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Erschienen in: Die Innere Medizin 12/2021

02.11.2021 | Chronisch-entzündliche Darmerkrankungen | Schwerpunkt: Was ist gesichert in der Therapie?

Was ist gesichert in der Therapie chronisch-entzündlicher Darmerkrankungen

verfasst von: Dr. med. Carolin F. Manthey, Dr. med. Dominik Reher, Prof. Dr. med. Samuel Huber

Erschienen in: Die Innere Medizin | Ausgabe 12/2021

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Zusammenfassung

Die Prävalenzen der chronisch-entzündlichen Darmerkrankungen (CED) Morbus Crohn (MC) und Colitis ulcerosa (CU) steigen weltweit an. Auch in Deutschland stellen die CED ein großes gesundheitspolitisches Problem dar. Die Pathogenese ist komplex und involviert genetische Faktoren, Umweltaspekte und Veränderungen in der immunologischen Konstitution. Weiterhin spielt das Darmmikrobiom eine Rolle bei der Aufrechterhaltung der Entzündung. In den letzten Jahren sind erfreulicherweise weitere Medikamente für die Behandlung der CED zugelassen worden, vor allem Biologika. Die Therapie der CU stützt sich hauptsächlich auf 5‑Aminosalicylsäure-Präparate, bevorzugt auch in topischer Form bei distaler Kolitis und Proktitis, sowie lokale Budesonidformulierungen. Bei ausgedehntem Befall, hoher Krankheitsaktivität oder refraktärem Verlauf kommen ähnlich wie beim MC auch Antikörper (Biologika) mit gutem Erfolg zum Einsatz. Neben Anti-Tumor-Nekrose-Faktor-Antikörpern (Infliximab, Adalimumab, Golimumab) werden der Integrinantikörper Vedolizumab sowie der Interleukin-12/23-Antikörper Ustekinumab erfolgreich verwendet. Einen zunehmenden Stellenwert erhält neben der intravenösen auch die subkutane Anwendung der Antikörpertherapien, die mittlerweile für alle Präparate zur Verfügung steht. Des Weiteren ist bei CU der Januskinaseinhibitor Tofacitinib eine orale Option. Der Therapieerfolg wird multimodal anhand von Endoskopie, Sonographie, Laborparametern, Calprotectinbestimmung im Stuhl und klinischen Scores beurteilt („treat-to-target approach“). Langfristig gilt das Ziel einer mukosalen Heilung. Trotz der Fortschritte in der medikamentösen Therapie leidet immer noch ein signifikanter Teil der Patienten mit CED unter therapierefraktären Verläufen und benötigt im Verlauf eine chirurgische Therapie.
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Metadaten
Titel
Was ist gesichert in der Therapie chronisch-entzündlicher Darmerkrankungen
verfasst von
Dr. med. Carolin F. Manthey
Dr. med. Dominik Reher
Prof. Dr. med. Samuel Huber
Publikationsdatum
02.11.2021
Verlag
Springer Medizin
Erschienen in
Die Innere Medizin / Ausgabe 12/2021
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-021-01207-6

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