Aktuelle Diagnostik und Therapie der Colitis ulcerosa – Update

Kernaussagen

Diagnostik

• Die Endoskopie stellt die zentrale Untersuchungsmethode in der Diagnostik chronisch entzündlicher Darmerkrankungen dar. Im Rahmen der Erstdiagnostik wird eine komplette Ileokoloskopie mit Stufenbiopsien durchgeführt.

• Die Häufigkeit weiterer Endoskopien richtet sich nach dem Krankheitsverlauf. Bei Vorliegen einer ausgedehnten Kolitis wird nach 7 Jahren Krankheitsdauer mit dem Überwachungsprogramm begonnen, d. h. es wird dann jährlich eine komplette Koloskopie mit Stufenbiopsien zur Karzinomprophylaxe durchgeführt.

• Bei der Erstdiagnostik und bei schweren und therapierefraktären Schüben sind zum Ausschluss einer infektiösen Genese immer Stuhlkulturen inklusive der Untersuchung auf Clostridium-difficile-Toxin indiziert.

Therapie

• Die distale Kolitis ist primär gut lokal mit 5-ASA-Präparaten behandelbar. Die ausgedehnte Colitis ulcerosa mit leichter bis mittlerer Aktivität sowie die Linksseitenkolitis werden kombiniert topisch und systemisch mit 5-ASA-Präparaten behandelt, bei Therapieversagen mit Steroiden.

• Die Standardtherapie der schweren Colitis ulcerosa ist die systemische Gabe von Steroiden. Für steroidrefraktäre Patienten gibt es die drei Therapieoptionen Ciclosporin plus Azathioprin, Tacrolimus plus Azathioprin oder Infliximab.

• Therapie der Wahl bei Steroidabhängigkeit ist Azathioprin.

• Zur erforderlichen remissionserhaltenden Therapie bei unkompliziertem Verlauf können Sulfasalazin, 5-ASA-Präparate und E. coli Nissle eingesetzt werden.

• Bei Vorliegen einer Pouchitis nach restaurativer Proktokolektomie sind Metronidazol, Ciprofloxacin und Budenosid-Einläufe wirksam. Probiotika helfen, die Chronifizierung zu vermeiden.

• Literatur

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