G.N. Tytgat – författare

International researchers summarize the current understanding of peptic disease and trace the development of a novel new drug for peptic disease therapy-sucralfate. Contributors present laboratory research along side data from clinical trials as well as from the practice of medicine. Articles discuss the history of sucralfate's development, mechanisms of action, clinical efficacy, and future directions for research. This volume will be of interest to scientists and clinicians working in gastroenterology and gastrointestinal physiology.

The fact that the differential diagnosis of inflammatory bowel disease includes intestinal infections has been a source of much interest and clinical concern for many years. Since the recognition of ulcerative colitis and Crohn's disease as clinical entities, numerous attempts have been made to identify a specific organism resulting in the clinical and pathologic picture of inflammatory bowel disease. The isolation, in 1984, of "M.paratuberculosis" initiated the current interest in and controversy about a mycobacterial etiology in Crohn's disease. The hypothesis that "Crohn's disease is Johne's disease" has led to a number of efforts, world-wide, to determine whether or not mycobacteria are associated with Crohn's disease. The most active research groups have contributed to this book, describing their attempts to unravel the hypothesis, providing the reader with an up to date review of knowledge available up to Fall, 1992. The book is based in part on presentations to the symposium on Crohn's disease held during European Digestive Disease Week, Amsterdam, 24 October 1992. The contributions have been especially updated for publication.

Endoscopy has revolutionized clinical gastroenterology. In 1961 Basil Hirschowitz published the first flexible endoscopic examination of the stomach and duodenal bulb. We moved from flexible fiberendoscopes to current video-endoscopic equip­ ment. Current video-endoscopes incorporate a black and white or color 'chip' at the tip of the instrument which transforms the visual image into electronic signals. The size of the pincet is constantly getting smaller, heading for 5 /Lm, further increasing the resolution. The signals are reassembled into high-quality color images in a video monitor. Endoscopes are now used to examine the entire gastrointestinal tract from esophagus to rectum, including the biliary and pancreatic ductal system. Targeted endoscopic biopsy offers rapid and precise diagnosis. Endoscopic ultrasonography is of unsurpassed accuracy in staging gastrointestinal tumors, in assessing pancreatic and biliary disease, and disorders of the rectum and anal canal. Moreover, targeted cytological sampling is possible of abnormalities of the intestinal wall or peri­ intestinal lymph node. Yet despite these glamorous achievements changes are to be expected in the overall emphasis of diagnostic endoscopy. Magnetic resonance cholangiopancreatography may very well compete for a substantial fraction of diagnostic ERCP. Virtual colonoscopy or computed tomographic colography may well compete with (and take over?) screening/surveillance colonoscopy.

The impact of Helicobacter pylori on basic science and the clinical management of patients with the complications of this infection is bewildering. The explosion of recent information both in the laboratory and at the bedside has progressed at an unprecedented rate. The objective of this text, in furthering this progress, has been to integrate this recent information and organize a series of presentations and discussions between investigators and clinicians on all aspects of H. pylori research and to review the current position and future research directions. To that end, the second meeting "Helicobacter pylori: Basic Mechanisms to Clinical Cure" was organized in June 1996 in Ottawa, Canada, following the successful format of the first such meeting held in Amelia Island, Florida, in 1993. The meeting again focused on all timely aspects of H. pylori research. Internationally renowned basic and clinical scientists explored in depth the spectrum of H. pylori infection and the related complications of gastritis, peptic ulcer, gastric cancer and lymphoma.The manuscripts in this text of the proceedings of the meeting reflect up-to-date information and state of the art approaches to research and management of H. pylori infection and should provide an invaluable reference source.

The format of the Falk Symposium 106 on "Advances in Inflammatory Bowel Diseases", held in Brussels, Belgium, June 18-20, 1998, attempted to link the new insights into pathogenetic mechanisms with new therapeutic approaches, resulting in optimal information transfer. This book summarizes the findings. The classic therapeutic schemes were updated with a special focus on step-wise build-up of therapy. Ulcerative colitis and Crohn's disease remain a great therapeutic challenge to the medical community. Knowledge about the pathogenesis of these diseases has progressed rapidly but the cause of the diseases remains completely unknown. It has become clear that dysregulation of the mucosal immune system is the basis for the chronic evolution of the diseases in a genetically susceptible population.

The fourth meeting in the series "Helicobacter pylori: Basic Mechanisms to Clinical Cure" was held on the island of Bermuda in late March 2000 and was sponsored by Axcan Pharmaceuticals. This was only some two years after the third meeting in San Diego, and it seemed hardly possible that there would be so much new information. However, as the contributions in this volume testify, there was plenty of new information with important implications for both understanding this infection and for clinical management. Some of this information was of a fundamental nature, such as the role of the acid sensitive urei channel in regulating the influx of urea and the formation of transported ammonia back in the microbial perisplasmic space to neutralize acid; the observation of genetic polymorphism of the IL-1b gene as an explanation of achlorhydria and gastric cancer risk in the first-degree relatives of gastric cancer patients; and the peculiar biochemical and physiological consequences of the genome of the microorganisms.The format of the meeting, with fifteen-minute presentations by world experts closely involved in helicobacter research followed by ample time for panel discussions, was again followed this year. Traditional aspects included detailed study of the microbial characteristics, the novel helicobacters, the interaction with the human host, the peculiarities of the inflammatory immune response, the short and long-term mucosal consequences, the effects on acid secretion, the problem of gastric malignancy, and the therapeutic possibilities. However, a series of short debates was introduced to highlight controversial issues, such as the pathogenic or commensal role of the organism, the role of virulence factors, the characteristics of the inflammatory immune response, the reversibility of mucosal atrophy and metaplasia, and the primary or secondary role of quadruple therapy, to name just a few. This provocative approach was very successful and provided fuel for further in-depth discussions.These debates have been included in this book in the form of conventional manuscripts in order to maintain the shortest possible production time for the publication of the proceed Helicobacter pylori has come a long way since the first meeting in Amelia Island, in 1993, and the science of this organism and the understanding of the consequences of the infection have advanced our knowledge fundamentally and revolutionized our thinking about gastrointestinal disease. We now recognize the existence of more than thirty Helicobacter species, some of which may play a significant role in human disease. The experience gained through our investigation of H. pylori promises to make a significant contribution to the future exploration of the possible role of Helicobacter species in hepatic, biliary, and intestinal diseases.

The fifth meeting in the successful series Helicobacter pylori: Basic Mechanisms to Clinical Cure took place in Maui, Hawaii, November 2002. The meeting focused on all aspects of contemporary H. pylori research. Internationally acclaimed basic and clinical researchers explored, in depth, the novel information across the spectrum of H. pylori infection, the characteristics of the organism, the inflammatory and tissue modifying consequences, the overall impact of this infection on a global scale, and new therapeutic possibilities. H. pylori infection, both in man and in the laboratory animal, has become a standard model to investigate fundamental problems in biology, such as microbial-host interactions, intracellular signalling, modulation of inflammation, mucosal atrophic metaplasia, and microbial resistance, to name just a few. The issues addressed in this book are grouped according to their leading theme. Topics include: the new Helicobacters, strain differences of H. pylori and their consequence on microbial-host interactions and the effects of H. pylori infection on the gastric mucosa. The role of H. pylori is explained in relation to: gastric carcinogenesis; gastroesophageal reflux disease; dyspepsia and long-term acid suppression.Eradication therapies are reviewed with respect to their global consequences and problems. The last two sections are devoted to a global update on therapeutic indications and finally on priorities for further research.

There is currently a significant growth of basic and clinical research in inflammatory bowel diseases. The extensive interest of the medical community in these diseases is largely explained by the devastating impact the illnesses have on the quality of life, their high prevalence in the community, and the fact that so many medical disciplines are involved in tackling the immensely complex studies on pathogenesis, clinical expression and treatment possibilities. The Falk Symposium number 85, held in The Hague, the Netherlands, 29 June-1 July 1995 brought together over 80 speakers and 1000 participants from all over the world. Plenary sessions and workshops allowed the discussion of basic and clinical research, enabling appropriate choices to be made. Topics reflected areas of high current basic research interest, clinical importance, and actual or future treatment potential.

International researchers summarize the current understanding of peptic disease and trace the development of a novel new drug for peptic disease therapy-sucralfate. Contributors present laboratory research along side data from clinical trials as well as from the practice of medicine. Articles discuss the history of sucralfate's development, mechanisms of action, clinical efficacy, and future directions for research. This volume will be of interest to scientists and clinicians working in gastroenterology and gastrointestinal physiology.

H. pylori infection, both in man and in the laboratory animal, has become a standard model to investigate fundamental problems in biology, such as microbial-host interactions, intracellular signalling, modulation of inflammation, mucosal atrophic metaplasia, and microbial resistance, to name just a few. The issues addressed in this book are grouped according to their leading theme. Topics include: the new Helicobacters, strain differences of H. pylori and their consequence on microbial-host interactions and the effects of H. pylori infection on the gastric mucosa. The role of H. pylori is explained in relation to: gastric carcinogenesis; gastroesophageal reflux disease; dyspepsia and long-term acid suppression. Eradication therapies are reviewed with respect to their global consequences and problems. The last two sections are devoted to a global update on therapeutic indications and finally on priorities for further research. These proceedings accurately reflect the state-of-the-art presentations delivered by world experts. This latest volume will further enrich this top-class series on H. pylori infection.

Helicobacter pylori has attracted widening interest from basic scientists and clinical investigators and the information on this organism is increasing exponentially. It is now accepted that H. Pylori is the most important cause of chronic active gastritis. Furthermore, data have confirmed a marked reduction in the relapse rate of both duodenal and gastric ulcer after eradication of the organism. These important clinical observations have served as a strong stimulus to the investigation of the basic mechanisms involved in the pathogenesis of H. pylori-associated inflammation and the subsequent alterations of gastroduodenal function and gastric mucosal architecture. The book contains chapters by a multidisciplinary, international group of basic scientists and clinical investigators who focus on various microbiological aspects of H. pylori, on the role of H. pylori in peptic ulcer and gastric cancer, and the current status of therapy. The book contains the proceedings of the conference on `Helicobacter pylori: Basic Mechanisms to Clinical Cure', held at Amelia Island, Florida, U.S.A., on November 3--6, 1993.

IS CROHN'S DISEASE A MYCOBACTERIAL DISEASE'! The fact that the differential diagnosis of inflammatory bowel disease includes intestinal infections has been a source of much interest and clinical concern for many years. Since the recognition of ulcerative colitis and Crohn's disease as clinical entities, numerous attempts have been made to identify a specific organism resulting in the clinical and pathologic picture of Inflammatory Bowel Disease. The first suggestion about a connection between Johne's disease, a chronic mycobacterial enteritis in cattle, and Crohn' s disease occurred in 1913, when Dalziel described enteritis in humans which, although resembling intestinal tuberculosis, he believed to be a new disorder. Since the work of Crohn in the thirties a few investigators attempted to look for mycobacteria in Crohn's disease. Until now the work of Van Patter, Burnham and others did not receive widespread recognition. In 1984 the isolation of M. paratuberculosis was reported by Chiodini et al. This report initiated the current interest and controversy about a mycobacterial etiology in Crohn's disease. The hypothesis "Crohn's disease is Johne's disease" did not receive widespread recognition, but has lead to the first muIticentered efforts to determine whether or not mycobacteria are associated with Crohn's disease.

Traditional aspects included detailed study of the microbial characteristics, the novel Helicobacters, the interaction with the human host, the peculiarities of the inflammatory immune response, the short and long-term mucosal consequences, the effects on acid secretion, the problem of gastric malignancy and the therapeutic possibilities.

The explosion of new information on Helicobacter pylori-related disease, both in the basic sciences and in clinical medicine, has continued to progress at an unprecedented pace. In many instances H. pylori infection, both in man and in the laboratory animal, has become a model to investigate fundamental biological issues such as micro-organism-host interactions, intracellular signalling, development of mucosal atrophy, mechanism of microbial resistance, disease modifying factors etc. In view of this bewildering flood of new information, the time was considered right to organize yet another update on H. pylori in the successful series 'Basic mechanisms to clinical cure' to define the 'state-of-affairs' in H. pylori research at this time. Our main objective was to integrate this new information in a series of top-quality presentations and discussions between investigators and clinicians, addressing all aspects of H. pylori research, and to review the current position and future research direc­ tions. The format included state-of-the-art presentations by world experts heavily involved in H. pylori research, followed by in-depth discussion on intriguing or controversial issues. The topics discussed were grouped according to the leading theme: characteristics of the organism, mode of transmission, mechanisms of H. pylori-induced inflammation, causation of disturbances of gastric secretory and motor function, aspects of clinical presentation and management, problems related to H. pylori-associated gastric adenocarcinoma and MALT-lymphoma, novel aspects of antimicrobial therapy, and vaccination. The meeting concluded with a synoptic agenda of suggested future studies for the microbiologist, the histopathologist and the clinician.

Endoscopy has revolutionized clinical gastroenterology. In 1961 Basil Hirschowitz published the first flexible endoscopic examination of the stomach and duodenal bulb. We moved from flexible fiberendoscopes to current video-endoscopic equip­ ment. Current video-endoscopes incorporate a black and white or color 'chip' at the tip of the instrument which transforms the visual image into electronic signals. The size of the pincet is constantly getting smaller, heading for 5 /Lm, further increasing the resolution. The signals are reassembled into high-quality color images in a video monitor. Endoscopes are now used to examine the entire gastrointestinal tract from esophagus to rectum, including the biliary and pancreatic ductal system. Targeted endoscopic biopsy offers rapid and precise diagnosis. Endoscopic ultrasonography is of unsurpassed accuracy in staging gastrointestinal tumors, in assessing pancreatic and biliary disease, and disorders of the rectum and anal canal. Moreover, targeted cytological sampling is possible of abnormalities of the intestinal wall or peri­ intestinal lymph node. Yet despite these glamorous achievements changes are to be expected in the overall emphasis of diagnostic endoscopy. Magnetic resonance cholangiopancreatography may very well compete for a substantial fraction of diagnostic ERCP. Virtual colonoscopy or computed tomographic colography may well compete with (and take over?) screening/surveillance colonoscopy.