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Chronisch-entzündliche Darmerkrankungen

Medikamentöse Therapie im Kindes- und Jugendalter

  • Chronisch-entzündliche Darmerkrankungen
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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Für die Remissionseinleitung der Colitis ulcerosa (CU) und des Morbus Crohn (MC) mit leichter und mittlerer Aktivität sind insbesondere die 5-Aminosalizylate geeignet. In schweren Fällen kommen Steroide peroral oder systemisch zum Einsatz. Budesonid kann bei Kindern mit ileozökalem MC verwendet werden. In der Langzeittherapie beider Erkrankungen haben Immunsuppressiva, insbesondere Azathioprin, eine große Bedeutung und werden zunehmend häufig und langfristig eingesetzt. Für „steroidrefraktäre“ Patienten mit CU kann der Einsatz von Cyclosporin A erwogen werden, bei Patienten mit MC stellt Infliximab die nächste Stufe der medikamentösen Therapie dar. Es ist außerdem in der Fisteltherapie des MC effektiv. Während 5-ASA-Präparate für die Remissionserhaltung der CU einen sicheren Stellenwert haben, kann dies in der Therapie des MC (noch) nicht mit gleicher Evidenz belegt werden. Antibiotika wie Metronidazol oder Ciprofloxacin zeigen eine gewisse Wirksamkeit in der Therapie des MC, insbesondere werden sie zur Behandlung von Fisteln oder der Pouchitis eingesetzt. Probiotika sind eine mögliche therapeutische Option, deren Bedeutung weiter untersucht werden wird.

Abstract

5-Aminosalicylates (5-ASA) are effective in inducing remission in low to moderate disease activity in both ulcerative colitis (UC) and Crohn’s disease (CD). In severe cases steroids are given, either orally or i.v. Budesonide might be an alternative for children with ileocoecal CD. Immunosuppressives such as azathioprin are an important weapon in the long-term treatment of patients with either UC or CD and are prescribed with increasing frequency and for increasingly long-term periods. In patients whose disease is refractory to steroids cyclosporin A can be considered for UC, while in those with CD the next step is to give infliximab, which is also effective in the treatment of fistulizing CD. Whilst 5-ASAs have been shown to be useful in the long-term treatment of UC, corresponding data obtained in CD are not (yet) convincing. Antibiotics, mainly metronidazole and ciprofloxacin, have some effect in CD, but mainly for the treatment of fistulizing CD and pouchitis. Probiotics could be a new option for therapy, and their significance is to be subjected to further investigation.

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  1. Zentrum für Kinderheilkunde, Universitätsklinikum Bonn

    S. Buderus

  2. Zentrum für Kinderheilkunde, Universitätsklinikum Bonn, Adenauerallee 119, 53113, Bonn

    S. Buderus

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Buderus, S. Chronisch-entzündliche Darmerkrankungen . Monatsschr Kinderheilkd 152, 133–144 (2004). https://doi.org/10.1007/s00112-004-0895-2

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