Neue und aktuelle Therapieziele bei chronisch entzündlichen Darmerkrankungen

Die Behandlung chronisch entzündlicher Darmerkrankungen (CED) hat sich in den letzten Jahrzehnten von einer symptomatischen Kontrolle hin zu präziseren, langfristigen Zielen entwickelt. So sind spezifische Marker entwickelt worden, mit denen sich die Therapieziele überwachen lassen. Der vorliegende Artikel konzentriert sich auf die neuen Therapieziele und diskutiert die Rolle der Therapieziel-Marker in der klinischen Praxis.

Abstract

Chronic inflammatory bowel diseases (IBD), such as Crohnʼs disease (MC) and ulcerative colitis (CU), are serious immune-mediated diseases that affect the gastrointestinal tract and represent a considerable burden for patients. In recent decades, the treatment of IBD has shifted from symptomatic control to more precise, long-term goals. Advances in IBD research have led to therapy goals having been redefined and expanded in order to achieve complete inflammation control and prevent complications in the long term.

An important component of modern therapeutic approaches is the definition of specific markers that serve as indicators for the achievement of these therapeutic goals. These markers enable objective monitoring of the success of treatment and thus offer a clear approach for controlling the therapy. The present article focuses on the new therapeutic goals in IBD treatment and discusses the role of therapeutic target markers in clinical practice.

A central goal in modern IBD therapy is endoscopic healing, i.e. the complete macroscopic healing of the intestinal mucosa. In clinical practice this includes in particular an ulcer-free mucosa. In contrast to clinical remission alone, endoscopic healing provides an objective assessment of the inflammatory state and correlates strongly with an improved long-term prognosis.

The histologic remission goes beyond endoscopic healing and aims to endoscopic healing to no longer detect signs of inflammation at the microscopic level. This is particularly relevant as the results show that patients who achieve a complete histological remission have an even lower recurrence rate and better long-term results than those who only achieve a clinical or endoscopic remission.

Even though no curative therapy for IBD currently exists, the complete cure remains the ultimate goal of research. In current practice, this goal is still unattainable in current practice, but progress in genetic and immunological research offers hope. In the long term, the aim is to innovative approaches such as gene editing or immunotherapy to cure the disease. This could mean that patients are not only free of symptoms, but also freed from the burden of the disease in the long term.

Kernaussagen

• Die klinische Remission, definiert als Symptomfreiheit oder signifikante Reduktion der Symptome, ist ein etabliertes und zentrales Therapieziel bei CED.

• Ein zentrales Ziel in der modernen CED-Therapie ist die endoskopische Heilung, also die vollständige makroskopische Heilung der Darmschleimhaut. In der klinischen Praxis beinhaltet dies insbesondere eine ulzerafreie Mukosa.

• Der erreichte Grad der endoskopischen Heilung ist ein wichtiger Indikator für den Therapieerfolg und sollte regelmäßig überprüft werden, um den langfristigen Krankheitsverlauf zu beurteilen und die Behandlung anzupassen.

• Die histologische Remission geht über die endoskopische Heilung hinaus und zielt darauf ab, auch auf mikroskopischer Ebene keine Entzündungszeichen mehr nachweisen zu können.

• Ein wichtiges langfristiges Therapieziel ist die Verhinderung von strukturellen Schäden des Darms (u.a. Vernarbungen, Strikturen, Fisteln und Abszesse).

• Die Bildgebung, insbesondere die Sonografie, ist ein zentrales Element zur Verlaufsbeurteilung der Entzündungsaktivität geworden. Hiermit lässt sich nicht invasiv, einfach und schnell die Krankheitsaktivität, direkt „bedside“, überwachen.

• Eine konsequente Kontrolle der Entzündung und regelmäßige Überwachung durch Koloskopien sind wesentliche Maßnahmen, um präkanzeröse Veränderungen frühzeitig zu erkennen und zu behandeln.

• Das Erreichen der Remission ist das höchste Therapieziel, insbesondere im Zusammenhang mit einem Kinderwunsch. Die persistierende Krankheitsaktivität stellt das größte Risiko für die werdende Mutter und das ungeborene Kind dar.

Schlüsselwörter

vollständige Entzündungskontrolle - Remission - endoskopisch - histologisch - tiefe Remission - intestinale Barrierefunktion - Lebensqualität - Kinderwunsch

Keywords

complete inflammation control - remission - endoscopic - histologic - deep remission - intestinal barrier function - quality of life - desire to have children

Publikationsverlauf

Artikel online veröffentlicht:
31. März 2025

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