Zusammenfassung.
Der Morbus Crohn ist eine chronische Entzündung, die alle Abschnitte des Gastrointestinaltraktes betreffen kann. Am häufigsten sind jedoch das terminale Ileum und/oder der Dickdarm befallen. Der (granulomatöse) Entzündungsprozeß ist diskontinuierlich, disproportional und häufig über alle Darmwandschichten (transmural) ausgebreitet. Die Erkrankung führt zu einer Reihe von intestinalen und extraintestinalen Komplikationen. Der Morbus Crohn wird heute als eine Allgemeinerkrankung mit intestinalem Schwerpunkt aufgefaßt. Die Ätiologie und Pathogenese des Morbus Crohn ist nach wie vor ungeklärt. Die heutige Arbeitshypothese ist, daß es bei genetischer Prädisposition und durch bestimmte Faktoren ausgelöst (u. a. Ernährung? Bakterien?) zu einer fehlerhaften Immunantwort (mangelhafter anti-inflammatorischer Prozeß?) des Darms mit Manifestation des Krankheitbildes „Morbus Crohn” kommt. Der folgende Übersichtsartikel beschreibt den heutigen Kenntnisstand bezüglich Ätiologie, Immunologie, Epidemiologie sowie dem makro- und mikroskopischen Erscheinungsbild des Morbus Crohn einschließlich seiner Differentialdiagnose zur Colitis ulcerosa.
Crohn's disease is a chronic inflammatory disorder which may involve any segment of the gastrointestinal tract, although the disease most commonly affects the terminal ileum and/or the colon. The (granulomatous) inflammatory process is discontinuous, disproportional and shows typically transmural involvement of all layers of the bowel wall. The disease may lead to a variety of intestinal and extra-intestinal complications. Although primarily an enteric disorder, Crohn's disease appears to be systemic in distribution. Its etiology and pathogenesis still remains unclear. This review deals with our present knowledge about etiology, immunology, epidemiology, and the macroscopical and microscopical appearence of Crohn's disease including its differential diagnosis to ulcerative colitis.
Schlüsselwörter:
Morbus Crohn - Ätiologie - Pathogenes - Krebsentstehung
Key words:
Crohn's disease - Etiology - Pathogenesis - Cancer development
Literatur
-
1
Crohn B B, Ginsburg L, Oppenheimer G D.
Regional ileitis: A pathologic and clinical entity.
J Am Clin Assoc.
1932;
99
1323-1329
-
2
Dalzeil T K.
Chronic interstitial enteritis.
Br Med J.
1913;
II
1068-1072
-
3
Lockhard-Mummary H E, Morson B C.
Crohn's disease of the large intestine.
Gut.
1964;
5
493-502
-
4
Lockhard-Mummary H E, Morson B C.
Crohn's disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis.
Gut.
1960;
1
87-105
-
5
Colp R.
A case of non-specific granuloma of the terminal ileum and cecum.
Surg Clin N Am.
1934;
14
443-449
-
6
Morson B C, Lockhard-Mummary H E.
Anal lesions in Crohn's disease.
Lancet.
1959;
II
1122-1123
-
7 Whitehead R. Extra-intestinal Crohn's disease. Does it exist?. In: Lee ECG, Nolan DJ (eds.) Surgery of Inflammatory Bowel Disease. Clinical Surgery International, Bd. 14, Churchill Livingstone London; 1987: 197-201
-
8
Fabricius P J, Gyde S N, Shouler P, Keighley M RP, Alexander-Williams J, Allan R N.
Crohn's disease in the elderly.
Gut.
1985;
26
461-465
-
9 Whitehead R. Crohn's colitis. In: LiVolsi VA (Consulting Editor) Major Problems in Pathology. Bd. 4: Mucosal Biopsy of the Gastrointestinal tract. W. B. Saunders Company Philadephia; 1990: 305-320
-
10 Morson B C, Dawson I MP, Day D W, Price A B, Williams G T. Crohn's disease. In: Morson & Dawson's Gastrointestinal Pathology. 3. Auflage. Blackwell Scientific Publications Oxford; 1990: 258-276
-
11
Rankin G B, Watts H D, Melnyk C S, Kelley M L.
National Cooperative Crohn's Disease Study: Extraintestinal manifestations and perianal complications.
Gastroenterology.
1979;
77
914-920
-
12
Weterman I T, Pena A S.
Familial incidence of Crohn's disease in The Nederlands and a review of the literature.
Gastroenterology.
1984;
86
449-452
-
13
Sirlin S M, Bankou K J, Kazlow P, Dolgin S, Dische R, Loleiko S.
Identical twins concordant for Crohn's disease.
J Clin Gastroenterol.
1986;
8
290-294
-
14
Murray C JW, Thompson A BR.
Marital idiopathic inflammatory bowel disease.
J Clin Gastroenterol.
1988;
10
95-102
-
15
Lindberg E, Tysk C, Anderson K, Janerot G.
Smoking and inflammatory bowel disease. A case control study.
Gut.
1988;
29
352-357
-
16
Mayberry J F, Rhodes J, Newcombe R G.
Increased sugar consuption in Crohn's disease.
Digestion.
1980;
20
323-326
-
17
Vessey M, Jewell D, Smith A, Yeates D, McPherson K.
Chronic inflammatory bowel disease, cigarette smoking, and use of oral contraceptives, findings in a large cohort of woman of childbearing age.
Br Med J.
1986;
292
1101-1103
-
18
O'Morain C, Segal A W, Levi A J.
Elemental diet as primary treatment of acute Crohn's disease, a controlled trial.
Br Med J.
1984;
288
1859-1862
-
19
Workman E M, Jones V, Wilson A J, Hunter J O.
Diet in the management of Crohn's disease.
Hum Nutr Appl Nutr.
1984;
38
469-478
-
20
Keighley M RB, Arabi Y, Dimock F, Burdon D, Allan R N, Alexander-Williams J.
Influence of inflammatory bowel disease on intestinal microflora.
Gut.
1978;
19
1099-1104
-
21
Thayer W R, Coutu J A, Chiodini R J, Kruiningen D VM, Merkal R S.
Possible role of Mycobacteria in inflammatory bowel disease. Mycobacterial antibodies in Crohn's disease.
Dig Dis Sci.
1984;
29
1080-1085
-
22
Hampson S J, McFadden J J, Hermon-Taylor J.
Mycobacterium and Crohn's disease.
Gut.
1988;
29
1017-1019
-
23
Kobayashi K, Brown W R, Brennan P J, Blaser M J.
Serum antibodies to mycobacterial antigens in active Crohn's disease.
Gastroenterology.
1988;
94
1404-1411
-
24
Hubbart J, Surawicz C M.
Etiological role of mycobacterium in Crohn's disease: An assessment of the literature.
Dig Dis.
1999;
17
6-13
-
25
Pantera C, Cribano M L.
Crohn's disease: the case for bacteria.
Ital J Gastroenterol Hepatol.
1999;
31
244-246
-
26
Schürmann G, Brüwer M, Klotz A, Schmid K W, Senninger N, Zimmer K P.
Transepithelial transport processes in the intestinal mucosa in inflammatory bowel disease.
Int J Colorectal Dis.
1999;
14
41-46
-
27
Buisine M P, Desreumaux P, Debailleul V, Gambiez L, Geboes K, Ectors N, Delescaut M P, Degand P, Aubert J P, Colombel J F, Porchet N.
Abnormalities in mucin gene expression in Crohn's disease.
Inflamm Bowel Dis.
1999;
5
24-35
-
28
Soderholm J D, Olaison G, Lindberg E, Hannestad U, Vindels A, Tysk C, Jarnerot G, Sjodahl R.
Different intestinal permeability patterns in relatives and spouses of patients with Crohn's disease: an inherited defect in mucosal defence?.
Gut.
1999;
44
96-100
-
29
Hodgson H J.
Pathogenesis of Crohn's disease.
Baillieres Clin Gastroenterol.
1998;
12
1-17
-
30
Bhan A K, Mizoguchi E, Smith R N, Mizoguchi A.
Colitis in transgenic and knockout animals as models of human inflammatory bowel disease.
Immunol Rev.
1999;
169
195-207
-
31
Leach M W, Davidson N J, Fort M M, Powrie F, Rennick D M.
The role of IL-10 in inflammatory bowel disease.
Toxicol Pathol.
1999;
27
123-133
-
32
Brooke B N.
What is ulcerative colitis?.
Lancet.
1953;
I
220-222
-
33
Petri M, Poulsen S S, Christensen K, Jarnum S.
The incidence of granulomas in serial sections of rectal biopsies from patients with Crohn's disease.
Acta Pathol Microbiol Immunol Scand.
1982;
A,90
145-147
-
34
Schmitz-Moormann P, Pittner P M, Malchow H, Brandes J W.
The granuloma in Crohn's disease.
Pathol Res Pract.
1984;
178
467-476
-
35
Korelitz B I, Sommers S C.
Rectal biopsies in patients with Crohn's disease. Normal mucosa on sigmoidoscopic examination.
J Am Med Assoc.
1977;
237
2742-2744
-
36
Lewin K, Swales J D.
Granulomatous colitis and atypical ulcerative colitis: histological features, behaviour and prognosis.
Gastroenterology.
1966;
50
211-223
-
37
McDermott F T, Pihl E A, Kemp D R, Polglase A L.
Co-existing Crohn's disease and ulcerative colitis.
Dis Colon Rectum.
1982;
25
600-602
-
38
White C L, Hamilton S R, Diamond M P, Cameron J L.
Crohn's disease and ulcerative colitis in the same patient.
Gut.
1983;
24
857-862
-
39
Price A B.
Overlap in the spectrum of non-specific inflammatory bowel disease: „colitis indeterminate”.
J Clin Pathol.
1978;
60
229-246
-
40
Hoffmann J P, Taft D A, Wheelers R F, Walker J H.
Adenocarcinoma in regional enteritis of the small intestine.
Arch Surg.
1977;
112
606-610
-
41
Bernstein D, Rogers A.
Malignancy in Crohn's disease.
Am J Gastrenterol.
1996;
91
434-440
-
42
Weedon D D, Shorter R G, Ustrup D M, Huizenga K A, Taylor W F.
Crohn's disease and cancer.
New Engl J Med.
1973;
289
1099-1102
-
43
Rubio C A, Befrits R.
Colorectal adenocarcinoma in Crohn's disease: a retrospective histologic study.
Dis Colon Rectum.
1997;
40
1072-1078
-
44
Ribeiro M B, Greenstein A J, Sachar D B, Barth J, Balasubramanian S, Harpaz N, Heimann T M, Aufses A H.
Colorectal adenocarcinoma in Crohn's disease.
Ann Surg.
1996;
223
186-193
Univ.-Prof. Dr. K. W. Schmid
Institut für Pathologie
Universitätsklinikum Essen
Hufelandstraße 55
45122 Essen
Email: kw.schmid.pathologie@uni-essen.de
