Die Rolle der Dünndarmendoskopie beim Management von Patienten mit chronisch-entzündlichen Darmerkrankungen: ein internationaler OMED-ECCO-Konsensus

Zusammenfassung

Der Morbus Crohn und die Colitis ulcerosa sind lebens­lange Erkrankungen, die vor allem in den entwickelten Ländern auftreten. Die Colitis ulcerosa ist eine chronische Entzündung, die eine diffuse und kon­tinuierliche mukosale Entzündung des Dickdarms verursacht. Der Morbus Crohn ist eine heterogene Erkrankung unterschiedlicher Phenotypen. Er kann den gesamten Gastrointestinaltrakt betreffen. Während der ersten Krankheitsjahre kann in etwa 10–15 % der Fälle ein Diagnosewandel vom Morbus Crohn zur Colitis ulcerosa erfolgen. Auf das Kolon bezogene chronisch-entzündliche Darmer­kran­kun­gen (CED), die nicht eindeutig als Colitis ­ulcerosa oder Morbus Crohn charakterisiert werden können, werden als nicht klassifizierbare CED benannt. Die Verfügbarkeit von Kapselendoskopie, Single- und Doppelballonenteroskopie hat die Bildgebung des Dünndarms revolutioniert. Sie beeinflussen in großem Maße die Diagnostik, die Klassifikation, Therapieentscheidungen und das Outcome beim Management von CED. Die Rolle dieser Untersuchungsmethoden bei der Diagnostik und beim Management von CED ist jedoch unklar. Dieses Dokument enthält einen aktuellen Konsensus, der von einer Gruppe inter­nationaler Endoskopie- und CED-Experten anlässlich eines Treffens in Brüssel vom 12.–13. Dezember 2008 erreicht wurde. Dieses Treffen war gemeinsam von der Europäischen Crohn- und Colitis-Organisation (ECCO) und der Weltorganisation für digestive Endoskopie (OMED) organisiert worden. Der Konsensus erfolgt in sieben Gebieten: Definition und Diagnostik; Morbus Crohn-Verdacht; gesicherter Morbus Crohn; nichtklassifizierbare CED; Colitis ulcerosa (einschließlich ileoanaler Pouch-Ana­s­to­mose); pädiatrische Praxis; Komplikationen und ­ungelöste Fragen. Die Konsensus-Leit­linien und Statements werden ergänzt von Kommentaren zur Evidenz und zu Meinungen. Die Statements sollten im Kontext mit den qualifizierten Kommentaren und nicht isoliert betrachtet werden.

Abstract

Crohn’s disease and ulcerative colitis are lifelong diseases seen predominantly in the developed countries of the world. Whereas ulcerative coli­tis is a chronic inflammatory condition causing diffuse and continuous mucosal inflammation of the colon, Crohn’s disease is a heterogeneous ­entity comprised of several different phenotypes, but can affect the entire gastrointestinal tract. A change in diagnosis from Crohn’s disease to ulcer­ative colitis during the first year of illness occurs in about 10 %–15 % of cases. Inflammatory bowel disease (IBD) restricted to the colon that cannot be characterized as either ulcerative colitis or Crohn’s disease is termed IBD-unclassified (IBDU). The advent of capsule and both single and double-balloon-assisted enteroscopy is revolu­tionizing small-bowel imaging and has major ­implications for diagnosis, classification, therapeutic decision making and outcomes in the man­agement of IBD. The role of these investigations in the diagnosis and management of IBD, however, is unclear. This document sets out the current Consensus reached by a group of international ­experts in the fields of endoscopy and IBD at a meeting held in Brussels, 12–13th December 2008, organised jointly by the European Crohn’s and Colitis Organisation (ECCO) and the Organisation Mondiale d’Endoscopie Digestive (OMED). The Consensus is grouped into seven sections: ­definitions and diagnosis; suspected Crohn’s dis­ease; established Crohn’s disease; IBDU; ulcera­tive colitis (including ileal pouch-anal anastomosis [IPAA]); paediatric practice; and complications and unresolved questions. Consensus guideline statements are followed by comments on the ­evidence and opinion. Statements are intended to be read in context with qualifying comments and not read in isolation.  

chronisch-entzündliche Darmerkrankung - Dünndarmerkrankung - Endoskopie - Colitis ulcerosa - Morbus Crohn

inflammatory bowel disease - small bowel disease - endoscopy - ulcerative colitis - Crohn’s disease

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