Background: Video lectures are an increasingly popular format. They allow an individual choice of time, place and speed of learning. Objective: The aim of the present study was to compare whether video lectures are as effective as live lectures to impart the complete contents of the clinical part of the medical exam. The study also examines whether students prefer live or video lectures and for what reason. Design: In 2014, a preparatory course was held at the University of Göttingen to train medical students for the clinical part of the medical exams. Three-quarters of the participants received 41 four-hour lessons live, while the same lessons were shown on video to the remaining quarter. The assignment to the video group changed daily, so that all students saw both live and video lectures. To compare the effectiveness, it was evaluated for 205 students how video and live students answered the 301 multiple choice questions of the medical exam. Results: There is hardly any difference regarding effectiveness. 36,735 of 46,926 questions (78.283%) were correctly answered by the live group, while 11,617 of 14,779 questions (78.605%) were correctly answered by the video group (n.s., p = 0.407, effect size ω = 0.003337). There were some differences in subjective evaluation: 48% of students preferred live lessons, 27% preferred video lessons and 25% stated ‘neutral’. The items ‘learning atmosphere’, ‘ability to concentrate’, ‘presence of other students’ and ‘acoustic intelligibility’ were assessed significantly better for the video courses than for the live courses. No item of the live course was rated better than in the video course. Conclusions: Video and live lectures are equally effective in preparation for the clinical part of the medical exams. Video lectures offer many benefits for the students and for the faculties, and may complement and partly replace conventional live events.

Background: According to a population-based study, approximately 6.8% of children and adolescents in Germany suffer from acute or chronic constipation. It can be of organic or functional origin and may be associated with comorbid disturbances, particularly fecal incontinence.Methods: We selectively searched the PubMed and Google Scholar databases for articles with the keywords "constipation," "children and adolescents," and "incontinence". Recommendations are based on the AWMF guideline on constipation and fecal incontinence and on international guidelines and reviews.Results: More than 90% of cases of chronic constipation are of functional origin. Organic causes vary with age and call for targeted differential diagnosis. Invasive tests are only rarely necessary. Functional constipation may be associated with fecal and urinary incontinence, and the relative risk of urinary tract infections is 2.2 to 6.5. There may be associated psychological symptoms and mental disorders in 30-50% of cases. The cornerstone of treatment is patient and parent education, along with laxative medication and toilet training. Instructional programs have been found effective in otherwise refractory cases.Conclusion: The treatment of constipation in childhood should begin as soon as the differential diagnostic evaluation is completed. The education of parents, follow-up at close intervals, and drug treatment and behavioral therapy that are adapted to the symptoms can improve quality of life.

Dysbiosis of the gut microbiome and a pathological immune response in intestinal tissues form the basis of Crohn's disease (CD), which is a debilitating disease with relevant morbidity and mortality. It is increasing in childhood and adolescents, due to western life-style and nutrition and a large set of predisposing genetic factors. Crohn's disease-associated genetic mutations play an essential role in killing pathogens, altering mucosal barrier function, and protecting the host microbiome, suggesting an important pathogenic link. The intestinal microbiome is highly variable and can be influenced by environmental factors. Changes in microbial composition and a reduction in species diversity have been shown to be central features of disease progression and are therefore the target of therapeutic approaches. In this review, we summarize the current literature on the role of the gut microbiome in childhood, adolescent, and adult CD, current therapeutic options, and their impact on the microbiome.

Objective A suggested mechanism of functional constipation (FC) is the refusal against painful bowel movements and a vicious circle of holding back stool, hardening, colonic dilatation and further painful defecation. The aim of this study is to describe perception of school toilets, prevalence of functional abdominal pain (FAP) and constipation in elementary schools. Design and Setting All elementary schools in Giessen County, Germany were contacted. Parents received a questionnaire on perception of toilets and criteria of functional abdominal pain and constipation in two consecutive years. Results 212 (76.5%) families responded the child would use the school toilet for passing urine always, commonly or regularly (ACR), only 92 (33.2%) did so for passing stool. 46 (16.6%) were always disgusted by their school toilets, further 145 (52.3%) reported to be disgusted commonly or regularly. 126 parents reported their child would retain stool to avoid using the school toilet (45.5%). Children who were disgusted by and avoided using the school toilet showed significant higher prevalence of abdominal pain ACR (23.6% vs. 11.2%, p=0.0103) Conclusions Prevalence of abdominal pain and constipation is high and increased after one year. Negative perception of school toilets with consecutive avoidance behavior could be an important and improvable influence.

Objective: Among patients with inflammatory bowel disease (IBD), the risk of thromboembolism (TE) is increased, representing a relevant cause of morbidity and mortality. In contrast to other extraintestinal IBD manifestations, TE receives much less attention because of its low incidence, estimated at merely 0.4–0.9% in hospitalised children with IBD.Methods: Cases with TE, as documented in the German-Austrian Paediatric IBD registry gesellschaft für pädiatrische gastroenterologie und ernährung – large paediatric patient registry (CEDATA-GPGE), were analyzed retrospectively. For all patients with signs of TE, a questionnaire was filled in by the treating paediatric gastroenterologist.Results: Over 10 years, 4,153 paediatric patients with IBD (0–18 years) were registered in the registry, and 12 of them identified with TE. Eight patients were diagnosed with ulcerative colitis (UC), three with Crohn’s disease (CD), and one with IBD-unclassified. The median age at IBD diagnosis was 10 years and at the manifestation of TE 13 years, respectively, with a median latency to TE of 2 years. Prevalence of TE was 0.3%, with a significantly higher risk for patients with UC than CD (OR 5.9, CI 1.56–22.33, p = 0.008). More girls than boys were affected (f:m = 7:5) without reaching significance. Approximately 90% of patients experienced TE during active disease, with relevant cerebral and limb involvement in 6/12 patients. Various risk factors, e.g., hospitalisation, coagulopathy, or anaemia were identified. TE management included intensive care and surgery. Among the 12 patients, 11 recovered fully, in which one patient has focal epilepsy as a sequela.Conclusion: Paediatric patients with IBD have a substantially increased risk for TE. Risk factors, such as those identified should be considered when managing paediatric IBD and preventive measures for those hospitalised taken routinely. Initiating pharmacological thromboprophylaxis is challenging for the lack of published trials on efficacy and safety in paediatric IBD but should be considered carefully in each case.

Aim. To determine the prevalence of anemia and its association with disease severity in children and adolescents with IBD.Methods. CEDATA-GPGE is a registry for pediatric patients with IBD in Germany and Austria from 90 specialized centers. As markers of disease severity, analysis included patient self-assessment on a Likert scale (1–5; 1 = very good) and physicians’ general assessment (0 = no activity to 4 = severe disease) and the disease indices. Anemia was defined as hemoglobin concentration below the 3rd percentile.Results. Prevalence of anemia was 65.2% in CD and 60.2% in UC. Anemic CD and UC patients showed significantly worse self-assessment than patients without anemia (average ± standard deviation; CD: 3.0 ± 0.9 versus 2.5 ± 0.9,p<0.0001; UC: 2.9 ± 0.9 versus 2.3 ± 0.9,p<0.0001). Accordingly, physicians’ general assessment (PGA) was significantly worse in anemic than in nonanemic patients in CD (p<0.0001) and UC (p<0.0001). PCDAI in anemic CD,p<0.0001, and PUCAI in anemic UC patients,p<0.0001, were significantly higher than in nonanemic patients. 40.0% of anemic CD and 47.8% of anemic UC patients received iron during follow-up.Conclusion. Almost 2/3 of pediatric IBD patients are anemic. Patients’ self-assessment and disease severity as determined by PGA and activity indices are worse in anemic patients. Contrastingly, only a minority received iron therapy.