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Intensivmedizin und chronisch entzündliche Darmerkrankungen (CED)

Schwerer und fulminanter Schub

Intensive care and inflammatory bowel diseases (IBD)

The severe and fulminant flare

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Zusammenfassung

Chronisch entzündliche Darmerkrankungen sind trotz aller Bemühungen nicht heilbar. Auch wenn es für die Colitis ulcerosa eine definitive chirurgische Behandlungsmöglichkeit zu geben scheint, sind die Patienten sowohl durch eine Entzündung des neu geschaffenen Reservoirs, die Pouchitis, als auch durch peri- und postoperative Komplikationen bedroht. Beim M. Crohn können wir derzeit durch medikamentöse Therapiestrategien eine notwendige Operation hinausschieben, eine definitive Heilung liegt jedoch in weiter Ferne. Die medikamentösen Therapien setzen die Patienten bei aller Wirksamkeit zudem einem potenziell lebensbedrohlichen Risiko aus. Gerade der schwerkranke Patient bedarf einer genauen Beobachtung und entsprechend maßvollen Therapie, die von Gastroenterologen und Chirurgen getragen werden muss. Nach wie vor zielt die konservative Therapie auf eine Unterdrückung erworbener Immunmechanismen und stellt damit keinen kausalen Ansatz dar. Nichtsdestotrotz ist es auf diese Weise gelungen, Operationsnotwendigkeit und Krankenhausaufenthalte zu reduzieren. Die Möglichkeiten und Besonderheiten dieser Strategien für den schweren und fulminanten Schub werden aufgezeigt.

Abstract

Inflammatory bowel disease (IBD) is a non-curable disease. Although we seem to have a definitive surgical solution for ulcerative colitis, patients are at risk of suffering from acute and chronic pouchitis as well as peri- and postoperative complications. In Crohn’s disease medical treatment is able to prolong surgery-free survival, but no definitive healing strategy is as yet at hand. Moreover, effective medication exposes patients to potentially life-threatening complications. The severely compromised patient in particular needs careful surveillance and requires a balanced treatment strategy endorsed by gastroenterologists and surgeons. Treatment is still aimed at suppressing immune mechanisms and is far from being causal. Nevertheless, this approach has resulted in a reduction in surgical procedures and hospitalizations. The following overview covers special issues related to strategies for severe and fulminant flares of inflammatory bowel disease.

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Abbreviations

ASA:

Aminosalizylsäure

BSG:

Blutsenkungsgeschwindigkeit

CDI:

Clostridium-difficile-Infektion

CED:

Chronisch entzündliche Darmerkrankung

CMV:

Zytomegalievirus

CRP:

C-reaktives Protein

CT:

Computertomographie

DGVS:

Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten

ECCO :

European Crohn’s and Colitis Organization

E. coli :

Escherichia coli

EDTA:

„Ethylene diamine tetraacetic acid“

EHEC:

Enterohämorrhagische E. coli

EIEC:

Enteroinvasive E. coli

HE:

Hämatoxylin-Eosin

HSV:

Herpes-simplex-Virus

KG:

Körpergewicht

MP:

Mercaptopurin

MRT:

Magnetresonanztomographie

PCR:

Polymerasekettenreaktion

TNF:

Tumornekrosefaktor

VZV:

Varicella-zoster-Virus

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Interessenkonflikte

Die korrespondierenden Autoren weisen auf folgende Beziehungen hin. Klaus Fellermann hat Vortragshonorare von Abbott, Shire und Falk Pharma bezogen sowie Reisekostenunterstützung von Abbott und Shire erhalten. Jürgen Büning hat Vortragshonorare von Abbott, Shire und Falk Pharma sowie Reisekostenunterstützung von Shire, Abbott und MSD bezogen.

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  1. Bereich Gastroenterologie und Hepatologie, Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein Campus Lübeck , Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    J. Büning & K. Fellermann

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  2. K. Fellermann
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Correspondence to J. Büning.

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Büning, J., Fellermann, K. Intensivmedizin und chronisch entzündliche Darmerkrankungen (CED). Internist 52, 833–842 (2011). https://doi.org/10.1007/s00108-010-2797-9

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