Subscribe to RSS
DOI: 10.1055/a-2407-2942
Interdisziplinäre Therapie des Morbus Crohn
Diagnose und Therapie des Morbus Crohn sind oft eine Herausforderung, da die Beschwerden und Befunde unspezifisch, vielgestaltig und fluktuierend sein können. Dieser Artikel zeigt die Möglichkeiten der modernen Diagnostik bei Erstdiagnose und im Schub sowie die auf den Patienten abgestimmte Therapie bei Erwachsenen.
-
Zur Diagnose eines Morbus Crohn ist die Kombination aus Endoskopie, bildgebenden und labortechnischen Verfahren sowie dem klinischen Verlauf notwendig. Ein eindeutiges Testverfahren existiert nicht.
-
Zur optimalen Therapie des Morbus Crohn müssen Chirurgen und Internisten eng zusammenarbeiten, da sich konservative und operative Verfahren ergänzen.
-
Die meisten Patienten erhalten eine antiinflammatorische, medikamentöse Therapie, am häufigsten mit systemischen Glukokortikoiden sowie Immunmodulatoren und Biologika. Systemische Glukokortikoide dürfen nicht dauerhaft gegeben werden.
-
Die Zahl der verfügbaren Wirkstoffe zur medikamentösen Therapie des Morbus Crohn hat in den letzten wenigen Jahren stark zugenommen. Neben TNF-α-Inhibitoren, IL-12/23- und Anti-Integrin-Antikörpern sind nun auch ein selektiver IL-23-Antikörper und ein JAK-Inhibitor zugelassen.
-
Etwa 50% der Morbus-Crohn-Patienten müssen im Krankheitsverlauf zumindest einmal operiert werden. Häufige Eingriffe sind die Ileozökalresektion, Strikturoplastiken und Fistelresektionen.
Schlüsselwörter
Morbus Crohn - chronisch entzündliche Darmerkrankung - Ileitis terminalis - Endoskopie - medikamentöse Therapie - ChirurgiePublication History
Article published online:
24 September 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Gasche C, Scholmerich J, Brynskov J. et al. A simple classification of Crohn’s disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998. Inflamm Bowel Dis 2000; 6: 8-15 DOI: 10.1097/00054725-200002000-00002. (PMID: 10701144)
- 2 Aniwan S, Harmsen WS, Tremaine WJ. et al. Overall and Cause-Specific Mortality of Inflammatory Bowel Disease in Olmsted County, Minnesota, From 1970 Through 2016. Mayo Clin Proc 2018; 93: 1415-1422 DOI: 10.1016/j.mayocp.2018.03.004.
- 3 Louis E, Collard A, Oger AF. et al. Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut 2001; 49: 777-782 DOI: 10.1136/gut.49.6.777. (PMID: 11709511)
- 4 Satsangi J, Silverberg MS, Vermeire S. et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006; 55: 749-753 DOI: 10.1136/gut.2005.082909. (PMID: 16698746)
- 5 Sturm A, Atreya R, Bettenworth D. et al. Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021–004. Z Gastroenterol 2022; 60: 332-418 DOI: 10.1055/a-1713-3941.
- 6 Shivashankar R, Tremaine WJ, Harmsen WS. et al. Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010. Clin Gastroenterol Hepatol 2017; 15: 857-863 DOI: 10.1016/j.cgh.2016.10.039.
- 7 Molodecky NA, Soon IS, Rabi DM. et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012; 142: 46-54 DOI: 10.1053/j.gastro.2011.10.001.
- 8 Torres J, Mehandru S, Colombel JF. et al. Crohn’s disease. Lancet 2017; 389: 1741-1755 DOI: 10.1016/S0140-6736(16)31711-1. (PMID: 27914655)
- 9 Adamina M, Bonovas S, Raine T. et al. ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment. J Crohns Colitis 2020; 14: 155-168 DOI: 10.1093/ecco-jcc/jjz187. (PMID: 31742338)
- 10 Albert JG, Kotsch J, Köstler W. et al. Course of Crohn’s disease prior to establishment of the diagnosis. Z Gastroenterol 2008; 46: 187-192 DOI: 10.1055/s-2007-963524. (PMID: 18253897)
- 11 Walldorf J, Krummenerl A, Engler K. et al. Health care for osteoporosis in inflammatory bowel disease: unmet needs in care of male patients?. J Crohns Colitis 2013; 7: 901-907 DOI: 10.1016/j.crohns.2012.12.008. (PMID: 23333038)
- 12 Jensen MD, Nathan T, Rafaelsen SR. et al. Diagnostic accuracy of capsule endoscopy for small bowel Crohn’s disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol 2011; 9: 124-129 DOI: 10.1016/j.cgh.2010.10.019. (PMID: 21056692)
- 13 Torres J, Bonovas S, Doherty G. et al. ECCO Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment. J Crohns Colitis 2020; 14: 4-22 DOI: 10.1093/ecco-jcc/jjz180. (PMID: 31711158)
- 14 Sands BE, Irving PM, Hoops T. et al. Ustekinumab versus adalimumab for induction and maintenance therapy in biologic-naive patients with moderately to severely active Crohn’s disease: a multicentre, randomised, double-blind, parallel-group, phase 3b trial. Lancet 2022; 399: 2200-2211 DOI: 10.1016/S0140-6736(22)00688-2. (PMID: 35691323)
- 15 Peyrin-Biroulet L, Chapman JC, Colombel J-F, Caprioli F, D’Haens GR, Ferrante M, Schreiber S, Atreya R, Danese S, Lindsay JO, Bossuyt P, Siegmund B, Irving P, Panaccione R, Neimark E, Wallace K, Anschutz T, Kligys K, Duan R, Pivorunas V, Huang X, Berg S, Shu L, Dubinsky MC. LB01: Risankizumab Versus Ustekinumab for patients with moderate to severe Crohn’s disease: Results from the Phase 3B SEQUENCE study. Copenhagen: UEG Week; 2023
- 16 Bischoff SC, Escher J, Hebuterne X. et al. ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease. Clin Nutr 2020; 39: 632-653 DOI: 10.20960/nh.03857. (PMID: 32029281)
- 17 Kim YM, Jang HJ, Lee YJ. The effectiveness of preoperative stoma site marking on patient outcomes: A systematic review and meta-analysis. J Adv Nurs 2021; 77: 4332-4346 DOI: 10.1111/jan.14915. (PMID: 34118170)
- 18 Rutgeerts P, Geboes K, Vantrappen G. et al. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990; 99: 956-963 DOI: 10.1016/0016-5085(90)90613-6. (PMID: 2394349)
- 19 Regueiro M, Feagan BG, Zou B. et al. Infliximab Reduces Endoscopic, but Not Clinical, Recurrence of Crohn’s Disease After Ileocolonic Resection. Gastroenterology 2016; 150: 1568-1578 DOI: 10.1053/j.gastro.2016.02.072. (PMID: 26946343)
- 20 Buisson A, Chevaux JB, Allen PB. et al. Review article: the natural history of postoperative Crohn’s disease recurrence. Aliment Pharmacol Ther 2012; 35: 625-633 DOI: 10.1111/j.1365-2036.2012.05002.x. (PMID: 22313322)
- 21 De Cruz P, Kamm MA, Hamilton AL. et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet 2015; 385: 1406-1417 DOI: 10.1016/S0140-6736(14)61908-5. (PMID: 25542620)
- 22 Ponsioen CY, de Groof EJ, Eshuis EJ. et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol 2017; 2: 785-792 DOI: 10.1016/S2468-1253(17)30248-0. (PMID: 28838644)
- 23 Bemelman WA, Warusavitarne J, Sampietro GM. et al. ECCO-ESCP Consensus on Surgery for Crohn’s Disease. J Crohns Colitis 2018; 12: 1-16 DOI: 10.1093/ecco-jcc/jjx061. (PMID: 28498901)
- 24 Rieder F, Fiocchi C, Rogler G. Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases. Gastroenterology 2017; 152: 340-350.e6 DOI: 10.1053/j.gastro.2016.09.047. (PMID: 27720839)
- 25 Carchman E. Crohn’s Disease and the Risk of Cancer. Clin Colon Rectal Surg 2019; 32: 305-313 DOI: 10.1055/s-0039-1683923. (PMID: 31275078)
- 26 Feng JS, Li JY, Yang Z. et al. Stapled side-to-side anastomosis might be benefit in intestinal resection for Crohn’s disease: A systematic review and network meta-analysis. Medicine (Baltimore) 2018; 97: e0315 DOI: 10.1097/MD.0000000000010315. (PMID: 29642162)
- 27 Ambe R, Campbell L, Cagir B. A comprehensive review of strictureplasty techniques in Crohn’s disease: types, indications, comparisons, and safety. J Gastrointest Surg 2012; 16: 209-217 DOI: 10.1007/s11605-011-1651-2. (PMID: 21909847)
- 28 Bislenghi G, Ferrante M, Sabino J. et al. Short- and Long-term Outcomes Following Side-to- side Strictureplasty and its Modification Over the Ileocaecal Valve for Extensive Crohn’s Ileitis. J Crohns Colitis 2020; 14: 1378-1384 DOI: 10.1093/ecco-jcc/jjaa066. (PMID: 32227163)
- 29 Ingle SB, Loftus jr EV. The natural history of perianal Crohn’s disease. Dig Liver Dis 2007; 39: 963-969 DOI: 10.1016/j.dld.2007.07.154. (PMID: 17720635)
- 30 Meima-van Praag EM, Buskens CJ, Hompes R. et al. Surgical management of Crohn’s disease: a state of the art review. Int J Colorectal Dis 2021; 36: 1133-1145 DOI: 10.1007/s00384-021-03857-2. (PMID: 33528750)
- 31 van Koperen PJ, Safiruddin F, Bemelman WA. et al. Outcome of surgical treatment for fistula in ano in Crohn’s disease. Br J Surg 2009; 96: 675-679 DOI: 10.1002/bjs.6608. (PMID: 19434701)
- 32 Panes J, Rimola J. Perianal fistulizing Crohn’s disease: pathogenesis, diagnosis and therapy. Nat Rev Gastroenterol Hepatol 2017; 14: 652-664 DOI: 10.1038/nrgastro.2017.104. (PMID: 28790453)
- 33 Kotze PG, Shen B, Lightner A. et al. Modern management of perianal fistulas in Crohn’s disease: future directions. Gut 2018; 67: 1181-1194 DOI: 10.1136/gutjnl-2017-314918. (PMID: 29331943)
- 34 Jarrar A, Church J. Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum 2011; 54: 1537-1541 DOI: 10.1097/DCR.0b013e31822d7ddd. (PMID: 22067182)
- 35 Ruffolo C, Penninckx F, Van Assche G. et al. Outcome of surgery for rectovaginal fistula due to Crohn’s disease. Br J Surg 2009; 96: 1190-1195 DOI: 10.1002/bjs.6661. (PMID: 19688772)
- 36 Hashash JG, Elkins J, Lewis JD. et al. AGA Clinical Practice Update on Diet and Nutritional Therapies in Patients With Inflammatory Bowel Disease: Expert Review. Gastroenterology 2024; 166: 521-532 DOI: 10.1053/j.gastro.2023.11.303. (PMID: 38276922)
- 37 Noor NM, Lee JC, Bond S. et al. A biomarker-stratified comparison of top-down versus accelerated step-up treatment strategies for patients with newly diagnosed Crohn’s disease (PROFILE): a multicentre, open-label randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9: 415-427 DOI: 10.1016/S2468-1253(24)00034-7. (PMID: 38402895)