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Klinik, CRP, Calprotectin, MRT oder Endoskopie?

Strategien zur sinnvollen Therapieüberwachung bei CED

Clinical symptoms, C-reactive protein, calprotectin, MRI or endoscopy?

Stragegies for therapy monitoring of IBD

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coloproctology Aims and scope

Zusammenfassung

Die Durchführung einer individualisierten Therapie chronisch-entzündlicher Darmerkrankungen bedarf einer intensiven Überwachung, insbesondere bei Patienten mit Risikoprofil für schwerwiegende Verläufe sowie nachweisbarer Entzündung. Eine rein klinische Evaluation hat eine Reihe von Limitationen, so dass weitere Instrumente zur Erfassung der Entzündung notwendig sind. Zu den nichtinvasiven Maßnahmen der Therapieüberwachung gehören insbesondere das CRP bei Morbus Crohn sowie fäkale Stuhlmarker wie Calprotectin für Morbus Crohn und Colitis ulcerosa, die teilweise eine sehr gute Korrelation zur endoskopischen Aktivität aufweisen. Zudem korrelieren Veränderungen dieser Parameter mit einem Therapieansprechen und weisen auf eine erhöhte Rezidivgefahr hin. Die Endoskopie bleibt allerdings weiterhin eine wichtige Methode in der Therapieüberwachung, die gerade bei wichtigen Therapieentscheidungen herangezogen werden muss. Nach Therapieeskalation oder auch -deeskalation kann man sich in der Beurteilung der Effektivität oft auf die Überprüfung von CRP und/oder fäkales Calprotectin beschränken und somit erneute endoskopische Untersuchungen vermeiden. Weniger gut evaluiert in der Therapieüberwachung sind Ultraschall, MRT und Kapselendoskopie, so dass diese eher in Einzelfällen herangezogen werden. Somit stehen insbesondere mit CRP und Calprotectin neben der Endoskopie wichtige Hilfsmittel zur Verfügung, um die Therapie chronisch-entzündlicher Darmerkrankungen nachhaltig zu optimieren.

Abstract

Close monitoring of the therapeutic efficacy and inflammation in inflammatory bowel diseases (IBD) is important in order to improve outcome and realize individualized treatment. As a symptom-based evaluation only has several limitations more objective tools are necessary. In this aspect C-reactive protein (CRP) especially in Crohn’s disease (CD) and fecal markers, such as calprotectin in both CD and ulcerative colitis (UC) have been shown to be associated with the inflammatory burden and endoscopic activity. Furthermore, they correlate well with treatment response and can be used in order to make a better prediction of disease relapse. Endoscopic evaluation is, however, still often necessary especially for important decisions on either treatment intensification or de-escalation. During therapy CRP and fecal markers can be used to evaluate efficacy and often make endoscopic interventions unnecessary. Ultrasound, magnetic resonance imaging (MRI) and capsule endoscopy are less well evaluated and are reserved for solitary cases. In summary, CRP, fecal calprotectin in addition to endoscopy represent important tools in order to optimize IBD treatment.

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Interessenkonflikt

Der korrespondierende Autor weist für sich auf Beziehungen zu folgenden Firmen hin: MSO (Beratertätigkeit, Vortragshonorare, Reisekostenzuschüsse); Abbot, Ferring (Reisekostenzuschüsse). M. Prager erhielt Reisekostenzuschüsse von MSO.

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  1. Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    M. Prager &  C. Büning

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  1. M. Prager
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Correspondence to C. Büning.

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Dieser Beitrag wurde erstpubliziert in Der Gastroenterologe 8:187–196.

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Prager, M., Büning, C. Klinik, CRP, Calprotectin, MRT oder Endoskopie?. coloproctology 36, 250–258 (2014). https://doi.org/10.1007/s00053-014-0464-7

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