggested for cholestasis due to type-II drug-induced hepatitis, and evaluate possible mechanisms involved in lymphokine-induced cholestasis. Results indicate that a cholestatic factor exists in alcoholic and acute viral hepatitis. Supernatants of lymphocytes from patients with alcoholic hepatitis stimulated by an extract of alcoholic hyalin evoked a 28% +/- 7.3 SEM reduction in rat bile flow (P less than 0.03). Supernatants of lymphocytes from patients with acute viral hepatitis activated by liver-specific protein caused a reduction in rat bile flow of 24% +/- 5.9 SEM (P less than 0.03). A decrease in bile flow also occurred following injections of sera from patients with alcoholic or acute viral hepatitis. In contrast, injection of supernatants of non-stimulated lymphocytes or those from chronic active hepatitis or healthy subjects did not produce a significant change in bile flow. Supernatants of stimulated lymphocytes from tuberculin-sensitized guinea pigs caused a similar decrease in rat bile flow and reduced excretion of human secretory immunoglobulin A (IgA). Despite reductions in rat bile flow there were no alterations in liver morphology, liver plasma membrane Na-K-ATPase activity, microsomal cholesterol-7 alpha-hydroxylase activity or low-dose indocyanine green clearance during the period of observation.

To evaluate the influence of chronic alcohol consumption on the cellular immune system in man, we investigated the immune response to seven intradermally applied common antigens and in vitro stimulation of peripheral lymphocytes by Phytohemagglutinin A and concanavalin A in chronic alcoholics with (n = 15) and without (n = 15) liver disease. The results suggest that the diminished cellular immune response in chronic alcoholics is not primarily a direct sequel to alcohol consumption; it is more likely that the impaired immune response is linked to severity of the liver damage itself and to malnutrition.

The results during the period 1979-1984 of intestinal endoscopies with brush cytology and biopsy of the same lesion at the same time were evaluated to define the value of these methods. Results were reported as "cancer present" or "not present" or as "suspicious/proving" versus "nonsuspicious for cancer" and were analyzed separately. Biopsy was shown to be of greater sensitivity than cytology in the stomach and cytology more sensitive in the colon. The combination of biopsy and cytology improved sensitivity, especially in the esophagus, small intestine and colon, and may help to dispense with unnecessary repetitions of endoscopic evaluations. The specificity was found to be extremely high when the results were reported as "cancer present" or "not present", with only one false positive report in a patient with ischemic colitis. In more than 60% the final diagnosis was cancer if the initial report showed suspicion of cancer, but the specificity of these results was low.

The mechanism of intrahepatic cholestasis in active liver disease has not yet been elucidated. Recent investigations in type II drug-induced hepatitis have suggested that lymphocytes produce a cholestatic factor. The authors' studies on lymphocyte cultures of patients with alcoholic hepatitis and acute viral hepatitis suggest that cellular immune phenomena may be of general significance in the pathogenesis of intrahepatic cholestasis. Supernatants of cultured lymphocytes of patients with alcoholic and acute viral hepatitis reduced bile flow and bile acid excretion in a rat model, provided that the lymphocytes had been previously stimulated by the appropriate antigen. An identical cholestatic effect was seen using sera of these patients. The pathogenetic mechanism of this lymphocytic factor is still unknown.

The growth of international tourism has increased the risk of diseases imported from abroad. Travel in developing countries involves a not inconsiderable risk, particularly of contracting hepatitis A. The risk of B or non A non B hepatitis is less marked, but the prognostic significance is more serious. The incidence, diagnosis and significance of the various types of "traveller's hepatitis", and the possibility of prevention, are discussed.

The pathogenesis of Crohn's disease is unknown, but immunologic mechanisms appear to play at least a partial role. Prompted by favourable experience with cyclosporin A in autoimmune diseases, the authors used it in steroid resistant acute Crohn's disease and started a pilot study comparing cyclosporin A with prednisone. Initial experience shows that cyclosporin A is effective in at least some patients with acute Crohn's disease. Side effects have thus far been minimal. However, oral dosage of the drug is difficult and regular determinations of the trough blood concentration are indispensable. A trough blood concentration of 200 ng/ml appears to be necessary to obtain full therapeutic activity. The lower antipyretic effect of cyclosporin A compared to prednisone may initially mask a favourable therapeutic effect. The effectiveness of cyclosporin A compared with prednisone cannot yet be evaluated.

Due to the growth in tourism, infectious diarrhea is no longer a problem of warm developing countries but a common condition encountered by the general practitioner. In this review the authors summarize the etiology, pathophysiology and clinical picture of the disease, and outline the diagnostic and therapeutic approach.