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Differenzialdiagnose der entzündlichen Enddarmerkrankungen

Differential diagnosis of inflammatory diseases of the rectum

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Zusammenfassung

Bei Patienten mit einer Proktitis – mit den Symptomen Tenesmen, anorektale Schmerzen, Diarrhö, Stuhldrang, Schleim- oder Blutabgang und Schmerzen im linken Unterbauch – sollte neben chronisch-entzündlichen Darmkrankheiten immer auch an die Möglichkeit einer infektiösen Ursache gedacht werden. Die Sexualanamnese, insbesondere der rezeptive anale Verkehr (dies muss auch bei heterosexuellen Frauen und auch bei Männern erhoben werden), spielt hier eine entscheidende Rolle. Patienten müssen über mögliche Risiken informiert und ggf. frühzeitig behandelt werden. Bei Nachweis einer Geschlechtskrankheit sollte dem Patienten ein weiterführendes Screening auf sexuell übertragbare Infektionen („sexually transmitted diseases“, STD) unter Einschluss eines HIV-Tests angeboten werden, da häufig mehrere Geschlechtskrankheiten gleichzeitig vorliegen können. Einer adäquaten und unverzüglichen Diagnostik sowie Therapie inklusive einer intensivierten Partnerbenachrichtigung und ggf. -therapie kommt hier eine besondere Bedeutung zu.

Abstract

In patients with proctitis—which include the symptoms tenesmus, anorectal pain, diarrhea, urge to defecate, discharge of mucus or blood, and pain in the left lower abdomen—the possibility of an infection should always be considered in addition to inflammatory bowel diseases. The patient’s sexual history, especially of receptive anal intercourse (this must be considered not only in men, but also in heterosexual women), plays a crucial role and patient must be informed about potential risks and, if necessary, be treated early. If a sexually transmitted disease (STD) is diagnosed, the patient should be offered further screening for other STDs, including an HIV test because several STDs often present simultaneously. Adequate and prompt diagnosis and treatment including partner notification and, if appropriate, partner therapy are of particular importance.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S.R. Vavricka, L. Biedermann und G. Rogler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to Prof. Dr. S.R. Vavricka.

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Vavricka, S., Biedermann, L. & Rogler, G. Differenzialdiagnose der entzündlichen Enddarmerkrankungen. Gastroenterologe 10, 174–184 (2015). https://doi.org/10.1007/s11377-015-0992-x

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Schlüsselwörter

  • Sexuell übertragbare Erkrankungen
  • Morbus Crohn
  • Proktokolitis
  • Syphilis
  • Neisseria gonorrhoeae

Keywords

  • Sexually transmitted diseases
  • Crohn disease
  • Proctocolitis
  • Syphilis
  • Neisseria gonorrhoeae