Treatment of Pouchitis with Dehydroepiandrosterone (DHEA) - a Case Report

Zusammenfassung

Hintergrund: Dehydroepiandrosteron (DHEA) inhibiert die Aktivierung von „nuclear factor kappa B” über den „peroxisome proliferator-activated receptor α”. Eine Aktivierung von „nuclear factor kappa B” ist in aktiv entzündeter Darmschleimhaut bei der Colitis ulcerosa nachweisbar. Die Pouchitis ist eine Komplikation nach Proktokolektomie aufgrund einer Colitis ulcerosa und stellt nach wie vor eine therapeutische Herausforderung dar.

Fall: Wir berichten über die Behandlung einer 35-jährigen Patientin mit Pouchitis mittels DHEA 200 mg/d über acht Wochen. Die Patientin wurde über weitere acht Wochen nachbeobachtet.

Die Stuhlfrequenz fiel von 15-18/d auf 8/d und die initiale Schleimbeimengung verschwand. Die Stuhlkonsistenz besserte sich von flüssig/weich zu weich/fest. Vorher vorhandene Bauchschmerzen verschwanden. Die endoskopisch-makroskopischen Entzündungszeichen besserten sich. Acht Wochen nach Beendigung der DHEA-Einnahme litt die Patientin erneut an 12 bis 18 weichen bis flüssigen Stühlen pro Tag und leichten Bauchschmerzen.

Schlussfolgerung: Die therapeutischen Effekte von DHEA bei der Pouchitis verdienen eine weitere, systematische Überprüfung.

Abstract

Background: Dehydroepiandrosterone (DHEA) inhibits activation of nuclear factor kappa B (NF-κB), which is known to be activated in inflammatory lesions of ulcerative colitis, via PPARα. In a pilot trial DHEA was effective for the treatment of active ulcerative colitis. Pouchitis is a common complication after proctocolectomy for ulcerative colitis and still a therapeutical challenge.

Case: DHEA 200 mg/d was tested in chronic active pouchitis in a 35-year-old female patient. DHEA was given for eight weeks, and follow up for further eight weeks was performed. The number of stools dropped from 15-18/d to 8/d, the addition of mucus, which was observed initially, was absent during treatment. The consistence of stools improved from liquid/soft to soft/solid. Abdominal pain resolved and endoscopical signs of inflammation improved. Eight weeks after termination of treatment with DHEA, the patient again suffered from 12 to 18 soft to liquid stools per day and mild abdominal pain.

Conclusion: Therapeutic effects of DHEA in pouchitis should be evaluated systematically.

Schlüsselwörter

Pouchitis - Dehydroepiandrosteron - Colitis ulcerosa

Key words

Pouchitis - Dehydroepiandrosterone - ulcerative colitis

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