Rationale und rationelle Diagnostik in unterschiedlichen Krankheitsphasen des Morbus Crohn

Zusammenfassung

Die Therapie von Patienten mit chronisch entzündlichen Darmerkrankungen hat in den vergangenen Jahren und Jahrzehnten durch die Einführung verschiedener Immunsuppressiva wie auch die Zulassung monoklonaler Antikörper an Komplexität gewonnen und erfordert eine sorgfältige Überwachung. Nationale und internationale Leitlinien definieren für den Arzt einen diagnostischen und therapeutischen Rahmen, können jedoch nur eingeschränkt auf konkrete Fragen zum Prozedere bei ihrem individuellen Patienten eingehen. Im Rahmen eines von der Firma Abbott initiierten Projekts mit dem Titel „IBD ahead“ haben 34 deutsche Gastroenterologen auf der Basis der publizierten Literatur und eigener Erfahrungen konkrete Vorschläge für die rationale und rationelle Diagnostik in unterschiedlichen Krankheitsphasen des Morbus Crohn erarbeitet, um somit eine Lücke zwischen den Leitlinien und dem klinischen Alltag zu schließen. Es wurden Stellungnahmen zur Wertigkeit der klinischen Beurteilung von Symptomen, der Endoskopie sowie des Einsatzes von Laborparametern einschließlich fäkaler Entzündungsmarker getroffen. Nachfolgend wird der Stellenwert der konventionellen Röntgendiagnostik, der Computertomografie, des Ultraschalls wie auch der Magnetresonanztomografie diskutiert. Die formulierten Empfehlungen werden jeweils anhand von Fallbeispielen aus der täglichen Praxis der beteiligten Zentren verdeutlicht.

Abstract

The treatment of patients with inflammatory bowel disease has become more complex in recent years through the introduction of various immunosuppressive agents as well as the approval of monoclonal antibodies. Patients receiving such treatment must be carefully monitored. National and international guidelines define a diagnostic and therapeutic context for the practitioner, but can only partially respond to specific questions on the procedure for individual patients. Within the framework of a project initiated by Abbott entitled “IBD ahead” 34 German IBD experts have elaborated concrete proposals for the utility of clinical symptom assessment, endoscopy and the use of laboratory parameters including foecal markers of inflammation. Furthermore, we discuss the significance of conventional X-rays, computed tomography, ultrasound and magnetic resonance tomography. These recommendations are illustrated by case studies from everyday practice in the participating centres.

Schlüsselwörter

Morbus Crohn

Key words

Crohn‘s disease

• Literatur

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