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Erstsymptome, extraintestinale Manifestationen und Schwangerschaftsverlauf bei chronisch entzündlichen Darmerkrankungen

Initial symptoms, extraintestinal manifestations and course of pregnancy in 392 patients with inflammatory bowel disease

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Coloproctology Aims and scope

Zusammenfassung

Chronisch entzündliche Darmerkrankungen werden häufig von extraintestinalen Manifestationen begleitet, die zusammen mit Diarrhöen und Schmerzen zu einer deutlichen Beeinträchtigung der Lebensqualität führen können. Ziel dieser Studie war es, Daten zu Erstsymptomen, extraintestinalen Manifestationen und Schwangerschaftsverläufen aus einem großen Patientenkollektiv des süddeutschen Raumes zu gewinnen.

Daten von 392 Patienten aus den Jahren 1975 bis 1989 wurden analysiert und teilweise mit aktuelleren Daten eines anderen Kollektivs von 211 Patienten (1992 bis 1995) verglichen.

Patienten mit Morbus Crohn waren zum Zeitpunkt der ersten Symptome im Schnitt 25 Jahre, diejenigen mit Colitis ulcerosa 30 Jahre alt. Die Gruppe der Patienten mit besonders langer Latenz zwischen ersten Symptomen und der Erstdiagnose (>1 Jahr) hat sich bei Morbus Crohn deutlich verkleinert, umfaßt aber immer noch 38%, wohingegen nur 23% der Kolitispatienten länger als ein Jahr ohne Diagnose waren. Führende erste Symptome beim Morbus Crohn waren Unwohlsein, Schmerzen und unblutige Diarrhöen, während die Colitis ulcerosa sich meistens mit blutigen Durchfällen manifestierte. 64,6% der Patienten mit Colitis ulcerosa und 76,0% der Crohn-Patienten entwickelten extraintestinale Manifestationen, 15 von 37 Schwangerschaften bei Morbus Crohn und sechs von zehn der Schwangerschaften bei Colitis ulcerosa waren durch Komplikationen geprägt.

Eine bessere Kenntnis der Initialsymptome und der extraintestinalen Manifestationen konnte den Anteil extrem langer Latenzen vom Auftreten der Symptomatik bis zur Diagnose verringern. Schwangere Patientinnen mit chronisch entzündlicher Darmerkrankung bedürfen einer intensivierten Überwachung.

Abstract

In many cases inflammatory bowel disease is accompanied by extraintestinal manifestations. This results in lowering of live quality. The aim of this study was to gather data retrospectively about initial symptoms, extraintestinal manifestations and course of pregnancy in a large unselected population with inflammatory bowel disease in South Germany.

Data from 1975 to 1989 (392 patients) were analyzed and partially compared with data from 1992 to 1995 (211 patients).

Patients with Crohn’s disease in average have been 25 years old at the time point of initial symptoms, whereas the age of ulcerative colitis patients was 30 years (p<0.0001). The number of Crohn’s disease patients with a long interval between initial symptoms and diagnosis (>1 year) was significantly decreased in the second population (50% vs 38%; p<0.05). Dominant initial symptoms in Crohn’s disease were indisposition, abdominal pain and non-bloody diarrhea in contrast to ulcerative colitis which manifested mostly with bloody diarrhea. Extraintestinal manifestations occurred in 76% of patients with Crohn’s disease and 64.6% with ulcerative colitis. Complications during the course of pregnancy have been detected in 40.5% in Crohn’s disease and 60% in ulcerative colitis.

A better knowledge of initial symptoms and extraintestinal manifestations in inflammatory bowel disease can help to decrease the interval between initial symptoms and the diagnosis. Pregnancy in patients with inflammatory bowel disease needs to be treated with special care.

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin 1, Klinikum der Universität, D-93042, Regensburg

    Heiko C. Rath, Tilo Andus, Inka Caesar & Jürgen Schölmerich

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  1. Heiko C. Rath
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  2. Tilo Andus
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  3. Inka Caesar
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  4. Jürgen Schölmerich
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Correspondence to Heiko C. Rath.

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Rath, H.C., Andus, T., Caesar, I. et al. Erstsymptome, extraintestinale Manifestationen und Schwangerschaftsverlauf bei chronisch entzündlichen Darmerkrankungen. Coloproctol 20, 214–221 (1998). https://doi.org/10.1007/BF03043890

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