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CED: Standards in Diagnostik und Therapie

Basierend auf den Leitlinien (ECCO, DGVS)

Standards on diagnosis and treatment of inflammatory bowel disease

Based on clinical guidelines (ECCO, DGVS)

  • Schwerpunkt
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Der Gastroenterologe Aims and scope

Zusammenfassung

In den letzten Jahren wurden deutsche und europäische Leitlinien über den M. Crohn (MC) und die Colitis ulcerosa (CU) erstellt. Bei der Diagnostik müssen initial und bei therapierefraktärem Verlauf infektiöse Ursachen, besonders Clostridien und CMV, ausgeschlossen werden. Im akuten Schub einer CU werden 5-Aminosalizylate (5-ASA) und/oder Kortikosteroide lokal (Klysmen, Schäume oder Zäpfchen) und/oder systemisch eingesetzt. Beim MC werden primär Steroide (z. B. Budesonid) p.o. eingesetzt; 5-ASA spielen eine untergeordnete Rolle. Zur Remissionserhaltung wird Rauchern mit MC strikte Nikotinkarenz empfohlen. Steroide haben keinen Stellenwert in der Remissionserhaltung. Medikamentös sind bei CU 5-ASA und Azathioprin wirksam, Letzteres auch bei MC. Bei refraktären Verläufen werden Methotrexat und Anti-TNF-α-Antikörper eingesetzt; Operationen sollten stets als alternative Behandlungsoption diskutiert werden. Bei Nachweis von hochgradigen Dysplasien oder Karzinomen sollte eine Proktokolektomie mit Pouchanlage erfolgen.

Abstract

Over the last few years, German and European guidelines on Crohn’s disease (CD) and ulcerative colitis (UC) were developed. With regard to diagnostics, infectious causes, particularly Clostridium and cytomegalovirus, must be excluded initially and whenever patients do not respond to standard therapy. Acute flare-ups of UC are treated with 5-aminosalicylates (5-ASA) and/or corticosteroids either locally (enema, foam, or suppository), systemically, or both. For CD, oral steroids (e.g. budesonide) are preferred; 5-ASA play only a minor role. For maintenance, smokers with CD are strongly recommended to stop smoking. Steroids have no role in maintenance therapy. 5-ASA and azathioprine are recommended for maintenance of UC, and azathioprine also for CD. Refractory courses require methotrexate and anti-tumor necrosis factor-alpha antibodies, and surgery should always be discussed as alternative treatment in these patients. High-grade dysplasias or malignancy should always lead to proctocolectomy with construction of a pouch.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor PD Dr. J.C. Hoffmann ist als Referent für die Firma Merckle-Recordati und die Falk-Foundation tätig.

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  1. Innere Medizin I, St.-Marienkrankenhaus, Salzburger Straße 15, 67067, Ludwigshafen, Deutschland

    J.C. Hoffmann

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Correspondence to J.C. Hoffmann.

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Hoffmann, J. CED: Standards in Diagnostik und Therapie. Gastroenterologe 2, 414–422 (2007). https://doi.org/10.1007/s11377-007-0116-3

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  • DOI: https://doi.org/10.1007/s11377-007-0116-3

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