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Monatsschrift Kinderheilkunde

, Volume 165, Issue 3, pp 257–270 | Cite as

Chronisch entzündliche Darmerkrankungen

  • T. Schwerd
  • S. Koletzko
CME

Zusammenfassung

Die Zahl der Kinder und Jugendlichen mit chronisch entzündlicher Darmerkrankung (CED) steigt, v. a. in Ländern mit westlichem Lebensstil. Weil die frühzeitige Diagnose und Therapie den Krankheitsverlauf maßgeblich beeinflussen, ist die enge Zusammenarbeit zwischen Kinderarzt und pädiatrischen Gastroenterologen notwendig. Nach Ausschluss infektiöser Ursachen muss bei chronischen oder rezidivierenden Beschwerden eine CED ausgeschlossen werden. Erhöhte Konzentrationen der Inflammationsmarker im Stuhl (z. B. Calprotectin) sind sehr sensitiv bei aktiver CED, aber nicht spezifisch. Überwiegend beinhaltet die Diagnostik die Endoskopie und die Dünndarmdarstellung. Neben medikamentöser und Ernährungstherapie bei Morbus Crohn stehen neue Biologika und Immunmodulatoren zur Verfügung. Grundlage des Einsatzes sind Kenntnis der Wirkungen, potenziellen Nebenwirkungen, Interaktionen und individueller Risikofaktoren, die exakte diagnostische Einordnung der CED sowie die Bestimmung der Krankheitsaktivität.

Schlüsselwörter

Gastrointestinaltrakt Morbus Crohn Colitis ulcerosa Calprotectin Immunmodulatoren 

Inflammatory bowel disease

Abstract

Chronic inflammatory bowel disease (IBD) is increasingly recognized in children and adolescents, particularly in countries with Western lifestyle. As timely diagnosis and therapy have a significant impact on the long-term outcome of the disease, close cooperation between pediatricians and pediatric gastroenterologists is necessary. In the absence of infectious causes IBD must be excluded in cases of chronic or recurrent symptoms. Increased concentrations of inflammatory markers in feces (e. g. calprotectin) are very sensitive in active IBD but not specific. The diagnostic work-up essentially includes endoscopy and small bowel imaging. In addition to pharmaceutical treatment and nutritional therapy for Crohn’s disease, new biologicals and immunomodulators are available. To tailor treatment modalities knowledge of drug effects, potential side effects, drug interactions, individual risk factors, IBD phenotype as well as disease activity is required.

Keywords

Gastrointestinal tract Crohn’s disease Ulcerative colitis Calprotectin Immunomodulators 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Schwerd erhielt Sprecher- bzw. Autorenhonorar von MSD und Falk Pharma. S. Koletzko erhielt Forschungsgelder von Mead Johnson, Nestle-Nutrition, Immundiagnostik, ThermoFisher, Euroimmum, Inova, R‑Biopharm und Eurospital. Sie erhielt Sprecher-, Autoren- oder Beratungshonorare von Abbvie, Danone, Janssen, Hipp, Menarini, Merck, MSD, Nestle Nutrition, Vifor, Boehringer Ingelheim, Biocodex, Thermofischer und Shire.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Benchimol EI, Fortinsky KJ, Gozdyra P et al (2011) Epidemiology of pediatric inflammatory bowel disease: A systematic review of international trends. Inflamm Bowel Dis 17:423–439CrossRefPubMedGoogle Scholar
  2. 2.
    Benchimol EI, Mack DR, Nguyen GC et al (2014) Incidence, outcomes, and health services burden of very early onset inflammatory bowel disease. Gastroenterology 147:803–813CrossRefPubMedGoogle Scholar
  3. 3.
    Maloy KJ, Powrie F (2011) Intestinal homeostasis and its breakdown in inflammatory bowel disease. Nature 474:298–306CrossRefPubMedGoogle Scholar
  4. 4.
    Khor B, Gardet A, Xavier RJ (2011) Genetics and pathogenesis of inflammatory bowel disease. Nature 474:307–317CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    El Mouzan MI, Saadah O, Al-Saleem K et al (2014) Incidence of pediatric inflammatory bowel disease in Saudi Arabia: A multicenter national study. Inflamm Bowel Dis 20:1085–1090PubMedGoogle Scholar
  6. 6.
    Levine A, Koletzko S, Turner D et al (2014) ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 58:795–806PubMedGoogle Scholar
  7. 7.
    Prenzel F, Uhlig HH (2009) Frequency of indeterminate colitis in children and adults with IBD – a metaanalysis. J Crohns Colitis 3:277–281CrossRefPubMedGoogle Scholar
  8. 8.
    Buderus S, Scholz D, Behrens R et al (2015) Inflammatory bowel disease in pediatric patients: Characteristics of newly diagnosed patients from the CEDATA-GPGE Registry. Dtsch Arztebl Int 112:121–127PubMedPubMedCentralGoogle Scholar
  9. 9.
    Moller FT, Andersen V, Wohlfahrt J et al (2015) Familial risk of inflammatory bowel disease: A population-based cohort study 1977–2011. Am J Gastroenterol 110:564–571CrossRefPubMedGoogle Scholar
  10. 10.
    Mack DR, Langton C, Markowitz J et al (2007) Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics 119:1113–1119CrossRefPubMedGoogle Scholar
  11. 11.
    Uhlig HH, Schwerd T, Koletzko S et al (2014) The diagnostic approach to monogenic very early onset inflammatory bowel disease. Gastroenterology 147:990–1007CrossRefPubMedGoogle Scholar
  12. 12.
    Ruemmele FM, Veres G, Kolho KL et al (2014) Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns Colitis 8:1179–1207CrossRefPubMedGoogle Scholar
  13. 13.
    Turner D, Levine A, Escher JC et al (2012) Management of pediatric ulcerative colitis: Joint ECCO and ESPGHAN evidence-based consensus guidelines. J Pediatr Gastroenterol Nutr 55:340–361CrossRefPubMedGoogle Scholar
  14. 14.
    Danese S, Vuitton L, Peyrin-Biroulet L (2015) Biologic agents for IBD: practical insights. Nature reviews. Gastroenterol Hepatol 12:537–545Google Scholar
  15. 15.
    Singh N, Rabizadeh S, Jossen J et al (2016) Multi-center experience of Vedolizumab effectiveness in pediatric inflammatory bowel disease. Inflamm Bowel Dis 22:2121–2126CrossRefPubMedGoogle Scholar
  16. 16.
    Ungar B, Kopylov U (2016) Advances in the development of new biologics in inflammatory bowel disease. Ann Gastroenterol 29:243–248PubMedPubMedCentralGoogle Scholar
  17. 17.
    Ardizzone S, Bevivino G, Monteleone G (2016) Mongersen, an oral Smad7 antisense oligonucleotide, in patients with active Crohn’s disease. Therap Adv Gastroenterol 9:527–532CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Veereman-Wauters G, De Ridder L, Veres G et al (2012) Risk of infection and prevention in pediatric patients with IBD: ESPGHAN IBD Porto Group commentary. J Pediatr Gastroenterol Nutr 54:830–837CrossRefPubMedGoogle Scholar
  19. 19.
    Rahier JF, Magro F, Abreu C et al (2014) Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 8:443–468CrossRefPubMedGoogle Scholar
  20. 20.
    Leleiko NS, Lobato D, Hagin S et al (2013) Rates and predictors of oral medication adherence in pediatric patients with IBD. Inflamm Bowel Dis 19:832–839CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag Berlin 2017

Authors and Affiliations

  1. 1.Dr. von Haunersches Kinderspital, Kinderklinik und KinderpoliklinikLudwig-Maximilians-UniversitätMünchenDeutschland

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