Diarrhö als Leitsymptom chronisch entzündlicher Darmerkrankungen bei Kindern und Jugendlichen

Zusammenfassung

Chronisch entzündliche Darmerkrankungen (CED) können Patienten aller Altersgruppen, vom Säugling bis zum Erwachsenen, betreffen. Daher ist es wesentlich, dass auch Kinder- und Jugendärzte diese Krankheitsgruppe bei der Differenzialdiagnostik von Diarrhöen berücksichtigen. Durchfall gehört zu den typischen Manifestationssymptomen bei M. Crohn und bei Colitis ulcerosa. Zusammen mit Bauchschmerzen und Gewichtsverlust liegt eine für den M. Crohn typische Trias vor; blutige Durchfälle ohne Erregernachweis sprechen für eine Colitis ulcerosa. Die Diagnose erfolgt durch eine Kombination klinischer und anamnestischer Angaben, die durch Labor- und bildgebende Befunde weiter charakterisiert wird. Im Zentrum der CED-Diagnostikstehen die Endoskopie des oberen und unteren Verdauungstraktes und die histopathologische Beurteilung der entnommenen Biopsate. Ziel ist es, möglichst frühzeitig eine spezifische Diagnose zu stellen und das Befallsmusterzu erheben, um dann durch eine optimale Therapie die Remission herbeizuführen und möglichst langzeitig zu erhalten.

Summary

Inflammatory bowel diseases (IBD) may manifest in patients of all age groups, from infancy to adulthood. Thus, it is essential that paediatricians, too, take this group of diseases into consideration when evaluating diarrhoea. A triad of diarrhoea, abdominal pain and weight loss is typical of Crohn’s disease, whilst non-infectious bloody diarrhoea is common in ulcerative colitis. The diagnosis is made by a combination of clinical findings and patient history which are further characterized by laboratory and imaging results. Endoscopy of the upper and lower gastrointestinal tract together with the histopathological evaluation of the biopsies are essential for a specific diagnosis. It is the aim to achieve a rapid and accurate diagnosis with a characterisation of the disease distribution in order to induce remission as soon as possible, and to maintain it long-term.

Schlüsselwörter

Durchfall - M. Crohn - Colitis ulcerosa - Endoskopie

Keywords

Diarrhoea - Crohn’s disease - ulcerative colitis - endoscopy

• Literatur

• 1 American Gastroenterological Association Clinical Practice Committee. American Gastroenterological Association medical position statement: perianal Crohn’s disease. Gastroenterology 2003; 125: 1503-7.
• 2 Auvin S, Molinie F, Gower-Rousseau C. et al. Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988–1999). J Pediatr Gastroenterol Nutr 2005; 41: 49-55.
• 3 Beattie RM, Croft NM, Fell JM. Inflammatory bowel disease. Arch Dis Child 2006; 91: 426-32.
• 4 Bremner AR, Griffiths M, Argent JD. et al. Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study. Pediatr Radiol 2006; 36: 947-53.
• 5 Buderus S. Chronisch-entzündliche Darmerkrankungen: Medikamentöse Therapie im Kindes- und Jugendalter. Monatsschr Kinderheilk 2004; 152: 133-44.
• 6 Bunn SK, Bisset WM, Main MJ. et al. Fecal calprotectin: validation as a noninvasive measure of bowel inflammation in childhood inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2001; 33: 14-22.
• 7 Cabrera-Arreu JC, Davies P, Matek Z. et al. Performance of blood tests in diagnosis of inflammatory bowel disease in a specialist clinic. Arch Dis Child 2004; 89: 69-71.
• 8 Griffith AM. Inflammatory bowel disease in childhood. In: Satsangi J, Sutherland LR. (eds). Inflammatory bowel diseases. Churchill Livingston: Elsevier Ltd: 2003: 699-715.
• 9 Gupta SK, Fitzgerald JF, Croffie JM. et al. Comparison of serological markers of inflammatory bowel disease with clinical diagnosis in children. Inflamm Bowel Dis 2004; 10 (03) 240-4.
• 10 Hildebrand H, Finkel Y, Grahnquist L. et al. Changing pattern of paediatric inflammatory bowel disease in northern Stockholm 1990–2001. Gut 2003; 52: 1432-4.
• 11 Hinds R, Brueton MJ, Francis N, Fell JM. Another cause of bloody diarrhoea in infancy: cytomegalovirus colitis in an immunocompetent child. J Paediatr Child Health 2004; 40 (9–10): 581-2.
• 12 Hohl C, Haage P, Krombach GA. et al. Diagnostic evaluation of chronic inflammatory intestinal diseases in children and adolescents: MRI with true-FISP as new gold standard?. Rofo 2005; 177: 856-63.
• 13 IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis – the Porto criteria. J Pediatr Gastroenterol Nutr 2005; 41: 1-7.
• 14 Kane SV, Sandborn WJ, Rufo PA. et al. Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation. Am J Gastroenterol 2003; 98: 1309-14.
• 15 Kugathasan S, Judd RH, Hoffmann RG. et al. Wisconsin Pediatric Inflammatory Bowel Disease Alliance. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. Pediatr 2003; 143: 525-31.
• 16 Langholz E, Munkholm P, Krasilnikoff PA, Binder V. Inflammatory bowel diseases with onset in childhood. Clinical features, morbidity and mortality in a regional cohort. Scand J Gastroenterol 1997; 32: 139-47.
• 17 Mamula P, Telega GW, Markowitz JE. et al. Inflammatory bowel disease in children 5 years of age and younger. Am J Gastroenterol. 2002; 97: 2005-10.
• 18 Neurath M, Vehling D, Schunk K. et al. Noninvasive assessment of Crohn’s disease activity: a comparison of 18-F-fluorodeoxyglucose positron emission tomography, hydromagnetic resonance imaging, and granulocyte scintigraphy with labeled antibodies. Am J Gastroenterol 2002; 97: 1978-85.
• 19 Parente F, Greco S, Molteni M. et al. Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn’s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy. Gut 2004; 53 (11) 1652-7.
• 20 Sawczenko A, Lynn R, Sandhu BK. Variations in initial assessment and management of inflammatory bowel disease across Great Britain and Ireland. Arch Dis Child 2003; 88: 990-4
• 21 Sawczenko A, Sandhu BK. Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child 2003; 88: 995-1000.
• 22 Sawczenko A, Sandhu BK, Logan RFA. et al. Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet 2001; 357: 1093-4.
• 23 Seidman EG, Sant’Anna AM, Dirks MH. Potential applications of wireless capsule endoscopy in the pediatric age group. Gastrointest Endosc Clin N Am 2004; 14: 207-17.
• 24 van der Zaag-Loonen HJ, Casparie M, Taminiau JA. et al. The incidence of pediatric inflammatory bowel disease in the Netherlands: 1999–2001. J Pediatr Gastroenterol Nutr 2004; 38: 302-7.