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Therapie der extraintestinalen CED-Manifestationen

Eine schwierige Herausforderung

Therapy of extraintestinal manifestion in CIBD

A difficult challenge

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coloproctology Aims and scope

Zusammenfassung

Morbus Crohn und Colitis ulcerosa sind chronisch-entzündliche Darmerkrankungen (CED), die nicht auf das Gastrointestinalsystem beschränkt sind. Zusätzlich können diverse Organsysteme mit betroffen sein, was die CED zu einer Systemerkrankung macht. Die häufigsten extraintestinalen Manifestationen beinhalten muskuloskelettale, ophthalmologische, dermatologische und hepatobiliäre Erkrankungen, obwohl prinzipiell jedes Organsystem betroffen sein kann. Sie können signifikant zur Morbidität von CED-Patienten beitragen und die Lebensqualität deutlich einschränken. Die Betreuung sollte aufgrund der Vielfalt der betroffenen Organsysteme interdisziplinär durch ein in der CED-Behandlung geschultes medizinisches Personal erfolgen. Ein frühes Erkennen von extraintestinalen Manifestationen ermöglicht eine gezielte Therapie und verringert die Gesamtmorbidität der betroffenen Patienten. Insbesondere kann eine effektive Erhaltungstherapie das Auftreten von Manifestationen, die eng mit der Krankheitsaktivität der zugrunde liegenden CED verknüpft sind, vermeiden helfen. Neben spezifischen Interventionen, die nicht mit der Krankheitsaktivität der CED verknüpft sind, spielt eine antiinflammatorische oder immunmodulatorische Therapie eine entscheidende Rolle. Zudem gewinnt die Verwendung einer TNF-Hemmer-Therapie in der Behandlung von verschiedenen extraintestinalen Manifestationen zunehmend an Bedeutung.

Abstract

Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases (CIBD) which are not limited to the gastrointestinal system. Diverse other organ systems can be affected which makes CIBD into a systemic disease. The most common extraintestinal manifestations include musculoskeletal, ophthalmological, dermatological and hepatobiliary diseases although every organ system can principally be affected. They can make a significant contribution to morbidity in patients with CIBD and severely limit the quality of life. Due to the multitude of affected organ systems treatment is interdisciplinary and carried out by medical personnel trained in the treatment of CIBD. Early recognition of extraintestinal manifestations allows targeted therapy and reduces the total morbidity of affected patients. An effective maintenance therapy in particular can help to avoid the occurrence of manifestations which are closely linked to the disease activity of the underlying CIBD. Apart from specific interventions which are not linked to the disease activity of CIBD, anti-inflammatory and immunomodulatory therapies play a decisive role. Additionally, the use of tumor necrosis factor (TNF) inhibition therapy is becoming increasingly more important for the treatment of various extraintestinal manifestations.

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Literatur

  1. Peyrin-Biroulet L et al (2011) Long-term complications, extraintestinal manifestations, and mortality in adult Crohn’s disease in population-based cohorts. Inflamm Bowel Dis 17: 471–478

    Article  PubMed  Google Scholar 

  2. Lakatos L et al (2003) Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype: results of a 25-year follow-up study. World J Gastroenterol 9: 2300–2307

    PubMed  Google Scholar 

  3. Vavricka SR et al (2011) Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort. Am J Gastroenterol 106: 110–119

    Article  PubMed  Google Scholar 

  4. Bernstein CN et al (2001) The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol 96: 1116–1122

    Article  CAS  PubMed  Google Scholar 

  5. Bernstein CN (2002) Treatment of the extraintestinal manifestations of inflammatory bowel disease. Curr Gastroenterol Rep 4: 513–516

    Article  PubMed  Google Scholar 

  6. Orchard TR, Wordsworth BP, Jewell DP (1998) Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut 42: 387–391

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Russell AS (1977) Arthritis, inflammatory bowel disease, and histocompatibility antigens. Ann Intern Med 86: 820–821

    Article  CAS  PubMed  Google Scholar 

  8. Van Assche G et al (2010) The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: special situations. J Crohns Colitis 4: 63–101

    Article  Google Scholar 

  9. Van Assche G et al (2012) Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 3: Special situations. J Crohn’s colitis

  10. Singh S, Graff LA, Bernstein CN (2009) Do NSAIDs, antibiotics, infections, or stress trigger flares in IBD? Am J Gastroenterol 104: 1298–1313 (quiz 1314)

    Article  CAS  PubMed  Google Scholar 

  11. Lakatos PL et al (2012) Treatment of extraintestinal manifestations in inflammatory bowel disease. Digestion, 86(Suppl 1): 28–35

  12. Herfarth H et al (2002) Improvement of arthritis and arthralgia after treatment with infliximab (Remicade) in a German prospective, open-label, multicenter trial in refractory Crohn’s disease. Am J Gastroenterol 97: 2688–2690

    Article  PubMed  Google Scholar 

  13. Kaufman I et al (2005) The effect of infliximab on extraintestinal manifestations of Crohn’s disease. Rheumatol Int 25: 406–410

    Article  CAS  PubMed  Google Scholar 

  14. Zochling J et al (2006) Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Ann Rheum Dis 65: 423–432

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Ardizzone S et al (2008) Extraintestinal manifestations of inflammatory bowel disease. Dig Liver Dis 40(Suppl 2): S253–S259

    Article  PubMed  Google Scholar 

  16. Orchard TR et al (2002) Uveitis and erythema nodosum in inflammatory bowel disease: clinical features and the role of HLA genes. Gastroenterology 123: 714–718

    Article  PubMed  Google Scholar 

  17. Farhi D et al (2008) Significance of erythema nodosum and pyoderma gangrenosum in inflammatory bowel diseases: a cohort study of 2402 patients. Medicine 87: 281–293

    Article  PubMed  Google Scholar 

  18. Travis S et al (1997) Sweet’s syndrome: an unusual cutaneous feature of Crohn’s disease or ulcerative colitis. The South West Gastroenterology Group. Eur J Gastroenterol Hepatol 9: 715–720

    Article  CAS  PubMed  Google Scholar 

  19. Orchard T (2003) Extraintestinal complications of inflammatory bowel disease. Curr Gastroenterol Rep 5: 512–517

    Article  PubMed  Google Scholar 

  20. Juillerat P et al (2007) Extraintestinal manifestations of Crohn’s disease. Digestion 76: 141–148

    Article  CAS  PubMed  Google Scholar 

  21. Bennett ML et al (2000) Pyoderma gangrenosum. A comparison of typical and atypical forms with an emphasis on time to remission. Case review of 86 patients from 2 institutions. Medicine 79: 37–46

    Article  CAS  PubMed  Google Scholar 

  22. Brooklyn TN et al (2006) Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut 55: 505–509

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Dabade TS, Davis MD (2011) Diagnosis and treatment of the neutrophilic dermatoses (pyoderma gangrenosum, Sweet’s syndrome). Dermatol Ther 24: 273–284

    Article  PubMed  Google Scholar 

  24. Trost LB, McDonnell JK (2005) Important cutaneous manifestations of inflammatory bowel disease. Postgrad Med J 81(959): 580–585

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Manganelli C, Turco S, Balestrazzi E (2009) Ophthalmological aspects of IBD. Eur Rev Med Pharmacol Sci 13 (Suppl 1): 11–13

    PubMed  Google Scholar 

  26. Biancone L et al (2008) European evidence-based Consensus on the management of ulcerative colitis: Special situations. J Crohns Colitis 2: 63–92

    Article  PubMed  Google Scholar 

  27. Mintz R et al (2004) Ocular manifestations of inflammatory bowel disease. Inflamm Bowel Dis 10: 135–139

    Article  PubMed  Google Scholar 

  28. Michaels A, Levy C (2008) The medical management of primary sclerosing cholangitis. Medscape J Med 10: 61

    PubMed Central  PubMed  Google Scholar 

  29. Smith MP, Loe RH (1965) Sclerosing Cholangitis; review of recent case reports and associated diseases and four new cases. Am J Surg 110: 239–246

    Article  CAS  PubMed  Google Scholar 

  30. Olsson R et al (1991) Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis. Gastroenterology 100: 1319–1323

    CAS  PubMed  Google Scholar 

  31. Ghazale A et al (2008) Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology 134: 706–715

    Article  PubMed  Google Scholar 

  32. Ashraf I et al (2012) Ursodeoxycholic acid in patients with ulcerative colitis and primary sclerosing cholangitis for prevention of colon cancer: a meta-analysis. Indian J Gastroenterol 31: 69–74

    Article  PubMed  Google Scholar 

  33. Eaton JE et al (2011) High-dose ursodeoxycholic acid is associated with the development of colorectal neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis. Am J Gastroenterol 106: 1638–1645

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Barnabas A, Chapman RW (2012) Primary sclerosing cholangitis: is any treatment worthwhile? Curr Gastroenterol Rep 14: 17–24

    Article  PubMed  Google Scholar 

  35. Barrie A, Regueiro M (2007) Biologic therapy in the management of extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis 13: 1424–1429

    Article  PubMed  Google Scholar 

  36. (o A) 2001 NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7–29, 2000: highlights of the conference. South Med J 94: 569–573

  37. Reinshagen M (2008) Osteoporosis in inflammatory bowel disease. J Crohns Colitis 2: 202–207

    Article  PubMed  Google Scholar 

  38. Miheller P, Lorinczy K, Lakatos PL (2010) Clinical relevance of changes in bone metabolism in inflammatory bowel disease. World J Gastroenterol 16: 5536–5542

    Article  PubMed Central  PubMed  Google Scholar 

  39. Jahnsen J et al (1997) Bone mineral density is reduced in patients with Crohn’s disease but not in patients with ulcerative colitis: a population based study. Gut 40: 313–319

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Ghosh S et al (1994) Low bone mineral density in Crohn’s disease, but not in ulcerative colitis, at diagnosis. Gastroenterology 107: 1031–1019

    CAS  PubMed  Google Scholar 

  41. Bernstein M, Irwin S, Greenberg GR (2005) Maintenance infliximab treatment is associated with improved bone mineral density in Crohn’s disease. Am J Gastroenterol 100: 2031–2035

    Article  CAS  PubMed  Google Scholar 

  42. Miheller P et al (2007) Changes of OPG and RANKL concentrations in Crohn’s disease after infliximab therapy. Inflamm Bowel Dis 13: 1379–1384

    Article  PubMed  Google Scholar 

  43. Miehsler W et al (2004) Is inflammatory bowel disease an independent and disease specific risk factor for thromboembolism? Gut 53: 542–548

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Nguyen GC, Sam J (2008) Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 103: 2272–2280

    Article  PubMed  Google Scholar 

  45. Papay P et al (2012) Clinical presentation of venous thromboembolism in inflammatory bowel disease. J Crohns Colitis

  46. Novacek G et al (2010) Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism. Gastroenterology 139: 779–787, 787 e1

    Article  PubMed  Google Scholar 

  47. Cohen AT et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371 (9610): 387–394

    Article  PubMed  Google Scholar 

  48. Geerts WH et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133 (Suppl 6): 381S–453S

    Article  CAS  PubMed  Google Scholar 

  49. Dobromirski M, Cohen AT (2012) How I manage venous thromboembolism risk in hospitalized medical patients. Blood 120: 1562–1569

    Article  CAS  PubMed  Google Scholar 

  50. Lloyd NS et al (2008) Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and meta-analysis. J Thromb Haemost 6: 405–414

    Article  CAS  PubMed  Google Scholar 

  51. Kahn SR et al (2012) Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 141 (Suppl 2): e195S–e226S

  52. Qaseem A et al (2011) Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med 155: 625–632

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Zürich, Schweiz

    J. Zeitz

  2. Klinik für Gastroenterologie und Hepatologie, UniversitätsSpital Zürich, Zürich, Schweiz

    J. Zeitz &  S.R. Vavricka

  3. Klinik für Gastroenterologie und Hepatologie, Stadtspital Triemli, Birmensdorferstr. 497, 8063, Zürich, Schweiz

    S.R. Vavricka

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  1. J. Zeitz
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  2. S.R. Vavricka
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Correspondence to S.R. Vavricka.

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Dieser Beitrag wurde erstpubliziert in Der Gastroenterologe 8:217–225.

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Zeitz, J., Vavricka, S. Therapie der extraintestinalen CED-Manifestationen. coloproctology 36, 439–446 (2014). https://doi.org/10.1007/s00053-014-0470-9

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