152 153 Intestinal Disease Meeting Berlin 2006 - Dr. Falk Pharma ...

Intestinal Disease Meeting 

Berlin 2006 

Endoscopy 2006 – 

Update and Live Demonstration 

Immunoregulation in Inflammatory 

Bowel Diseases – Current 

Understanding and Innovation 

Berlin (Germany), May 4–7, 2006 

Congress Short Report Falk Symposia 

152 

153

Publisher 

FALK FOUNDATION e.V. 

Leinenweberstr. 5 

Postfach 6529 

79041 Freiburg 

Germany 

© 2006 Falk Foundation e.V. 

All rights reserved. 

Text: 

Christine Vetter 

Medical Journalist 

Cologne (Germany) 

© Photos: Kai-Uwe Wudtke 

1st edition 2006 ISBN 3-933186-78-1

Falk Symposium 152 

Endoscopy 2006 – 

Update and Live Demonstration 


Immunoregulation in Inflammatory 

Bowel Diseases – Current 

Understanding and Innovation 

Berlin (Germany), May 4–7, 2006 



153

Introduction 

Scientific Organizers 

Falk Symposium 152 Falk Symposium 153 

P. Fockens, 

Amsterdam 

(The Netherlands) 

Foreword 

H.-J. Schulz, 

Berlin 

(Germany 

T. Rösch, 

Berlin 

(Germany) 

J. Špičák, 

Prague 

(Czech Republic) 

The Falk Symposia “Endoscopy 2006” and 

“Immunoregulation in Inflammatory Bowel 

Diseases” occupy a prominent place among 

the topics discussed at the Intestinal Disease 

Meeting held in Berlin, May 4–7, 2006. In all, 

more than 1,400 participants from 48 nations 

traveled to the German capital in order to update 

their knowledge and exchange experiences 

with professional colleagues. “Endoscopy is of 

central importance in gastroenterology. As a 

method, it is dependent on new developments 

in gastroenterology, basic research and technology.” 

This was the message of the scientific organizers 

of the Falk Symposium 152, P. Fockens 

A. Dignass, 

Frankfurt 

(Germany) 

E.F. Stange, 

Stuttgart 

(Germany) 

D. Rachmilewitz, 

Jerusalem 

(Israel) 

J.V. Weinstock, 

Boston 

(USA) 

(Amsterdam), T. Rösch (Berlin), H.-J. Schulz 

(Berlin) and J. Špičák (Prague). Live demonstrations 

were included among the attractions of 

this symposium. 

The objective of Falk Symposium 153 was to 

present current standards and potential new 

options in the diagnosis and therapy of inflammatory 

bowel diseases. It was organized by 

A. Dignass (Frankfurt), D. Rachmilewitz 

(Jerusalem), E.F. Stange (Stuttgart) und 

J.V. Weinstock (Boston). Among other controversial 

topics, participants discussed whether 

the treatment of inflammatory bowel diseases 

should follow a “Top Down” or “Step Up” 

approach.


Endoscopy 2006 – Update and Live Demonstration 

Berlin, May 4–5, 2006 

• 

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• 

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Page 

The Most Relevant New Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 

Role of Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 

Bile and Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 

State-of-the-Art Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 

Gastrointestinal Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 

Prevention and Management of Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 

Endoscopy 2006 – Live Demonstration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 

Interview with Professor Dr. H.-J. Schulz (Berlin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 


Immunoregulation in Inflammatory Bowel Diseases – 

Current Understanding and Innovation 


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• 

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• 

Advances in the Pathogenesis of IBD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 

Optimization in Therapy Through Improved Disease Classification? . . . . . . . . . . . . . . . . . 31 

Conventional Immunomodulator Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 

Relevance of Biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 

State-of-the-Art Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 

New Therapeutic Approaches (Part I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 

New Therapeutic Approaches (Part II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 

Presentation of Difficult Cases – Panel Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 

Chairpersons, Speakers and Scientific Organizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 

Further Congress Short Reports of Falk Symposia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 



3

Session 1 


Endoscopy 2006 – Update and Live Demonstration 


4 

The Most Relevant New Technologies 

Chair: 

P. Fockens, Amsterdam 

F. Hagenmüller, Hamburg 

J.F. Riemann, Ludwigshafen 

Transnasal endoscopy – not yet 

part of the clinical routine in 

Germany 

Although capsule endoscopy has received much 

recent attention and has been celebrated as an 

example of progress in this field, conventional 

Fig. 1 

I Ultrathin gastroscopes (H. Neuhaus, Düsseldorf) 

endoscopy has not lost any of its importance. 

In fact, there has been a series of very promising 

advances that, on the one hand, improve the 

method’s diagnostic potential and, on the other, 

make the endoscopic examination less unpleasant 

for the patient. As an example, H. Neuhaus

(Düsseldorf) cited the development of ultrathin 

gastroscopes that now permit transnasal 

gastroscopy (figure 1). “Unlike in France,” 

H. Neuhaus said, “this method, which enjoys 

high patient acceptance, has yet to become 

established in Germany.” 

An objection to transnasal endoscopy has been 

that the resolution is inferior to that provided 

by conventional endoscopes. According to 

H. Neuhaus, however, the resolution is no longer 

a problem with the newer units. Because of 

the small navigation mechanism, the ultrathin 

endoscopes have the advantage of being able 

to inspect directly behind mucosal folds – an 

Fig. 2 

H. Neuhaus 

I Chromoendoscopy: Methylene blue staining of Barrett’s metaplasia 

(H. Neuhaus, Düsseldorf) 

Congress Short Report Falk Symposium 152 

important capability, such as in the search for 

esophageal carcinomas. Potential indications for 

the new method, H. Neuhaus said, would include 

diagnostic esophagogastroduodenoscopy 

(EGD) without sedation, screening for Barrett’s 

esophagus, dysphagia work-up, transnasal tube 

placement and passage of high-grade stenoses 

in the proximal gastrointestinal tract. 

Chromoendoscopy: better 

evaluation of lesions 

Another example of progress is the method of 

chromoendoscopy (figure 2), which, because of 

the color technology, enables a better evaluation 

of lesions. “In particular, lesions are much better 

demarcated,” H. Neuhaus explained. One method 

that has not gained broad acceptance is the 

technique of zoom endoscopy, which, despite 

its capabilities for magnification, does not offer 

any advantages over conventional methods. In 

the general, the reliability of findings returned 

by endoscopic examinations depends to a great 

degree on the quality of patient preparation and 

the examination technique. The exact clinical 

utility of further increases in resolution is difficult 

to assess, but would seem helpful. 

5

Session 1 

6 

Capsule endoscopy – a new 

dimension for examination 

A new dimension in the study of changes of 

the gastrointestinal tract is offered by capsule 

endoscopy, M.M. Delvaux (Vandoeuvre) said. 

Although not yet a routine examination, the 

method offers untold capabilities for visualization 

of the small bowel. “We must, however,” 

M.M. Delvaux warned, “get used to a completely 

different view of the bowel.” For example, 

with conventional endoscopy, there is a variable 

Fig. 3 

M.M. Delvaux 

Malabsorption syndromes 

Diffuse intestinal diseases 

Amyloidosis 

exudative enteropathy 

distance between the light source and the bowel, 

while, with capsule endoscopy, the light source 

impinges directly on the bowel wall, providing a 

completely different impression of the mucosa. 

“Lesions may, in some cases, have a completely 

different appearance under these conditions,” 

M.M. Delvaux cautioned. 

Indications for capsule endoscopy, M.M. Delvaux 

said, include work-up of obscure gastrointestinal 

bleeding in patients with either open bleeding 

or chronic anemia, as well as in the diagnosis of 

Crohn’s disease, celiac disease and NSAID-associated 

enteropathy. Polyposis and the work-up of 

tumors, together with amyloidosis, Whipple’s 

disease, exudative enteropathy and eosinophilic 

gastroenteritis can also be important indications 

for capsule endoscopy (figure 3). “In such disorders, 

capsule endoscopy does not replace conventional 

endoscopy but can supplement it,” 

M.M. Delvaux said. 

Whipple’s disease 

eosinophilic gastroenteritis 

I Some further indications for capsule endoscopy (M.M. Delvaux, Vandoeuvre)

New techniques are in development 

“We need continued new developments in endoscopy.” 

This was the opinion of P. Fockens 

(Amsterdam). He referred especially to techniques 

with which flat or depressed lesions could be 

more reliably identified. One very useful technique 

that has yet to experience widespread clinical 

use, P. Fockens said, is chromoendoscopy. In 

addition, the method of “narrow band imaging” 

(figure 4), which has recently become commercially 

available, facilitates evaluation of lesions. 

This can be especially useful in patients with 

ulcerative colitis in order to limit the number of 

required biopsies. P. Fockens also anticipates 

Fig. 4 

I Narrow band imaging – colon (P. Fockens, Amsterdam) 


P. Fockens 

progress in the area of autofluorescence imaging 

(figure 5) and endomicroscopy (figure 6). “All 

these methods still require careful scientific 

evaluation,” P. Fockens said. 

7

Session 1 

8 

Fig. 5 

I Autofluorescence (P. Fockens, Amsterdam) 

Fig. 6 

I Endomicroscopy of normal rectal mucosa (P. Fockens, Amsterdam)

Endoscopy – It also has therapeutic 

value 

Modern endoscopy’s role is not limited to diagnosing 

disorders. As N. Soehendra (Hamburg) 

noted, it also has therapeutic value. Examples 

include endoscopic mucosal resection and 

endoscopic submucosal dissection (figure 7), 

as well as treatment of pancreatic abscesses and 

clipping. 

Especially in the therapy of early carcinomas of 

the esophagus and stomach, endoscopic mucosal 

resection can represent an attractive alterna- 

Fig. 7 

N. Soehendra 

I Endoscopic submucosal dissection (N. Soehendra, Hamburg) 


tive to conventional surgery. The endoscopic excision 

of circumscript malignant lesions is associated 

with long-term results comparable to those 

of conventional surgery. “There is,” N. Soehendra 

observed, “a significantly lower morbidity and 

this means increased quality of life for the patients.” 

Based on this positive experience the range of 

indications for endoscopic methods has become 

broader. Limitations include the depth of infiltration 

and the size of the tumor. Tumors that are restricted 

to the topmost submucosal layer and do 

not exceed 30 mm in diameter can be removed 

completely using the technique of submucosal 

dissection. If in certain cases it is necessary to 

remove long mucosal segments, N. Soehendra 

noted that the operator may use a “suck-andcut” 

technique or, where more suitable, ligatures 

or the so-called “piecemeal” technique can be 

used in order to successively remove neighboring 

areas of mucosa (figure 8). 

9

Session 1 

10 

Fig. 8 

I ”Piecemeal” technique (N. Soehendra, Hamburg) 

Another indication is the therapy of pancreatic 

abscesses in severely ill patients in whom conventional 

open surgery is not possible. In about 

70% of cases successful endoscopic treatment 

is feasible. In many other patients, the situation 

can at least be stabilized to the extent that surgery 

can be performed at a later time. In addition, 

endoscopy has therapeutic importance in the 

case of hemorrhage, which can be controlled by 

clipping. The same technique has also been successfully 

used for closure of perforations.

Pancreatobiliary endoscopy in 

therapy and palliation 

According to G. Costamagna (Rome), pancreatobiliary 

endoscopy has also developed in the past 

two decades from a purely diagnostic to a therapeutic 

tool. It has become the method of choice 

in the treatment and palliation of benign and 

malignant diseases. The most important methods, 

G. Costamagna said, include papillotomy 

(figure 9) and the placement of stents in the 

biliary tract. However, as G. Costamagna noted, 

the drainage of pseudocysts and even the evacuation 

of pancreatic necroses are possible, though 

this application is currently restricted to specialized 

centers. 

Fig. 9 

duodenal 

musculature 

Sphincter 

choledochus 


G. Costamagna G. Kähler 

Sphincter 

papillae 

Sphincter 

pancreaticus 

I Papilla of Vater (G. Costamagna, Rome) 

Endoscopy or minimally invasive 

surgery? 

A further new development, described by 

G. Kähler (Mannheim), involves the combination 

of endoscopy with equipment originally developed 

for use with laparoscopy. For example, staplers 

with a flexible, unfolding shaft and remote 

controlled triggering have been developed for 

use in laparoscopic procedures. Such equipment 

can also be used endoluminally and facilitate endoluminal 

applications. According to G. Kähler, 

such equipment can be used, for example, in the 

treatment of rectal anastomotic stenoses, as well 

as in cases of full-wall gastric resections and for 

the endoscopic therapy of Zenker’s diverticula. 

Combined procedures consisting of laparoscopy 

and intraluminal flexible endoscopy have been 

recommended for treatment of extensive adenomatous 

lesions of the colon and gastrointestinal 

tumors of the stomach (GIST). “Their clinical 

relevance cannot be definitively evaluated at 

this time,” G. Kähler noted. 

11

Session 1 

12 

Important new developments in 

ultrasound 

According to M. Gebel (Hannover), endoscopy 

has not been the only area in which new developments 

can be reported: Ultrasound has experi- 

Fig. 10 

M. Gebel 

I Contrast-enhanced echography of hepatocellular carcinoma (HCC) 

(M. Gebel, Hannover) 

enced clear progress in the diagnosis of gastrointestinal 

disorders. As an example, he cited contrast 

enhanced ultrasound. “A number of different 

contrast media have been introduced that can 

be used in ultrasound,” M. Gebel noted. Contrast-enhanced 

echography has, in his opinion, 

a role in the diagnosis of liver tumors (figure 10), 

which can be clearly differentiated in most cases. 

Further examples of progress in ultrasound examinations, 

M. Gebel explained, include elastography, 

in which the compressibility of tissue is 

studied, and 3D ultrasonography, which to date, 

however, has only achieved a narrow clinical 

importance.

Session 2 

Role of Endoscopy 

Chair: 

J. Devière, Brussels 

H. Lochs, Berlin 

Gastroesophageal reflux disease – 

Will tomorrow’s therapy be 

endoscopic? 

According to J. Mössner (Leipzig), endoscopy 

plays a central role in the diagnosis of gastroesophageal 

reflux disease (GERD), although only 

about 50% of GERD patients actually exhibit 

endoscopically recognizable lesions in the esophagus. 

Obtaining a baseline examination early in 

the disease is important and provides a basis for 

assessing the subsequent disease course, as well 

as for work-up of a Barrett’s esophagus. In addition, 

an emergent endoscopic examination is indicated 

in any patient reporting alarm systems 

Fig. 11 

I Barrett’s esophagus (J. Mössner, Leipzig) 


J. Mössner 

such as dysphagia, weight loss or hemorrhage. 

Finally, patients with reflux symptoms who do 

not respond promptly to standard therapy with 

a proton pump inhibitor (PPI) represent a further 

indication for endoscopy. 

According to J. Mössner, the role of the newer 

techniques, such as chromoendoscopy, zoom 

endoscopy and narrow band imaging for the diagnosis 

of GERD cannot be definitively assessed 

at this time. However, he does expect significant 

progress from the application of high-resolution 

endoscopy in the identification of high-grade 

dysplasias and early carcinomas in patients with 

Barrett’s esophagus (figure 11). In this area, he 

13

Session 2 

14 

does not feel that chromoendoscopy or narrow 

band imaging offer any further advantages over 

high-resolution techniques. 

The increasing importance of 

endoscopy in antireflux therapy 

J. Mössner also sees a significant watershed 

event in another area. In his opinion, endoscopy 

is on the threshold of assuming an increasing 

therapeutic role in the management of GERD. 

This is not limited to patients who do not respond 

adequately to PPIs. In fact, endoscopic 

antireflux therapy may represent an alternative 

to drug therapy in patients who cannot or will 

not take oral medication regularly as well as in 

those who may experience long-term enhanced 

quality of life as a result of endoscopic treatment. 

These new techniques, however, must not be 

used indiscriminately. “At the present time,” 

J. Mössner reminded his audience, “we have 

only limited experience and long-term data is 

completely missing.” 

Fig. 12 

Diagnosis: Ulcerative colitis 

• Characteristic pattern of inflammation 

(Sub)total colitis 15–20 % 

Left-sided colitis 30–50 % 

Proctosigmoiditis 30–50 % 

Backwash ileitis –10 % 

I Endoscopy in IBD – ulcerative colitis (F. Hartmann, Frankfurt) 

F. Hartmann 

Essential in inflammatory bowel 

diseases 

Endoscopy also plays a decisive role in the workup 

of inflammatory bowel diseases (IBD), said 

F. Hartmann (Frankfurt). The examination services 

to establish the diagnosis, exclude other possible 

etiologies and to assess the pattern, extent and 

activity of the patient’s disease. 

In general, endoscopy in patients with ulcerative 

colitis reveals subtotal colitis in 15–20% of cases, 

while 30–50% show left-sided colitis and 30–50% 

suffer from proctosigmoiditis (figure 12). In patients 

with Crohn’s disease, endoscopy reveals 

involvement of the esophagus, stomach and 

duodenum in 3–5% of patients, while in 25–30% 

of cases only the small bowel is affected. Both 

the small bowel and colon are affected in

Fig. 13 

Diagnosis: Crohn’s disease 

• Characteristic pattern of inflammation 

Esophagus, stomach, 

duodenum 3–5 % 

Small bowel 25–30 % 

Small and large bowel 40–55 % 

Rectum 11–26 % 

I Endoscopy in IBD – Crohn’s disease (F. Hartmann, Frankfurt) 

40–55% of patients (figure 13), while rectal 

involvement is seen in 11–26% of patients. 

Thanks to endoscopy, a reliable differential diagnosis 

is possible in most cases and IBD can be 

distinguished from infectious enteritis, drug-induced 

enterocolitis, mesenteric ischemia, diverticulitis 

and malignant disease. 

This does not, however, represent the limits of 

endoscopy. “We cannot only inspect the mucosa, 

but also obtain biopsies,” F. Hartmann said. In 

his opinion, the strength of endoscopy lies in its 

capacity to monitor the disease course, especially 

with regard to the possible development of dysplasias. 

He was more guarded in his assessment 

of the new developments in endoscopy, noting 

that “I do not believe that we need capsule endoscopy 

to reliably diagnose Crohn’s disease.” 


P.N. Meier 

Special care is required in children 

Special conditions apply to pediatrics, P.N. Meier 

(Hannover) explained. One must always consider 

the special situation of children who, while they 

may not directly fear the endoscopic procedure, 

are more prone to anxiety at being separated 

from their parents. There are also some practical 

issues involved, such as the fact that children are 

not able to remain abstinent from food for long 

periods. “They should always be examined early 

in the morning,” P.N. Meier noted. Wherever 

possible, the procedure should be conducted 

under general anesthesia. With the exception of 

newborns and young children, P.N. Meier said, 

special endoscopy units are not required. Good 

cooperation between the pediatrician and the 

consulting gastroenterologist is essential. 

15

Session 3 

16 

Bile and Pancreas 

Chair: 

G. Costamagna, Rome 

S. Jonas, Berlin 

Preoperative classification of 

tumors 

As an example of the importance of endoscopy 

in diseases of the biliary ducts and pancreas, 

T. Rösch (Berlin) cited the so-called Klatskin 

tumors. ERCP is very useful in the pre-operative 

work-up of these tumors, facilitating an exact 

classification of the tumor and providing crucial 

data for planning patients’ therapeutic management. 

Stage I and II tumors can even be treated 

endoscopically and, when palliative treatment 

is contemplated, stent placement for further 

drainage can be performed. 

Endoscopy is also useful in cases of chronic pancreatitis, 

when over the course of the disease 

patients develop complications such as obstructions 

and stenoses. Objective of the method 

is to reduce pain and increase both exo- and 

endocrine pancreatic function. Endoscopic 

treatment is necessary in about one-half of all 

patients at some point during their disease 

course, said J.F. Riemann (Ludwigshafen). 

T. Rösch J.F. Riemann 

Stents can alleviate stenoses 

In some cases, placement of a stent may be 

helpful in alleviating stenosis. If the pancreatic 

duct is occluded by stones, it may be possible 

using endoscopic methods to fragment the 

stone and re-open the duct. This is frequently 

done in combination with extracorporeal shockwave 

lithotripsy and several published studies 

have confirmed the use of this combination. 

Pancreatic pseudocysts represent another complication 

that is effectively treated with endoscopic 

techniques, the gastroenterologist said. “Success 

rates range as high as 96%,” J.F. Riemann said. 

Surgery is indicated only when conservative and 

endoscopic therapeutic methods have been exhausted.

Accurate work-up of pseudocysts 

According to J. Devière (Brussels), pancreatic 

pseudocysts are fairly common. One must, however, 

assess patient’s findings with a certain degree 

of caution, J. Devière warned, “since not 

everything that looks like a pseudocyst actually 

is one.” In fact, in about 15% of cases, patients 

suffer from a cystic tumor (figure 14): Hence, in 

no case should drainage be attempted prior to 

completion of a full work-up. In addition, pseudo- 

Fig. 14 

Pseudocysts 

85 % 

J. Devière 

I Cystic lesions of the pancreas – classification (J. Devière, Brussels) 


Cystic tumors 

≈15 % 

cysts very frequently resolve spontaneously. Intervention 

is therefore required only in patients 

with persisting symptoms. This is of even greater 

importance due to the fact that the procedure 

itself is not without complications. For example, 

bleeding occurs in 2–4% of cases. Retroperitoneal 

perforation occurs in about an equal number of 

cases. J. Devière also reminded his audience of 

the danger of infection. 

• mucinous 49 % 

• serous 32 % 

• IPMT 11 % 

• rare 8% 

17

State-of-the-Art-Lecture 

18 


Chair: 

S. Bar-Meir, Tel Hashomer 

C. Ell, Wiesbaden 

Capsule endoscopy in the work-up 

of obscure bleeding 

Endoscopy plays a special role in the identification 

and therapy of bleeding of the gastrointestinal 

tract. Here, one distinguishes between open 

and obscure bleeding, the source of which is unknown, 

said F. Hagenmüller (Hamburg) in a 

state-of-the-art lecture. 

Occult bleeding is normally discovered by Hemoccult 

or similar examination of the stool or is 

suspected due to chronic, but otherwise unexplained 

anemia. In many cases, however, neither 

radiological nor conventional endoscopic evaluations 

identify the source. Capsule endoscopy and 

double-balloon endoscopy have, however, decisively 

improved our capacity to discover obscure 

bleeding in the upper intestinal tract. “Metaanalyses 

show that capsule endoscopy is clearly 

F. Hagenmüller 

superior to push endoscopy in detecting bleeding 

sources,” F. Hagenmüller said, noting that 

the most common cause of occult bleeding is 

angiectasis, accounting for 50% of cases. However, 

other causes, such as ulcers, diverticula and 

tumors may be responsible. Even with these new 

methods, the cause of occult bleeding is not 

identified in about one-fourth of cases. In some 

cases, whether the bleeding source is found or 

not depends on the time of the examination. If 

the examination is conducted within the first 

two weeks, the bleeding source is found in more 

than 90% of patients, but this rate falls to about 

34% if the examination is postponed past this 

time.

Session 4 

Gastrointestinal Oncology 

Chair: 

N. Soehendra, Hamburg 

B. Wiedenmann, Berlin 

Overcoming stenoses by placement 

of stents in the colon 

Similar to the upper gastrointestinal tract, stenoses 

and obstructions in the more distal segments of 

the bowel may be amenable to endoscopic 

treatment. Usually, metal stents are placed, said 

T. Ponchon (Lyon). Stents should be flexible and 

easy to deploy. The situation in the colon, due to 

the possible presence of residual stool, is somewhat 

more difficult than in the upper gastrointestinal 

tract. In addition, stents must be sufficiently 

long and should have soft ends in order 

to conform to intestinal motility (figure 15). 

T. Ponchon told his audience in Berlin about his 

own experiences with the placement of stents in 

575 patients. In 64% of cases, the procedure 

was done with a palliative indication, while in 

the remaining 36% of patients a pre-operative 

Fig. 15 

I Types of metal stents (T. Ponchon, Lyon) 


T. Ponchon 

decompression was intended. The treatment 

was successful in 88% of cases. Of the 12% of 

procedures that were considered unsuccessful, 

medical issues were responsible in 4.5% and 

technical problems in 7.5% of cases. 

Perforation occurred in 3.8% of patients while, 

in 8.5%, migration of the stent was observed. 

Bleeding occurred in 4.7% of patients and was 

severe in 0.5%. According to T. Ponchon, these 

complications usually occur soon after the procedure. 

Long-term morbidity after stent placement 

must also be considered. For example, about one 

in ten patients experiences renewed obstruction 

despite the indwelling metal stent. This risk is 

higher in cases of stents placed with palliative 

intention, since these normal remain in place 

longer than those placed temporarily for 

drainage. 

19

Session 5 

Prevention and Management 

of Complications 

Chair: 

F. Schreiber, Graz 

P.A. Testoni, Milan 

20 

Endoscopic procedures are associated 

with low overall mortality 

The overall mortality associated with diagnostic 

endoscopic procedures is reported as 0.3–0.5 

per 1000 procedures, of which about 50% of 

deaths are due to cardiopulmonary complications, 

the majority of which develop as a result 

of pre-medication. “The risks of endoscopic 

procedures are overall very low,” said M. Jung 

(Mainz). 

In his opinion, it is important to consider the 

dangers of premedication. It is common practice 

before a procedure to administer a short-acting 

benzodiazepine either alone or in combination 

with an opiate. Most commonly used agents are 

midazolam or propofol. Both agents are characterized 

by a short elimination half-life and corresponding 

short duration of action. Propofol has 

advantages over benzodiazepines, especially 

because patients recover very quickly from the 

medication. 

M. Jung W. Schmitt 

Propofol: Does an anesthesiologist 

need to be present? 

On the other hand, this hypnotic agent induces 

a certain amount of cardiac and respiratory depression 

and there is no antagonist that can be 

administered if the situation becomes critical. 

Nevertheless, M. Jung does not consider justified 

those recommendations that propofol be used 

only in the presence of an anesthesiologist. Experience 

to date suggests that, with the proper 

training, this agent can be safely used in patients 

undergoing endoscopic interventions. 

Low rate of complications 

associated with polypectomy 

The rate of complications is also comparatively 

low with polypectomy, explained W. Schmitt 

(Munich). Overall morbidity stands at 0.36–4.8%, 

of which bleeding makes up 0.6–3.4% of cases. 

In second place are perforations at 0.08–0.83%. 

Mortality associated with the procedure is reported 

as 0.006–0.03%. 

Under discussion is the question of prophylactic 

clipping as a means of reducing the risk of 

bleeding. “Convincing data supporting its use 

have yet to be published,” said W. Schmitt. If 

bleeding does occur, it can be treated with sclerotherapy, 

clipping or by means of coagulation.


H.-J. Schulz J. Špičák 

The risks are higher with ERCP 

The risk of complications is significantly higher 

with ERCP than with polypectomy, said 

H.-J. Schulz (Berlin), noting that the most 

common and the most serious complication 

is pancreatitis. Pancreatitis takes a severe course 

in 10–15% of cases and pancreatitis is the most 

common cause of death following ERCP. Risk 

factors include female gender, sphincter of 

Oddi dysfunction and pre-existing pancreatitis 

(figure 16). Further complications include bleeding, 

cholangitis and perforation. Added to this 

are the complications secondary to sedation. 

The risk of complications is different for diagnostic 

and therapeutic ERCP; the rate of complications 

is necessarily higher with the latter. Complications 

for the most part relate to the sphincterotomy 

and in general depend on the extent 

of the procedure. Hence, one should avoid diagnostic 

ERCP in cases in which less invasive procedures 

can provide the required data. 

Perforation is the main risk in 

patients undergoing dilatation 

Unlike polypectomy and ERCP, the most common 

complication of endoscopic dilatation is 

perforation. In general, however, endoscopic 

dilatation, said J. Špičák (Prague), is considered 

an established procedure that can be safely used 

in practically all forms of strictures and stenoses 

of the gastrointestinal tract (figure 17), whether 

due to benign or malignant processes. 

Highly amenable to endoscopic treatment are 

stenoses associated with benign disorders of the 

esophagus and colon. Methods include balloon 

dilatation, use of sounds, electrocoagulation and 

the placement of temporary stents, or even a 

combination of these different techniques, 

J. Špičák said. 

21

Session 5 

22 

Fig. 16 

Cumulative risk factors of post-ERCP pancreatitis 

45 

40 

35 

30 

25 

20 

15 

10 

5 

0 

2.5 

female 

I Complication rate of ERCP (H.-J. Schulz, Berlin) 

4.8 

female 

+ bili < 1 

SOD = sphincter of Oddi dysfunction 

Fig. 17 

Schatzki ring 

peptic stenosis 

Adjusted risk of pancreatitis [%] 

12.4 

female 

+ bili < 1 

+ SOD 

Crohn’s disease 

16.2 

female 

+ bili < 1 

+ difficult 

cannulation 

I Stenoses of the gastrointestinal tract (J. Špičák, Prague) 

42.1 

female 

+ bili < 1 

+ difficult 

cannulation 

+ SOD

Live Demonstration 

Endoscopy 2006 – Live Demonstration 

G. Costamagna, J. Devière, P. Fockens, K. Gellert, 

F. Hagenmüller, R. Kiesslich, P.N. Meier, H. Neuhaus, 

G. Niemann, T. Ponchon, T. Rösch, N. Soehendra, 

C.B. Williams, and the OZK-Endoscopy-Team 

Moderators: R. Drossel, Berlin; S. Faiss, 

Hamburg; L. Familiari, Messina; F. Hagenmüller, 

Hamburg; M.-L. Hermans, Euskirchen; M. Jung, 

Mainz; H. Martin-Nowacki, Berlin; H. Neuhaus, 

Düsseldorf; U. Pfeifer, Düsseldorf; J.F. Riemann, 

Ludwigshafen; T. Rösch, Berlin; G. Schachschal, 

Berlin; W. Schiffelholz, Augsburg; R. Schöfl, Linz; 

H.-J. Schulz, Berlin; J. Špičák, Prague; K. Wietfeld, 

Marl; E. Zehnter, Dortmund; C. Ziegeler, Berlin 

The live demonstrations, transmitted directly to 

the congress hall from the Sana Klinikum in 

Berlin-Lichtenberg, attracted broad interest. 

About 1,000 physicians and nurses were able to 

watch 30 patients with disorders of all segments 

of the gastrointestinal tract were examined and 

treated by German and international experts. 

Viewers were able to see first-hand that the 

limits of endoscopic therapy have broadened 

significantly past large common bile duct stones 

or large polyps in the colon. 

Endoscopy – soon a procedure for 

nurses? 

It is also a matter for discussion to what extent 

endoscopic examinations and procedures can 

be performed by health care professionals other 

than physicians. In other countries, for example, 

in Great Britain, it has become an established 


C.S. Neumann 

fact that simple examinations are entrusted 

to specially trained endoscopy nurses, said 

C.S. Neumann (Birmingham). “The doctor shortage 

and ever longer waiting lists have forced 

the issue.” Prerequisite for nurses to perform 

these procedures is that they complete a formal 

course and regular training, as is also required 

for physicians, C.S. Neumann said. In such 

cases, as experience in England has shown, 

endoscopic procedures performed by nurses 

are acceptable. 

English endoscopy nurses started with simple 

examination techniques, such as esophagogastroduodenoscopy 

(EGD) without sedation of 

the patient. The spectrum, however, has since 

expanded, C.S. Neumann said. Procedures requiring 

sedation have also become the domain 

of endoscopy nurses in many English clinics. 

Similarly, sigmoidoscopy without polypectomy 

has been entrusted to trained nurses, while even 

removal of polyps is done by nurses in certain 

hospitals. “It has even been discussed whether 

we may even perform emergency procedures,” 

the endoscopy nurse noted. 

She warned that such considerations should best 

be decided ahead of time. The trend of allowing 

endoscopy to pass partially from the hands of 

physicians into those of allied health professionals 

can hardly be stopped, once it has started. 

23

Live Demonstration 

24 

P. Rogalla 

Virtual endoscopy: Is this the next 

step? 

Congress participants in Berlin were also presented 

with information on a potential future development 

– virtual endoscopy. The technique is 

based on data derived from either computed tomography 

(CT) or magnetic resonance imaging 

(MRI). According to P. Rogalla (Berlin), it is possible 

to obtain 3D images from the acquired data 

sets. Intestinal polyps are very amenable to visualization 

using the new technology. CT-derived 

data sets currently provide slightly superior 

images. Meta-analyses report a sensitivity of 

70% and a specificity of 86% for the method. 

According to P. Rogalla, progress can also be 

expected in the work-up of rectal carcinoma and 

in the diagnosis of flat or even depressed lesions 

of the bowel. “These lesions are frequently overlooked 

during the conventional examination,” 

P. Rogalla said. Virtual endoscopy, however, is 

still in an early stage of development: Whether 

it will ever represent a serious competitor to 

conventional endoscopy remains questionable.

Interview 

Interview with 

Professor Dr. H.-J. Schulz 

(Berlin) 

The potential of modern endoscopy: 

exciting and live on the bog screen 

The Falk Symposium 152 “Endoscopy 2006” 

was a great success with its presentations and 

especially the live demonstrations. Participants 

filling the congress hall to overflowing were 

able to watch live transmissions of endoscopic 

procedures conducted by experts at the Sana 

Klinikum in Berlin-Lichtenberg. What are the 

new perspectives? What’s new in terms of 

equipment? What do you do when unexpected 

complications arise? Which procedures are safe 

and reliable? What are the limits of endoscopy? 

These were questions that participants had answered 

– close up and in real time. In a brief 

interview, Professor Dr. Hans-Joachim Schulz 

(Berlin) explains the special attraction of the live 

demonstrations. 

? Professor Schulz, you chaired the Falk Symposium 

“Endoscopy 2006”. What gave you the 

idea to include live demonstrations in this symposium? 

! Schulz: Live demonstrations are able to convey 

the potential of modern endoscopy much more 

effectively than presentations or video films. The 

therapeutic importance of endoscopic procedures 

continues to grow, but at the same time these 

procedures have become increasingly complex. 

Words can go only so far in conveying this. One 

gets a total different impression of the capabilities 

of modern endoscopy when experiencing 

the advance of the endoscope, seeing what the 

endoscopist does and how he reacts to different 


H.-J. Schulz 

situations. The demonstration thus has a very 

distinct educational value. Indirectly, it contributes 

to quality. 

? This does not require live transmission in the 

congress hall. 

! Schulz: That is correct. One can certainly conduct 

live demonstrations in the clinic and that is 

something we regularly do. Unfortunately, only a 

few persons can participate at any one session. 

Including the number of participants as we have 

here in Berlin would be impossible. In addition, 

over the course of the day, we have been able to 

present many different patients exhibiting a wide 

range of pathology that has been examined and 

treated by many different endoscopists. This, 

too, is exciting. One can see how many different 

colleagues, all of them experts in their respective 

fields, deal with problems as they arise. 

? How do you explain the unusually high 

degree of interest among the audience? 

! Schulz: There are probably a number of 

reasons that so many viewers have assembled. 

First, extensive and comprehensive live demonstrations 

of this kind are rare and it appears that 

many of our colleagues have welcomed the opportunity 

this event has provided for continuing 

medical education. Among the viewers were 

many colleagues who themselves perform endoscopic 

procedures and are interested in seeing 

internationally known experts use new equipment. 

Not only have they been able to see new 

25

Interview 

26 

concepts but have also learned new tips and 

tricks for dealing with difficult situations. There 

are other viewers who, although they themselves 

do not perform endoscopy, have taken advantage 

of this event to update their knowledge on 

the current perspectives of this method. Hence, 

practically every viewer, regardless of his own 

expertise, can find information that will help him 

in his own practice. Another advantage of a liver 

demonstration is that the situations are authentic 

and the cases are real. One can follow along 

directly and see what happens during the procedure. 

? What has been the development of endoscopy 

and what is its current role? 

! Schulz: The development of endoscopy over 

the past years and decades has been unbelievably 

exciting. Again and again, we have had the 

impression that we have been working on the 

cutting edge and that further improvements 

were practically impossible. Again and again, 

however, there were spectacular leaps that significantly 

advanced both the diagnostic and, 

more recently, also the therapeutic potential of 

endoscopic procedures. Starting with the normal 

optic endoscopes, we soon advanced to the 

flexible optical fiber units. Then came the leap 

to videoendoscopy that continued to improve 

and add new features, particularly in terms of 

magnification and color techniques. Currently, 

we are experiencing another technological leap. 

Image resolution has become significantly better 

and we have benefited from new technologies, 

such as narrow band imaging, with which we 

can visualize vasculature and thus better assess 

areas suspicious for malignancy. Endoscopy continues 

to develop into a more therapeutically 

relevant method. 

In addition, pathology of the biliary tract and 

the pancreas is now increasingly amenable to 

endoscopic treatment, sparing patients the risks 

of conventional open surgery. Using the doubleballoon 

technique, we can now reach all regions 

of the gastrointestinal tract without surgery. 

Biopsies can be obtained, pre-cancerous and 

early-stage tumors can be removed and other 

disorders can be therapeutically addressed. Besides 

this, further advances are occurring, including 

capsule endoscopy, which is already being 

used and developed, as well as other endoscopic 

technologies. The relevance of virtual endoscopy 

cannot, however, be definitively assessed at this 

time. 

Professor Schulz, thank you for the interview.

Session 1 



Immunoregulation in Inflammatory Bowel Diseases – 

Current Understanding and Innovation 


Advances in the Pathogenesis 

of IBD 

Chair: 

A. Dignass, Frankfurt 

D. Rachmilewitz, Jerusalem 

Inflammatory bowel diseases: 

strong genetic components 

Inflammatory bowel diseases (IBD) such as 

Crohn’s disease (CD) and ulcerative colitis (UC) 

usually manifest themselves in adolescents or 

young adults. Their incidence has been increasing 

over the past decades and, according to 

S. Schreiber (Kiel), it occurs more frequently in 

some families. This, together with the high concordance 

in monozygotic twins (over 55%), 

which is not observed in fraternal twins (under 

5%), supports the hypothesized strong genetic 

component of these diseases. 

IBD are polygenetic diseases, although recent research 

has identified the NOD2 (CARD15) gene 

that potentially acts as a trigger in the pathogenesis 

of Crohn’s disease (figure 18). According to 

S. Schreiber, NOD2 belongs to a large family of 

S. Schreiber 

proteins involved in defending the organism from 

bacterial invasion. “NOD2, however, is not by 

far the only component of the pathomechanism 

of inflammatory bowel diseases,” S. Schreiber 

said. Corresponding mutations are involved in 

the disease process in less than half of all patients 

(figure 19), which means that the search must 

continue for further potential pathogenetic 

factors. 

Like NOD2, some other factors may involve chromosome 

16, on which several areas have been 

identified that may be involved in the development 

of IBD. Here, S. Schreiber said, gene splicing 

may play a role. This process, in which RNA 

fragments of varying length and corresponding 

protein fragments are produced, lends high 

plasticity to the human genome. 

27

Session 1 

28 

Fig. 18 

NOD2 (CARD15, IBD1) 

G908R (CD) 

LP1007P (CD) truncation 

I 3-Dimensional protein structure of NOD2 (S. Schreiber, Kiel) 

Fig. 19 

NOD2 

contributes 

No contribution of NOD2 

I Crohn’s disease and NOD2 (S. Schreiber, Kiel) 

NOD2 major factor 

R702W 

(CD)

Congress Short Report Falk Symposium 

D.K. Podolsky E. Cario I. Fuss 

Set point changes in the Toll-like 

receptors 

A human being’s genetic material serves as the 

basis for his inborn immunity, which is distinguished 

from his acquired immunity, D.K. Podolsky 

(Boston) said. Both systems control a person’s 

immune reactions by means of the formation of 

cytokines and chemokines, which, in turn, trigger 

signal cascades in the involved cells and thus 

mediate both immune and inflammatory reactions. 

An important role is played by the so-called 

Toll-like receptors (TLR), which are closely associated 

with the NOD2 system. D.K. Podolsky believes 

that changes in the “set points” in the TLRs 

are responsible for the interaction of epithelial 

and mucosal cells with the intestinal flora, which 

can also serve as a trigger in the pathogenesis 

of IBD. “We still understand far too little about 

how the different signal pathways coincide,” 

D.K. Podolsky conceded. 

According to E. Cario (Essen), however, the TLRs 

do not operate independently. They are, in fact, 

dependent on cooperation with the MD-2 receptor 

(myeloid differentiation protein 2) in order to 

adequately recognize lipopolysaccharides (LPS). 

Although MD-2 has a high affinity for LPS, the 

exact role of this co-receptor in the pathogenesis 

remains unclear, E. Cario said. 

Differences between ulcerative colitis and Crohn’s 

disease may, according to I. Fuss (Bethesda), lie 

in the activated cell systems. In his opinion, there 

is strong evidence that it is especially the Th1 

cells that control the inflammatory process in 

Crohn’s disease through formation of inflammatory 

cytokines such as interleukin-12 (IL-12), interferon-γ 

(IFN-γ) and tumor necrosis factor-α 

(TNF-α). Ulcerative colitis, on the other hand, is 

believed to be a disease that develops due to 

changes in the Th2 cells, with an additional association 

with the natural killer cells (NK cells). 


29

Session 1 

30 

Fig. 20 

A B 

C 

P. Marteau 

Does the intestinal flora itself 

trigger Crohn’s disease? 

Beside the immune system, the bacteria of the 

gastrointestinal tract play a role in the pathogenesis 

of Crohn’s disease. In the presence of a genetically 

determined susceptibility the intestinal 

A: Listeria monocytogenes; B: Measles 

C. Mycobacterium paratuberculosis; D: Saccharomyces 

I Crohn’s disease and pathogens? Conflicting results (P. Marteau, Paris) 

flora can actually directly promote inflammation. 

According to P. Marteau (Paris), bacteria exert 

physiological effects on the mucosal structure, 

epithelial turnover, the development of immune 

reactions and even on intestinal function. These 

reactions are mediated through the TLRs and 

the NOD2 system. This explains why changes in 

the intestinal flora can result in changes on the 

immunological level. According to P. Marteau, 

discussion has centered on the involvement of 

numerous bacterial species (figure 20), and there 

is evidence that there may be differences between 

Crohn’s disease and ulcerative colitis. While involvement 

by intestinal flora seems most pronounced 

in Crohn’s disease, it may be considerably 

less so in ulcerative colitis. 

D

Session 2 

Optimization in Therapy 

Through Improved Disease 

Classification? 

Chair: 

M. Gasull, Badalona 

H. Goebell, Essen 

Classification of the clinical 

phenotype – pros and cons 

Just as there are controversies regarding the 

exact pathogenesis of IBD, there is also disagreement 

on the best classification of these two disease 

entities. W. Reinisch (Vienna) argued for a 

classification by clinical phenotype: “The clinical 

phenotype is the fastest and most objective 

means of assessing the disease.” However, the 

claim of different classification schemas to describe 

the disease according to objective and 

reproducible criteria is, W. Reinisch said, hardly 

more than a “wish list” that “is out of touch 

with reality”. Similarly, there is no standard 


W. Reinisch 

method for the diagnosis of IBD. “We are actually 

confronted more with a diagnostic puzzle,” 

W. Reinisch said. Important components include 

the clinical evaluation in combination with the 

endoscopic, histological and radiological findings, 

as well as the results of laboratory studies. 

W. Reinisch also criticized the so-called Vienna 

Classification, which, among other factors, also 

takes into account the localization and clinical 

course of the disease. Both can be variable and 

are not, in his opinion, suitable for describing 

the disease. 

31

Session 2 

32 

Fig. 21 

inflammatory 

G. van Assche 

Include genetic and serological 

parameters 

In the opinion of G. van Assche (Leuven), a clear 

classification of IBD, based not only on clinical 

phenotype but also on serological and genetic 

parameters, is essential. “It would give us important 

clues on the future course of the disease 

I Long-term evolution of disease behavior in Crohn’s disease 

(G. van Assche, Leuven) 

and for assessing the patient’s prognosis,” 

G. van Assche said (figure 21). For example, there 

is a close correlation between NOD2 variants 

and the clinical phenotype in Crohn’s disease. 

In addition, G. van Assche argued for further 

“fine tuning” of both the Vienna Classification 

and also of the Montreal Classification, derived 

from it. For example, he recommended including 

serological markers such as antibodies to Saccharomyces 

cerevisiae (ASCA), which is associated 

with Crohn’s disease, as well as perinuclear antineutrophilic 

cytoplasmic antibody (p-ANCA), 

which appears to be associated with ulcerative 

colitis. The serological markers will probably also 

be important in predicting the reaction of individual 

patients to biological therapy options, 

which are currently under development. 

stricturing

Fig. 22 

CDP571 

34 

21 

Placebo 

I CRP and response to biologicals (S. Vermeire, Leuven) 

49 

15 


S. Vermeire K. Herrlinger 

CRP helps assess patients’ reaction 

to biologics 

In addition to these serological markers, said 

S. Vermeire (Leuven), there are also biomarkers 

that could be used to better classify the disease 

manifestation. Disease activity is most commonly 

assessed using C-reactive protein (CRP), which 

also predicts to a certain degree patients’ reaction 

to biologics (figure 22). A further possible 

marker is calprotectin, which is determined from 

stool. Both CRP and calprotectin, S. Vermeire 

said, are very sensitive markers for inflammation. 

They are, however, not specific and can be 

elevated in cases of infection or malignant 

processes. 

Response [%] 

60 

50 

40 

30 

20 

10 

0 

60 

50 

40 

30 

20 

10 

In the opinion of K. Herrlinger (Stuttgart), pharmacogenetic 

studies could be used to predict 

the reaction to a given therapeutic agent. He 

cited azathioprine as an example. This immunosuppressant 

helps maintain remission in many 

patients and use of this agent helps spare corticosteroids. 

Thiopurine S-methyltransferase 

(TPMT), the enzyme responsible for the breakdown 

of azathioprine, however, exhibits a genetic 

polymorphism, with the result that there 

are rapid, intermediate and slow metabolizers of 

azathioprine. Patients’ status can be determined 

prior to treatment, K. Herrlinger said, thus allowing 

the physician to estimate to some degree the 

risk of side effects and to adjust the medication 

dose accordingly. 

0 

Week 2 all Week 2 CRP Week 12 all Week 12 CRP 

> 10 mg/l 

> 10 mg/l 

44 

37 

CDP571 

53 

Placebo 

18 


33

Session 3 

Conventional Immunomodulator 

Therapy 

Chair: 

W.E. Fleig, Leipzig 

M. Lémann, Paris 

34 

Increasing importance of 

immunomodulators 

Alongside the standard medications, immunomodulators, 

such as azathioprine, have been 

gaining increased importance in the treatment 

of IBD, said S.P.L. Travis (Oxford). Azathioprine is 

indicated when, after a severe disease flare, patients 

require treatment with steroids multiple 

times within one year, if the disease recurs while 

patients are on steroids or within three months 

of their discontinuance, and also for postoperative 

prophylaxis of Crohn’s disease. 

Fig. 23 

Remission induced by prednisolone; tapered over 12 weeks 

Patients not failing trial [%] 

100 

80 

60 

40 

20 

Steroids + 

azathioprine 

Azathioprine 

S.P.L. Travis 

Studies show that azathioprine is significantly 

more effective than placebo for maintenance of 

remission (figure 23). Usually, the agent is administered 

when patients are either refractory to, 

or dependent on, steroids. Azathioprine is also 

the agent in this class with the most clinical experience. 

Only after it has been shown to be 

ineffective does the focus shift to the other immunomodulators, 

such as methotrexate. 

Placebo (n = 30) 

Azathioprine 2.5 mg/kg 

bw/day (n = 33) 

0 

0 15 

Duration of trial [Months] 

Candy et al. Gut 1995, 37: 674 

I Azathioprine for maintaining clinical remission in Crohn’s disease after steroid 

induction (S.P.L. Travis, Oxford)

Optimize clinical efficacy, minimize 

risks 

It is important to remember, said J.-F. Colombel 

(Lille), that therapy with immunosuppressants 

has specific side effects, such as a significantly 

increased risk of infection (figure 24). This is less 

pronounced with the clinically established immunosuppressants, 

such as azathioprine, whose 

side effects are well known, than with the biologics 

now flooding the market. “The risk of side 

Fig. 24 

Herpes simplex 

CMV 

Varicella zoster 

EBV 

HPV 


J.-F. Colombel M. Lémann 

M. tuberculosis 

M. avium sp. 

M. xenopi 

Listeria monocytogenes 

Staphylococcus sp. 

Nocardia 

E. coli 

Salmonella sp. 

I Infections associated with immunomodulator therapy in IBD 

(J.-F. Colombel, Lille) 

effects associated with these substances must 

not be underestimated. We must do all we can 

to optimize clinical efficacy and reduce the risks 

of these substances secondary to their toxicity,” 

J.-F. Colombel advised. Because of their clinical 

efficacy, immunosuppressants such as azathioprine 

and also methotrexate are being used 

earlier in the clinical course of IBD. They are indicated 

in chronic active disease and also for postoperative 

prophylaxis of disease recurrence, said 

Histoplasmosis 

Aspergillus spp. 

Cryptococcus spp. 

Candida spp. 

Coccidioides immitis 

Blastomyces 

Pneumocystis jiroveci 

Toxoplasma gondii 


35

Session 3 

36 

M. Lémann (Paris). M. Lémann also reported current 

discussion of a combination of azathioprine 

and anti-TNF antibodies (figure 25). 

The recurrence rate increases after 

azathioprine is discontinued 

At this point it must be asked, how long patients 

need to be kept on immunosuppressants. In general, 

once maintenance of remission with azathioprine 

has been started, it should be continued 

long-term. Current data show that the recurrence 

rate rapidly increases once the immunosuppressant 

is discontinued (figure 26). For example, 

a study in 157 patients with Crohn’s disease 

in whom azathioprine was discontinued 

after they had been treated for six months with 

the agent, showed a massive increase in disease 

recurrence compared to those who continued 

to take the medication. In general, a four-year 

follow-up shows an increased risk of disease 

recurrence is observed after discontinuing the 

immunosuppressant. 

Fig. 25 

Chronically active IBD Emerging indications 

Early 

I Azathioprine/6-mercaptopurine – when to start? (M. Lémann, Paris) 

This was recently confirmed by data reported 

from the GETAID (Groupe d'Etudes Therapeutiques 

des Affections Inflammatoires Digestives) 

study, which found an increase in disease recurrence 

after discontinuing azathioprine. In the 

study, 83% of patients receiving azathioprine 

reported no acute symptoms. Patients in whom 

a placebo was substituted for azathioprine, 

however, suffered a disease relapse within 

18 months in 21% of cases, compared to only 

8% of those who continued to receive azathioprine. 

According to M. Lémann, the risk of recurrence 

is significantly increased in patients taking 

azathioprine for periods less than 3.5–4 years. 

“Azathioprine should be taken for at least this 

period of time,” M. Lémann advised. 

In addition, the risk of recurrence can be assessed 

using biological markers, such as the CRP level. 

“High CRP levels combined with low hemoglobin 

suggests an increased risk of recurrence,” 

M. Lémann said. 

Postoperative prevention 

Combined with anti-TNF antibodies

Fig. 26 

% of relapse 

70 

60 

50 

40 

30 

20 

10 

0 

7 

13 

Years 

I Recurrence rate after azathioprine withdrawal (M. Lémann, Paris) 

Infliximab and azathioprine can be 

combined 

An initial combination of immunosuppressants 

appears to improve overall efficacy. This is also 

true for the combination of the immunosuppressant 

azathioprine and corticosteroids. This kind of 

induction therapy, said W.J. Sandborn (Rochester), 

also appears to increase the success rate of a 

maintenance therapy with azathioprine. A similar 

situation appears to apply to a combination 

7 


stopped 

4 

150 

99 

57 

35 

24 

n.s. 

12 

5 

0–1 1–2 2–3 3–4 4–5 > 5 

6 

n.s. 

maintained 

W.J. Sandborn 

of azathioprine and infliximab prior to monotherapy 

with azathioprine. The addition of azathioprine 

to infliximab appears to reduce the risk of 

antibodies being produced against the anti-TNF 

antibodies. 


37

Session 4 

38 

Relevance of Biologics 

Chair: 

M.A. Kamm, Harrow 

H. Lochs, Berlin 

Therapy planning – Step Up or 

Top Down? 

The classification of IBD was not the only area 

that sparked controversy in Berlin. Questions of 

therapy planning were also a matter of discussion, 

focusing to a great extent on whether the 

conventional “Step Up” approach should continue 

to be applied or whether, by integrating the 

use of biologics, a “Top Down” approach might 

have better chances of success. 

Speaking for this concept, in which biologics, such 

as infliximab, are used initially, was S.B. Hanauer 

(Chicago). The early, aggressive therapy with 

biologics can, he said, result in rapid disease 

stabilization and mucosal healing, with possible 

Fig. 27 

Crohn’s disease 

Surgery 

Infliximab 

MTX 

AZA/6-MP 

Systemic steroids 

Budesonide 

Antibiotics 

5-ASA 

Severe 

Moderate 

Mild 

I Current “therapeutic pyramids” (S.B. Hanauer, Chicago) 

S.B. Hanauer 

favorable effects on the further clinical course 

(figure 27). Evidence for this concept has been 

reported from a first comparison study in which 

130 patients with active Crohn’s disease were 

treated initially with either infliximab plus azathioprine 

or with budesonide or prednisolone. 

Patients not responding to infliximab/azathioprine 

could receive prednisolone, while those 

not responding to steroids could receive azathioprine 

with or without infliximab. According to 

S.B. Hanauer, another piece of evidence underscoring 

the benefit of the “Top Down” approach 

was that patients in this group more frequently 

exhibited mucosal healing than did those in the 

“Step Up” group. 

Ulcerative colitis 

Surgery 

Cyclosporine 

Infliximab 

Systemic steroids 

5-ASA

J. Schölmerich 

Only a minority of patients profits 

from the “Top Down” concept 

Not in favor of this concept was J. Schölmerich 

(Regensburg). In his opinion, the proponents of 

the “Top Down” concept overlook the fact that 

only a minority of patients do not benefit from 

the currently standard “Step Up” paradigm. The 

more aggressive “Top Down” approach would 

represent an unnecessary risk for these patients 

and also burden the medical insurance system 

with unjustifiable increased costs. According to 

J. Schölmerich, the goal of treatment of IBD consists 

of reducing patients’ symptoms, inducing 

and maintaining disease remission and thus preventing 

renewed acute disease flares and structural 

changes. “These objectives,” he said, “are 

realized in the majority of patients using the 

standard therapy.” 

Start with medications of proven 

efficacy 

The “Step Up” model begins with medications 

of proven efficacy, such as mesalazine in ulcerative 

colitis and, in Crohn’s disease, of this medication 

together with the locally acting steroid 

budesonide and, where indicated, antibiotics. 

Only when these medications do not prove effective, 

said J. Schölmerich, should patients be 

started on medications, such as systemic corticosteroids, 

azathioprine or even methotrexate, 


that are stronger but also are associated with 

greater risk of side effects. If patients fail to respond 

to these medications with remission or if 

they relapse the next step can be administration 

of the TNF-α inhibitor infliximab or cyclosporine, 

which is indicated in ulcerative colitis. 

Very few patients require 

accelerated therapy 

This type of accelerated therapy is required in 

only a small percentage of patients, the gastroenterologist 

said. A majority of patients, in 

fact, can be brought to remission during the first 

therapy step and can be maintained free of disease 

flares for extended periods. J. Schölmerich 

cited data according to which 35% of Crohn’s 

patients and 48% of those with ulcerative colitis 

remain symptom-free and feel well at four years. 

The fact that patients with inflammatory bowel 

diseases exhibit a practically normal life expectancy 

also confirms the success of the current standard 

treatment in the majority of cases. 

In addition, J. Schölmerich said, the exact meaning 

for an individual patient of endoscopically 

documented mucosal healing and whether this 

observation is associated with a better long-term 

outcome remains completely unclear. “Unlike in 

rheumatology, where joint destruction can be 

directly visualized, there are no corresponding 

endpoints in inflammatory bowel diseases,” 

J. Schölmerich said. At present, mucosal healing 

can be considered a surrogate parameter, the 

long-term meaning of which in achieving a favorable 

disease course remains unclear. According 

to J. Schölmerich, the current situation does 

not justify treating patients with newly diagnosed 

Crohn’s disease or ulcerative colitis according to 

the “Top Down” model. This would, in his opinion, 

represent “overtreatment”. 


39

Session 4 

40 

G. D´Haens 

Set mucosal healing as a goal 

Nevertheless, said G. D’Haens (Bonheiden), mucosal 

healing should be a goal. This is the only 

effective way of preventing further loss of iron, 

blood and proteins. Mucosal healing can also 

help prevent development of complications, 

such as fistulation and the formation of stenoses, 

and it also counters the risk of developing dysplasias. 

Mucosal healing is of particular importance 

in children, G. D’Haens said, because of 

its role of preventing growth retardation.



Chair: 

J. Schölmerich, Regensburg 

What is the relevance of defensins? 

Bacteria play a central role in the induction of inflammatory 

processes in the bowel. Hence, the 

body’s own immune system, especially the socalled 

defensins, should be a center of attention, 

said J. Wehkamp (Stuttgart). The defensins can 

be thought of as a kind of “antibiotic” produced 

by the body to prevent bacterial invasion of the 

intestinal wall. “Nearly all species possess a broad 

spectrum of these substances, which have antimicrobial 

effects,” J. Wehkamp said. 

In patients with Crohn’s disease, however, this 

system appears to be abnormal, which would 

Fig. 28 

Contact? 

Mucous layer between bacteria and inflammatory cells 

I Normal gut epithelium is sterile! (J. Wehkamp, Stuttgart) 


J. Wehkamp 

explain why patients exhibit bacteria in the normally 

sterile intestinal epithelium (figure 28). 

J. Wehkamp’s own studies have shown that 

Crohn’s patients exhibit reduced levels of defensins, 

especially in the so-called Paneth cells. 

The current data point to a primary defect. This 

fuels optimism that, based on these findings, 

wholly new therapy concept can be established. 

“These could have the goal of re-establishing 

the disturbed balance of the defensins,” 

J. Wehkamp concluded. 

41

Session 5 

New Therapeutic Approaches 

(Part I) 

Chair: 

W.J. Sandborn, Rochester 

E.F. Stange, Stuttgart 

42 

The search for new therapy concepts 

Because the currently available therapeutic options 

do not help all IBD patients, the search for new 

therapeutic concepts continues with heightened 

intensity. Researchers are focusing on promising 

concepts such as immunostimulating DNA sequences 

(ISS) and on synthetic oligonucleotides 

which, said D. Rachmilewitz (Jerusalem) inhibit 

apoptosis in the epithelial cells of the colon 

(figure 29). In experimental models of colitis, ISS 

possess pronounced anti-inflammatory properties, 

making these DNA sequences attractive 

Fig. 29 

naive 

D. Rachmilewitz A. Sturm 

target structures for the development of new 

therapeutic agents for IBD. Another promising 

therapy concept, said A. Sturm (Berlin) is represented 

by the probiotics, which appear to inhibit 

the release of proinflammatory cytokines. “Probiotics 

reduce disease activity,” A. Sturm said. 

As evidence, he cited three double-blind placebo-controlled 

studies in patients with ulcerative 

colitis, in which the active agent successfully 

maintained remission. Probiotics could therefore 

be a possible alternative to mesalazine in patients 

who do not tolerate this medication. 

DSS DSS & M-ODN DSS & ISS-ODN 

ISS-ODN = immunostimulatory sequence oligodinucleotides 

M-ODN = methylated oligodinucleotides 

DSS = dextran sulfate sodium 

I ISS-ODN inhibits DSS-induced apoptosis of colonic epithelium (D. Rachmilewitz, Jerusalem)

Promising results with helminths 

The observation that IBD occurs almost exclusively 

in industrial nations and much less frequently 

in the developing world may also contribute to 

the development of new therapy concepts. “The 

pathogenesis of these diseases also appears to 

have something to do with the standard of hygiene,” 

said J.V. Weinstock (Boston). Observations 

in mice that animals exposed to certain worms 

of the helminth group appeared to be protected 

against inflammation in the colon led to the 

effort to establish this principle in humans. According 

to J.V. Weinstock, the helminths may 

Fig. 30 

J.V. Weinstock R.W. Summers 

2. Larvae 

released 

1. Ingestion 

Infective ova 

Ingested 

3. Mucosal attachment 

Penetrate 

and develop 

in mucosa 

Internal 

Embryonated egg 

(infective stage) 

External 

I Trichuris suis life cycle (R.W. Summers, Iowa City) 


trigger immune reactions, such as the release of 

IL-12 and IFN-γ. 

Meanwhile the first clinical studies on humans 

treated with helminth (Trichuris suis) ova (figure 

30) report a reduction in disease symptoms. Very 

promising were the results of a pilot study of 

54 patients with ulcerative colitis presented in 

Berlin by R.W. Summers (Iowa City). Patients were 

treated with Trichuris suis ova, with 45% of patients 

responding to therapy. The difference with 

respect to placebo was not initially significant 

but became so after six weeks. Over the twelveweek 

treatment a total of 60% of patients responded 

positively to treatment with helminth 

ova compared to 12% showing improvement 

on placebo. 

There are also first reports of therapeutic efficacy 

in patients with Crohn’s disease. In one study, 

29 patients were treated, of whom 65% achieved 

remission within twelve weeks, with a total of 

76% of patients showing a clear clinical response. 

Side effects and serious complications were not 

observed. 

Cell 

Eggs in feces 

(diagnostic stage 

4. Maturation 

5. Egg excretion(noninfective) 

6. Embryonation 

in soil 


43

Session 5 

44 

Phosphatidyl choline as a 

protective layer in the bowel 

Also promising is a completely different therapy 

concept, namely the administration of phosphatidylcholine 

(PC), about 90% of which accumulates 

in the phospholipid fraction of the intestinal 

mucus (figure 31). PC is arranged in the 

form of laminary corpuscles and apparently 

provides a type of surface protection, reported 

W. Stremmel (Heidelberg). According to findings 

in animal experiments, PC is synthesized in the 

ileum, but not in the colon. A more careful study 

Fig. 31 

PC 

Laminary 

corpuscles 

W. Stremmel 

showed that the concentration of laminary corpuscles 

is reduced by more than 70% in patients 

with ulcerative colitis, independent of whether 

acute inflammation is present. “This would appear 

to be a fundamental pathogenetic factor,” 

W. Stremmel said. The loss of this protective 

layer appears to promote bacterial invasion with 

the corresponding consequences, such as inflammation. 

Scientists are now confronted with 

the development of a topical therapy with PC, 

which would substitute for the missing protective 

layer and provide direct anti-inflammatory 

efficacy. A first “proof of concept” study, in 

which 60 patients with chronic active steroiddependent 

ulcerative colitis participated, appears 

to confirm that this is possible. Remission was 

documented in 53% of patients receiving phosphatidyl 

choline but in only 10% of patients in 

the placebo group. 

Because of the significant side effects of systemic 

steroids attention has been paid to establishing a 

method for local treatment with steroids, said 

Mucous cell 

layer 

Mucous layer 

Intestinal lumen 

I Phosphatidylcholine (PC) is enriched in the phospholipid fraction of intestinal 

mucus – active secretory mechanism (W. Stremmel, Heidelberg)

T. Andus (Bad Cannstatt). The principle foresees 

taking full advantage of the steroids’ anti-inflammatory 

action (figure 32) while minimizing side 

effects. Ulcerative colitis appears to be most 

amenable to such local therapy, because the dis- 

Fig. 32 

T. Andus 

Anti-inflammatory 

actions 

Inflammatory 

cells 

I Corticosteroids – pleiotropic actions (T. Andus, Bad Cannstatt) 


ease manifests as proctosigmoiditis in more than 

70% of cases (figure 33). According to T. Andus, 

the greatest experience has been had with 

budesonide, which is also the best studied drug 

in clinical investigations. 

It has been, for example, shown that doses of 

both 2 mg/day and 8 mg/day, applied as an 

enema, are clinically effective, resulting in complete 

remission in 19% and 27% of patients, 

respectively. More than 90% of study subjects 

exhibited normal ACTH levels. “In the meantime, 

meta-analyses have shown that budesonide 

possesses good clinical efficacy but is associated 

with significantly lower rates of side effects than 

is the case with systemic corticosteroid therapy.” 

Metabolic 

actions 

90% bound to transcortin 

2,000–70,000 receptors/cell 

Affinity: 30 nmol/l (~ conc. in blood) 

Negative feedback receptor-regulation 


45

Session 5 

46 

Fig. 33 

Cushing 

Osteoporosis 

Acne 

Weight gain 

Water 

retention 

Psychological 

disturbances 

Diabetes mellitus 

Increased 

appetite 

Others 

2.0 

4.6 

4.6 

4.6 

7.3 

12.6 

16.6 

24.5 

23.2 

0 10% 20% 30% 

I Corticosteroids – side effects from the doctor’s view (T. Andus, Bad Cannstatt)

Session 6 

New Therapeutic Approaches 

(Part II) 

Chair: 

S.B. Hanauer, Chicago 

M. Zeitz, Berlin 

Apheresis in cases otherwise 

refractory to therapy 

Leukocyte apheresis can also be used in the 

treatment of ulcerative colitis, but the method 

involves significant investment for the gastroenterologist. 

According to T. Hibi (Tokyo), the 

method resembles hemodialysis treatment and 

can in many cases contribute to inducing 

remission in patients refractory to mesalazine 

or steroids. Pilot studies suggest that the method 

Fig. 34 

CDAI 

400 

300 

200 

100 

0 

0 

0 

0 

Box plot showing 75th and 25th percentile 

I GM-CSF (sargramostim) – pilot study (J.R. Korzenik, Boston) 


* 

Treatment [Weeks] 

T. Hibi J.R. Korzenik 

may also be useful as a therapeutic improvement 

in patients with Crohn’s disease. 

A further innovative concept, treatment with 

growth factor GM-CSF (sargramostim), was presented 

by J.R. Korzenik (Boston), who reported 

on a pilot study in which patients responded 

with reduced disease activity (figure 34). 

K. Fellermann (Stuttgart) presented data according 

to which inhibition of calcineurin reduces the 

risk of colectomy by 85%. Calcineurin is inhibit- 

* 

* 

p < 0.01 

* * 

0 1 2 3 4 6 8 

Mean CDAI 

pre: 346 

post: 156 

47

Session 6 

48 

K. Fellermann D.W. Hommes B.G. Feagan 

ed by cyclosporine A but there are many different 

agents that have the same effect. Examples include 

tacrolimus and TOR inhibitors (target of 

rapamycin), such as everolimus and sirolimus. 

In this area, too, there is a future potential for 

development of new therapy options. 

This holds also for T-cell modulating antibodies, 

a class to which infliximab belongs. According to 

D.C. Baumgart (Berlin), further substances with 

a similar mechanism of action are appearing on 

the market, such as adalimumab, already used 

in rheumatology, and the humanized CD3-antibody, 

visilizumab. 

Modulation of cytokines may also open new 

therapeutic vistas, said D.W. Hommes (Amster- 

dam). “Cytokines are linked to one another in a 

complex network and control a wide variety of 

processes in the organism,” D.W. Hommes said 

(figure 35). The problem is finding a way to put 

this complex feedback system to therapeutic 

use. “We have already seen so many cytokines 

come and go on which we had placed serious 

therapeutic hopes,” D.W. Hommes said. 

A completely different concept could involve 

prevention of leukocyte migration into inflamed 

tissue. This would, however, said B.G. Feagan 

(London/Ontario), require blocking cell adhesion. 

Current research is also focusing on such strategies, 

such as inhibition of the adhesion molecule 

VCAM-1.

Fig. 35 

Wound 

healing 

Infections 

Tissue 

remodeling 

I Which cytokine to select? (D.W. Hommes, Amsterdam) 


Cell 

proliferation Cell 

differentiation 

Cytokine 

functions 

Cell 

metabolism 

Immune 

response 

Hematopoesis 


49

Presentation of Difficult Cases – Panel Discussion 

Presentation of Difficult Cases - 

Panel Discussion 

Chair: 

M.A. Kamm, Harrow 

50 

I Panel: (from left to right): A Dignass, Frankfurt; H.J. Buhr, Berlin; W. Kruis, Cologne; S.P.L. Travis, 

Oxford, D. Rachmilewitz, Jerusalem; W.J. Sandborn, Rochester; J. Schölmerich, Regensburg, 

E.F. Stange, Stuttgart 

I Case Presentations: M. Böhmig, Frankfurt; C. Büning, Berlin; A. Grabig, Berlin; B. Wittig, Berlin

Index 

Chairpersons, Speakers and 

Scientific Organizers 

Prof. Dr. T. Andus 

Innere Medizin 

Klinikum Stuttgart 

Krankenhaus Bad Cannstatt 

Prießnitzweg 24 

D-70374 Stuttgart 

Germany 

Prof. Dr. G. van Assche 

Univ. Ziekenhuis Gasthuisberg 

Department of Gastroenterology 

Herestraat 49 

B-3000 Leuven 

Belgium 

Prof. Dr. S. Bar-Meir 

Chaim Sheba Medical Center 


2 Sheba Road 

IL-52 621 Tel Hashomer 

Israel 

PD Dr. D.C. Baumgart 

Hepatologie/Gastroenterologie 

Charité Universitätsmedizin 

Campus Virchow Klinikum (CVK) 

Augustenburger Platz 1 

D-13353 Berlin 

Germany 

Dr. M. Bertullies 


Sana-Klinikum Lichtenberg 

Oskar-Ziethen-Krankenhaus 

Fanningerstr. 32 


Germany 

Dr. M. Böhmig 

Markus-Krankenhaus 

Wilhelm-Epstein-Str. 2 

D-60431 Frankfurt 

Germany 


Prof. Dr. H.J. Buhr 

Allgemein und Gefäßchirurgie 


Campus Benjamin Franklin (CBF) 

Hindenburgdamm 30 


Germany 

Dr. C. Büning 

Gastroenterologie/Hepatologie 


Campus Charité Mitte 

Schumannstr. 20–21 


Germany 

PD Dr. E. Cario 


Universitätsklinikum Essen 

Hufelandstr. 55 

D-45147 Essen 

Germany 

Prof. Dr. J.-F. Colombel 

Hôpital Claude Huriez 

CHRU Lille 

Gastroenterology & Hepatology 

1, place de Verdun 

F-59037 Lille 

France 

Prof. Dr. G. Costamagna 

Policlinico Gemelli 

Unitá Operativa di 

Endoscopia Digestiva 

Largo Gemelli, 8 

I-00168 Rome 

Italy 

Prof. Dr. G. D’Haens 

Imelda Ziekenhuis 

Gastroenterologie 

Imeldalaan 9 

B-2820 Bonheiden 

Belgium 

Dr. M.M. Delvaux 

Hôpitaux de Brabois Adultes 

C.H.U. de Nancy 

Department of Internal Medicine & 

Digestive Pathology 

Rue du Morvan 

F-54511 Vandoeuvre-Nancy 

France 

Prof. Dr. J. Devière 

Université Libre de Bruxelles 

Hôpital Erasme 

Route de Lennik 808 

B-1070 Brussels 

Belgium 

Prof. Dr. A. Dignass 

Innere Medizin I 

Markus-Krankenhaus 

Wilhelm Epstein Str. 2 


Germany 



51

Index 

52 

Dr. R. Drossel 

Internist 

Gastroenterologie 

Etkar-André-Str. 8 


Germany 

Prof. Dr. C. Ell 

Innere Medizin II 

HSK Dr. Horst Schmidt Klinik 

Ludwig-Erhard-Str. 100 

D-65199 Wiesbaden 

Germany 

PD Dr. S. Faiss 

Innere Medizin III 

Asklepios Klinik Barmbek 

Rübenkamp 220 

D-22307 Hamburg 

Germany 

Prof. Dr. L. Familiari 

Policlinico Universitario 

Clinica Medica I 

I-98100 Messina 

Italy 

Dr. B.G. Feagan 

University of Western Ontario 

Robarts Research Institute 

LCTRG 

100 Perth Drive 

London, ON N6A 5K8 

Canada 

Dr. K. Fellermann 

Robert Bosch Krankenhaus 


Auerbachstr. 110 


Germany 

Prof. Dr. W.E. Fleig 

Medizinischer Vorstand 

Universitätsklinikum Leipzig 

Philipp-Rosenthal-Str. 27 

D-04103 Leipzig 

Germany 

Prof. Dr. P. Fockens 

Universiteit van Amsterdam 

Academisch Medisch Centrum 

Department of Endoscopy 

Meibergdreef 9 

NL-1105 AZ Amsterdam 

The Netherlands 

I. Fuss, M.D. 

National Institutes of Health 

NIAID, Bldg. 10, Room 11N242 

Mucosal Immunity Section 

Bethesda, MD 20892 

USA 

Prof. Dr. M. Gassull 

Hospital Universitari Germans 

Trias i Pujol 

Servicio de Gastroenterologia 

Carretera del Canyet s/n 

E-08916 Badalona 

Spain 

Prof. Dr. M. Gebel 


Medizinische Hochschule Hannover 

Carl-Neuberg-Str. 1 

D-30625 Hannover 

Germany 

Prof. Dr. K. Gellert 

Chirurgie 





Germany 

Prof. Dr. H. Goebell 

Schinkelstr. 34 

D-45138 Essen 

Germany 

A. Grabig 






Germany 

Prof. Dr. F. Hagenmüller 


Asklepios Klinik Altona 

Paul-Ehrlich-Str. 1 


Germany 

S.B. Hanauer, M.D. 

Professor of Medicine 

University of Chicago 

Department of Medicine 

Gastroenterology Section 

5841 S. Maryland Ave. 

Chicago, IL 60637 1463 

USA 

Prof. Dr. F. Hartmann 

Katharina-Kasper-Kliniken 

St. Marienkrankenhaus 


Richard-Wagner-Str. 14 


Germany 

Dr. M.-L. Hermans 

Internistin 

Gastroenterologische 

Schwerpunktpraxis 

Viktoriastr. 5 

D-53879 Euskirchen 

Germany 

Dr. K. Herrlinger 





Germany 

Prof. Dr. T. Hibi 

Keio University 

School of Medicine 

35, Shinano machi 

Shinjuku ku, Tokyo 160 8582 

Japan 

Dr. D.W. Hommes 

Universiteit van Amsterdam 

Academisch Medisch Centrum 

Academisch Ziekenhuis 

Meibergdreef 9 

NL-1105 AZ Amsterdam 

The Netherlands

Prof. Dr. S. Jonas 

Allgemein- und Viszeralchirurgie 


Campus Virchow-Klinikum (CVK) 



Germany 

Prof. Dr. M. Jung 


Katholisches Klinikum Mainz 

St. Hildegardis-Krankenhaus 

Hildegardstr. 2 

D-55131 Mainz 

Germany 

PD Dr. G. Kähler 

Chirurgische Endoskopie 

Klinikum Mannheim 

Theodor-Kutzer-Ufer 1–3 

D-68167 Mannheim 

Germany 

Prof. Dr. M.A. Kamm 

St. Mark’s Hospital 

Gastroenterology Unit 

Colorectal Disorders 

Watford Road 

Harrow HA1 3UJ 

Great Britain 

PD Dr. R. Kiesslich 


Klinikum der Universität 

D-55131 Mainz 

Germany 

J. Korzenik, M.D. 

Assistant Professor of Medicine 

Harvard Medical School 

MGH Digestive Health Center 

100 Charles River Plaza 

Boston, MA 02114 

USA 

Prof. Dr. W. Kruis 


Evang. Krankenhaus Kalk 

Buchforststr. 2 

D-51103 Köln 

Germany 

Prof. Dr. M. Lémann 

Hôpital Saint Louis 

Service d’Hépato Gastro 

Entérologie 

1, ave. C. Vellefaux 

F-75010 Paris 

France 


Prof. Dr. H. Lochs 




Schumannstr. 20 21 


Germany 

Prof. Dr. P. Marteau 

Hôpital Européen 

Georges Pompidou 

Service d’Hépato Gastroentérologie 

20, rue Leblanc 

F-75908 Paris 

France 

H. Martin-Nowacki 

Ltd. Endoskopiefachschwester 

Elisabeth-Klinik 

Lützowstr. 24–26 


Germany 

Dr. P.N. Meier 


Medizinische Hochschule Hannover 

Carl-Neuberg-Str. 1 

D-30625 Hannover 

Germany 

Prof. Dr. J. Mössner 

Universitätsklinikum Leipzig 


Philipp-Rosenthal-Str. 27 

D-04103 Leipzig 

Germany 

Prof. Dr. H. Neuhaus 


Evangelisches Krankenhaus 

Kirchfeldstr. 40 

D-40217 Düsseldorf 

Germany 

C.S. Neumann 

University of Birmingham 

City Hospital Birmingham 

c/o Clinical Investigation Unit 

Dudley Road 

Birmingham, B18 7QH 

Great Britain 

Dr. G. Niemann 


Helios Klinikum Emil von Behring 

Walterhöferstr. 11 


Germany 

U. Pfeifer 

Endoskopieschwester 

Evangelisches Krankenhaus 

Kirchfeldstr. 40 

D-40217 Düsseldorf 

Germany 

D.K. Podolsky, M.D. 


Massachusetts General Hospital 


GI Unit 

55 Fruit Street 

Boston, MA 02114 2696 

USA 

Prof. Dr. T. Ponchon 

Hôpital Eduard Herriot 

Specialités Digestives 

Pavillon H 

Place d’Arsonval 

F-69437 Lyon 

France 

Prof. Dr. D. Rachmilewitz 

Shaare Zedek Medical Center4 

Department of Medicine 

P.O. Box 3235 

IL-91 031 Jerusalem 

Israel 

Prof. Dr. W. Reinisch 

Universitätskliniken Wien 


Währinger Gürtel 18–20 

A-1090 Wien 

Austria 



53

Index 

54 

Prof. Dr. J.F. Riemann 

Innere Medizin C 

Klinikum der Stadt Ludwigshafen 

Bremserstr. 79 

D-67063 Ludwigshafen 

Germany 

PD Dr. P. Rogalla 

Röntgendiagnostik 





Germany 

Prof. Dr. T. Rösch 

Interdisziplinäre Endoskopie 





Germany 

W.J. Sandborn, M.D. 


Mayo Clinic 

Division of Gastroenterology 

West 19A 

200 First Street SW 

Rochester, MN 55905 

USA 

Dr. G. Schachschal 






Germany 

Dr. W. Schiffelholz 

Internist 

Gastroenterol. Schwerpunktpraxis 

Halderstr. 29 

D-86150 Augsburg 

Germany 

Prof. Dr. W. Schmitt 


Städtisches Klinikum München 

Krankenhaus München Neuperlach 

Oskar-Maria-Graf-Ring 51 

D-81737 München 

Germany 

Prof. Dr. R. Schöfl 

Krankenhaus der Elisabethinen 


Fadingerstr. 1 

A-4020 Linz 

Austria 

Prof. Dr. J. Schölmerich 

Klinik für Innere Medizin I 


Regensburg 

D-93042 Regensburg 

Germany 

Prof. Dr. F. Schreiber 

Medizinische Universität Graz 

Universitätsklinik für Chirurgie 

Innere Medizin I und III 

Auenbruggerplatz 29 

A-8036 Graz 

Austria 

Prof. Dr. S. Schreiber 

Klinische Molekularbiologie 

Universitätsklinikum 

Schleswig Holstein, 

Campus Kiel 

Schittenhelmstr. 12 

D-24105 Kiel 

Germany 

Prof. Dr. H.-J. Schulz 






Germany 

Prof. Dr. N. Soehendra 

Interdisziplinäre Endoskopie 

Universitätsklinikum Eppendorf 

Martinistr. 52 


Germany 

Prof. Dr. J. Špičák 

Institute for Clinical and 

Experimental Medicine 

Videnska 1958/9 

CZ-140 21 Prague 4 

Czech Republic 

Prof. Dr. E.F. Stange 





Germany 

Prof. Dr. W. Stremmel 

Innere Medizin IV 


Im Neuenheimer Feld 410 

D-69120 Heidelberg 

Germany 

PD Dr. A. Sturm 






Germany 

R.W. Summers, M.D. 


University of Iowa 


Department of Internal Medicine 

200 Hawkins Drive 

Iowa City, IA 52242 

USA 

Prof. Dr. P.A. Testoni 

Ospedale S. Raffaele 

Divisione di Gastroenterologia 

e Endoscopia 

Via Olgettina 60 

I-20132 Milan 

Italy 

Dr. S.P.L. Travis 

John Radcliffe Hospital 

NHS Trust 


Headley Way Headington 

Oxford OX3 9DU 

Great Britain

Dr. S. Vermeire 

Univ. Ziekenhuis Gasthuisberg 

Gastroenterology Unit 

Herestraat 49 

B-3000 Leuven 

Belgium 

Dr. J. Wehkamp 

Dr. M. Fischer Bosch Institut 

für Klinische Pharmakologie 



Germany 

J.V. Weinstock, M.D. 


Tufts New England 

Medical Center 

Box 233 

750 Washington Street 

Boston, MA 02111 

USA 

Prof. Dr. B. Wiedenmann 






Germany 


K. Wietfeld 

Ltd. Endoskopiefachschwester 

Paracelsus-Klinik der Stadt Marl 

Lipper Weg 11 

D-45770 Marl 

Germany 

Prof. Dr. C.B. Williams 

St. Mark’s Hospital 

Wolfson Unit for Endoscopy 

Watford Road 

Harrow, HA1 3UJ 

Great Britain 

PD Dr. B. Wittig 

Medizinische Klinik I 





Germany 

Dr. E. Zehnter 

Gastroenterologische Fachpraxis 

Am Oelpfad 12 

D-44263 Dortmund 

Germany 

Prof. Dr. M. Zeitz 

Medizinische Klinik I 





Germany 

C. Ziegeler 

Ltd. Endoskopieschwester 

Vivantes Klinikum Neukölln 

Standort Rudower Straße 

Rudower Str. 48 


Germany 



55

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Postfach 65 29 

FOUNDATION e.V. 

79041 Freiburg 

Germany 

ISBN 3-933186-78-1 

FSK152/153e 1-11/2006/5.000 Konk

152 153 Intestinal Disease Meeting Berlin 2006 - Dr. Falk Pharma ...

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