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Gastroenterologie up2date 2012; 08(04): 279-289
DOI: 10.1055/s-0032-1325945
Darm/Anorektum
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Diagnostik und Therapie der Colitis ulcerosa – Update

Klaus Herrlinger
,
Eduard F. Stange
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Publikationsverlauf

Publikationsdatum:
06. Dezember 2012 (online)

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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.

 

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