Acta Chirurgica Austriaca

, Volume 27, Issue 3, pp 133–139 | Cite as

Diagnostik und Therapie bei verifizierten chronisch entzündlichen Darmerkrankungen

  • B. Aichbichler
  • Th. Hinterleitner
  • W. Petritsch
Themenschwerpunkt: Entzündliche Darmerkrankungen
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Zusammenfassung

Grundlagen

Colitis ulcerosa und Morbus Crohn sind entzündliche Darmerkrankungen mit chronischem Verlauf. Sie sind gekennzeichnet durch intermittierend auftretende akute Schübe.

Methodik

Ziel dieser Übersicht soll die Zusammenfassung diagnostischer Maßnahmen vor Einleitung einer Therapie bei gesicherter chronisch entzündlicher Darmerkrankung sowie die Darstellung verschiedener medikamentöser Therapiemöglichkeiten sein.

Ergebnisse

Bei bereits in der Vorgeschichte verifizierter Grunderkrankung ist das Ausmaß der diagnostischen Maßnahmen und die Art der Therapie individuell unterschiedlich. Sowohl beim Morbus Crohn als auch bei der Colitis ulcerosa sind die Basis für das Ausmaß der Diagnostik neben einer genauen Anamnese eine physikalische Untersuchung und ein limitierter Laborastatus inklusive Stuhlkultur. Die routinemäßige Durchführung einer Endoskopie bei jedem akuten Schub einer chronisch entzündlichen Darmerkrankung ist nicht notwendig. In der Verlaufsbeobachtung ist beim Morbus Crohn die Röntgenuntersuchung bezüglich der Beurteilung von Fisteln und Stenosen der Endoskopie überlegen. Die konservative Therapie richtet sich nach Aktivität und Lokalisation der Grunderkrankung. Mehrere etablierte Medikamente wie Salazosulfapyridin, 5-Aminosalizylsäure, Kortikosteroide und Azathioprin stehen zur Verfügung. Sowohl als Basistherapie im akuten Schub als auch in der Rezidivprophylaxe werden heute in erster Linie Präparate mit 5-Aminosalizylsäure eingesetzt. Die Auswahl der zur Verfügung stehenden galenischen Präparationen richtet sich nach der Krankheitslokalisation. Bei hoher entzündlicher Aktivität und bei Versagen der Basistherapie sind nach wie vor Kortikosteroide Mittel erster Wahl. Azathioprin hat sich in der Therapie des chronisch aktiven Morbus Crohn etabliert. Dagegen hat sich das Immunsuppressivum Cyclosporin A nur bei akuter, kortisonresistenter Colitis ulcerosa durchgesetzt. Die Wahrscheinlichkeit einer Operation im Verlauf der Erkrankung ist bei Patienten mit bekanntem Morbus Crohn etwa 90%, bei Patienten mit einer Colitis ulcerosa etwa 25%. Operationsindikationen und Zeitpunkt sollten in enger Kooperation zwischen Gastroenterologen und Abdominalchirurgen abgestimmt werden.

Schlußfolgerungen

Bei einem Schub einer verifizierten chronisch entzündlichen Darmerkrankung ist das Ausmaß der diagnostischen Maßnahmen unterschiedlich. Obligat sind ein limitierter Laborstatus sowie eine Stuhlkultur. Die Durchführung einer Endoskopie insbesondere zur Überprüfung des konservativen Therapieerfolges ist nicht notwendig. Die Auswahl konservativer Therapien wie 5-Aminosalizylsäure, Kortikosteroide und verschiedener Immunsuppressiva richtet sich nach dem Grad der Entzündung und der Lokalisation der Grunderkrankung.

Schlüsselwörter

Morbus Crohn Colitis ulcerosa Diagnostik konservative Therapie 

Verified inflammatory bowel disease: Diagnosis and treatment

Summary

Background

Ulcerative colitis and Crohn's disease are chronic inflammatory bowel diseases which are characterized by recurrent exacerbation of acute inflammation, demanding different diagnostic approaches and medical treatment.

Methods

This article reviews the diagnostic procedures and recommended treatment in patients with established diagnosis.

Results

Management with each relapse of Crohn's disease and ulcerative colitis include a detailed medical history, a physical examination, blood tests and one stool culture. Routine endoscopy with each relapse of inflammatory bowel disease is not necessary. To evaluate fistulas and stenosis in the course of Crohn's disease radiology is superior to endoscopy. Medical treatment depends on activity, extent and site of the disease. Well established drugs for therapy include sulphasalazine, 5-aminosalicylic acid, corticosteroids and azathioprin. 5-Aminosalicylic acid is the drug of choice in moderately active disease and for maintenance therapy. The use of different galenic preparations of 5-aminosalicylic acid should depend on extent and site of the disease. Corticosteroids are drugs of first choice in patients with high inflammatory activity. Their use is also indicated if therapy with 5-aminosalicylic acid fails. Azathioprin is well established in the treatment of chronic active Crohn's disease. The immunosuppressive agent cyclosporine A has been shown to be effective only in severe ulcertive colitis which is refractory to corticosteroids. About 90% of patients with Crohn's disease and 25% with ulcerative colitis will need surgical intervention during the course of the disease. Criteria and timing for surgical intervention should be planned in close cooperation between gastroenterologist and abdominal surgeon.

Conclusions

Management with each relapse of a verified inflammatory bowel disease is individually different. A blood test and a stool culture should be done obligatory. Routine endoscopy with each relapse is not necessary. Well established drugs for therapy include 5-aminosalicylic acid, corticosteroids and different immunosuppressive agents. The choice of medical treatment depends of activity, extent and site of the disease.

Key-words

Crohn's disease ulcerative colitis diagnostic procedures medical treatment 

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Copyright information

© Blackwell Science Ltd 1995

Authors and Affiliations

  • B. Aichbichler
    • 1
  • Th. Hinterleitner
    • 1
  • W. Petritsch
    • 1
  1. 1.Klinische Abteilung für GastroenterologieMedizinische UniversitätsklinikGraz

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