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Allgemein- und Viszeralchirurgie up2date 2024; 18(05): 425-444
DOI: 10.1055/a-2407-2942
Unterer Gastrointestinaltrakt, Koloproktologie

Interdisziplinäre Therapie des Morbus Crohn

Achim Jatkowski 
,
Lazaros Lazarou
,
Jörg Köninger
,
Jörg G. Albert 
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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.
Kernaussagen

  • 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 - Chirurgie


Publication History

Article published online:
24 September 2024

© 2024. Thieme. All rights reserved.

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