Pouchitis

Präambel

Insgesamt ist die Datenlage zu Definition, Therapie und Prognose der Pouchitis sehr begrenzt. Bessere Daten liegen zur langjährigen Nachbeobachtung vor [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11].

Da der Begriff „Pouchitis” jedwede Form einer Entzündung umschreibt unabhängig von der Ursache, sollte eine bessere Nomenklatur (Pouchitis im engeren Sinne, idiopathische Pouchitis, prim./sek. Pouchitis) erarbeitet werden [12]. Im vorliegenden Text wird unter dem Begriff „Pouchitis” ausschließlich die idiopathische bzw. primäre Pouchitis gefasst. Die Verlaufsformen der Pouchitis sind ebenfalls in der Literatur nicht einheitlich definiert, wodurch insbesondere bei der Therapie kaum verwertbare Daten existieren. Es wird versucht, eine plausible und klinisch relevante Klassifikation vorzuschlagen. Auf der Basis von klinischen und experimentellen Untersuchungen muss davon ausgegangen werden, dass die Pouchitis eine Remanifestation der chronisch entzündlichen Darmerkrankung unter neuen Bedingungen darstellt. Die Proktokolektomie bei Colitis ulcerosa führt daher nicht zu einer Heilung der Grunderkrankung. Die restaurative Proktokolektomie mit ileoanaler Pouchanlage schafft letztlich die Bedingungen zur Entstehung der Pouchitis mit bisher nicht sicher abzuschätzender Häufigkeit und Langzeitprognose. Unbeschadet hiervon ist dieser Eingriff die Methode der Wahl bei klarer Indikation bei Patienten mit Colitis ulcerosa. Der Wert dieses Eingriffs und der Benefit für die Patienten in definierten klinischen Situationen ist unbestritten.

Literatur

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