Development and progression of gastrointestinal disease involves inflammatory, vascular, fibrogenetic and immune reactions accompanied by deregulation of cellular growth and death often resulting in cancer of theorgans affected. This book, the proceedings of Falk Symposium 132 on Disease Progression and Carcinogenesis in the Gastrointestinal Tract', held in Freiburg, Germany, October 9-10, 2002, addresses these various cellularprocesses in five sections in order to build up a broad pathogenic concept of gastrointestinal disease, purposely going beyond organ-specific research. Each section...

Cell-cell and cell-matrix interactions are of fundamental importance for the development and the maintenance of tissues and organs in multicellular organisms. Adhesive processes are mediated and controlled by an increasingly large and complex number of cell adhesion molecules that are anchored to the cell surface membrane by transmembrane domains. According to their structural and functional features, cell adhesion molecules have been classified into at least four major families: the integrins, selectins, cadherins and members of the immunoglobulin superfamily. Apart from linking cells to...

In recent years considerable progress has been achieved in regard to our understanding of the induction and modulation of the immune response in the intestinal mucosa. It is clear that this mucosal immune reaction is predominantly steered by certain T-cell populations, which are characterized by their cytokine secretion profile. Less well known are the conditions under which the uptake and processing of a specific antigen leads to a certain immune response, whether it be protective, tolerant or inflammatory. However, here again distinct progress has been made in our understanding. Equally...

In spite of significant scientific progress in recent years, the aetiopathogenesis of chronic inflammatory bowel diseases (IBD) remains elusive. With a prevalence of 1:700 to 1:500 in central Europe, both diseases are not rare. However, most physicians will generally treat only a few patients with IBD in their clinical practice. Because of this limited experience and the variety of clinical IBD manifestations, IBD patients are frequently treated in specialized tertiary care centres. Nevertheless, IBD patients will also consult less specialized general practitioners, who will not be able to...

This book, the proceedings of a Falk Workshop on Topical Steroids in Gastroenterology and Hepatology', held in Berlin, Germany, on 14 June 2003, critically discusses the current role of budesonide in gastroenterology, hepatology, surgery and oncology and focuses especially on potential new indications for the use of budesonide. A number of smaller clinical studies and anecdotal case reports with impressive clinical effects are reported in patients with gastrointestinal, hepatic, oncological and surgical problems. In addition, the use of budesonide for the treatment of distal ulcerative...

During the last decade, knowledge about cholestatic liver disease and concomitant diseases, such as ulcerative colitis, cholangio- and hepatocellular carcinoma, pancreas and colon cancer, has increased considerably. Studies on ursodeoxycholic acid treatment alone or in combination with immunosuppressive compounds and their positive effects on biliary liver disease as well as on so-called overlap syndromes or intestinal tumors are published in increasing numbers, and stimulate discussion on whether or not ursodeoxycholic acid is able to improve the general condition and/or life expectancy of...

In several liver diseases, the underlying cause cannot always be eliminated, i.e. the progression of liver disease cannot be prevented. This is particularly true for non-responders to the treatment of chronic hepatitis C (HCV). It is relevant for more than 40% of patients with HCV genotype 1 and up to 20% of patients with genotype 2 or 3. Several approaches are now underway to prevent or ameliorate mechanisms of disease progression. In Asia, and particularly in Japan, Glycyrrhizine-SNMC has been widely used for this purpose. At present, SNMC is under clinical evaluation in Europe.

...

The liver is of central importance to the entire organism due to its diverse functions in metabolism, its ability to detoxify and excrete, the hepatic formation and inactivation of mediators, and its involvement in non-specific defence mechanisms. Thus, extrahepatic manifestations of liver disease are often decisive for the disease course.
In the last few years, knowledge about interaction between the liver and other organs or systems - e.g. kidneys, GI tract, skeleton, endocrine, haematopoietic and nervous sytems - has increased considerably. Thus many extrahepatic manifestations of...

Short chain fatty acids (SFCA) are synthesized by the colonic microflora primarily from non-absorbed carbohydrate; there is also some limited production from non-absorbed protein. In contrast, SFCA are not normally present in the diet. During the past 15 years SFCA have attracted considerable interest in human nutrition, physiology and pathophysiology as a result of the realization that SFCA represent an important mechanism for carbohydrate and calorie conservation and may play a role in various types of colitides and possibly in colonic neoplasia. In addition, SFCA, produced in large amounts...

Cytokines are synthesized and secreted in the liver by Kupffer cells, and are important for inflammation processes, the non-specific immune response, and probably the destruction and removal of tumour cells. The production of signal substances such as tumour necrosis factor-alpha, interleukin 1 and 6, and interferon alpha/beta is regulated by a complex set of pathways, which can also be modified by cellular mediators, e.g. prostaglandins, growth factors and cortico-steroids. Signal exchange between different cell types in the liver is important for the synthesis of acute phase proteins, liver...