Zusammenfassung
Das Therapiespektrum bei Colitis ulcerosa hat sich in den letzten Jahren deutlich erweitert. Mesalazin gilt bei der unkomplizierten Colitis ulcerosa in unterschiedlichen Applikationsformen nach wie vor als Standardtherapeutikum. Glukokortikoide sind hochwirksam in der Akuttherapie der Colitis ulcerosa, aufgrund der ausgeprägten Nebenwirkungen aber nur kurzfristig einzusetzen. Für komplizierte Verlaufsformen der Colitis ulcerosa stehen nach Versagen der konventionellen Therapie immunsupprimierende und -modulierende Substanzen wie Azathioprin sowie verschiedene Biologika, Januskinase-Inhibitoren (JAKi), Sphingosin-1-Phosphat-Rezeptor-Agonisten (S1PR-Agonisten) und Calcineurin-Inhibitoren zur Verfügung. Eine Proktokolektomie sollte bei therapierefraktärem Verlauf oder beim Nachweis von Karzinomen und höhergradigen epithelialen Dysplasien erwogen werden.
Abstract
The treatment spectrum for ulcerative colitis has greatly increased in recent years. Mesalazine is still the standard drug treatment for uncomplicated ulcerative colitis in various forms of administration. Glucocorticoids are highly effective in the acute treatment of ulcerative colitis but should only be used on a short-term basis due to the pronounced side effects. For forms with a complicated course of ulcerative colitis, immunosuppressive and immunomodulating substances, such as azothioprine as well as various biologicals, Janus kinase inhibitors (JAKi), sphingosine-1-phosphate receptor agonists (S1PR agonists) and calcineurin inhibitors are available after failure of conventional treatment. A proctocolectomy should be considered in cases of a treatment-refractive course or with detection of carcinomas and high-grade epithelial dysplasia.
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T. Kucharzik: Von folgenden Unternehmen erfolgten Honorare im Rahmen einer Berater- oder Vortragstätigkeit: Abbvie, Amgen, Arena Pharmaceuticals, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Dr. Falk Pharma, Ferring Arzneimittel, Galapagos, Gilead, Janssen, MSD Sharp & Dome GmbH, Pfizer, Roche, Takeda Pharma, Vifor Pharma.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Kucharzik, T. Living Guideline Colitis ulcerosa. Chirurg 93, 261–265 (2022). https://doi.org/10.1007/s00104-022-01594-y
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DOI: https://doi.org/10.1007/s00104-022-01594-y