Zum Hauptinhalt springen

Colitis ulcerosa

Zuletzt bearbeitet: Zuletzt revidiert:
Zuletzt revidiert von:


Definition:
Sich kontinuierlich, vom Rektum aus nach oral ausbreitende Entzündung der Kolonschleimhaut, die zu chronisch entzündlichen Darmerkrankungen gehört.
Häufigkeit:
Inzidenz von 3–4 auf 100.000 Personen in Deutschland.
Symptome:
Blutig-schleimige Diarrhöen mit Tenesmen und imperativem Stuhldrang.
Befunde:
Bauchschmerzen, häufig Zeichen der Mangelernährung mit Anämie, ggf. extraintestinale Manifestationen wie Arthralgien oder Erythema nodosum.
Diagnostik:
Anamnese, körperliche Untersuchung, Labor mit u. a. Calprotectin im Stuhl, Sonografie, Endoskopie mit Biopsien und histopathologischer Aufarbeitung.
Therapie:
Therapie der Wahl Mesalazin, im schweren Schub Steroide und ggf. Eskalation auf Immunmodulatoren, z. B. TNF-alpha-Blocker.
  • Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Colitis ulcerosa: Diagnostik und Therapie. AWMF-Leitlinie Nr. 021-009. S3, Stand 2021. www.awmf.org 
  • Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Addendum zu den S3-Leitlinien Morbus Crohn und Colitis ulcerosa: Betreuung von Patienten mit chronisch–entzündlichen Darmerkrankungen in der COVID-19 Pandemie – offene Fragen und Antworten. AWMF-Leitlinie Nr. 021-030, 021-009, 021-004. Stand 2020. www.awmf.org 
  • Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Kolorektales Karzinom. AWMF-Leitlinie Nr. 021-007OL. S3, Stand 2017. www.awmf.org 
  1. Basson MD. Ulcerative Colitis. Medscape, last updated Jul 26, 2019. emedicine.medscape.com  
  2. Carter MJ, Lobo AJ, Travis SP, for the IBD Section, British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut 2004; 53 (suppl 5): 1-16. www.ncbi.nlm.nih.gov  
  3. Langan RC, Gotsch PB, Krafczyk MA. Ulcerative colitis: Diagnosis and treatment. Am Fam Physician 2007; 76: 1323-30. PubMed  
  4. Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Colitis ulcerosa: Diagnostik und Therapie. Stand 2021. www.awmf.org  
  5. Silverberg MS, Satsangi J, Ahmad T et al. Toward an Integrated Clinical, Molecular and Serological Classification of Inflammatory Bowel Disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005; 19: 5-36. pubmed.ncbi.nlm.nih.gov  
  6. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated Oral 5-Aminosalicylic Acid Therapy for Mildly to Moderately Active Ulcerative Colitis. NEJM 1987; 317: 1625-9. www.nejm.org  
  7. Däbritz J, Gerner P, Enninger A, et al. Chronisch-entzündliche Darm­er­krank­ungen bei Kindern und Jugendlichen. Dtsch Arztebl Int 2017; 114: 331-8. pubmed.ncbi.nlm.nih.gov  
  8. Fischer S, Rath T, Neurath MF. Chronisch-entzündliche Darmerkrankungen Morbus Crohn und Colitis ulcerosa. Der Internist 2018; 59 : 681–693. doi.org  
  9. Becker C, Neurath MF, Wirtz S. The Intestinal Microbiota in Inflammatory Bowel Disease. ILAR J 2015; 56(2): 192-204. pubmed.ncbi.nlm.nih.gov  
  10. Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002; 347: 417-29. PubMed  
  11. Forrest K, Symmons D, Foster P. Systematic review: is ingestion of paracetamol or non-steroidal anti-inflammatory drugs associated with exacerbations of inflammatory bowel disease? Aliment Pharmacol Ther 2004; 20: 1035-43. PubMed  
  12. Mahid SS,Minor KS,Soto RE et al. Smoking and Inflammatory Bowel Disease: A Meta-Analysis. Mayo Clin Proc 2006; 81(11): 1462-71. pubmed.ncbi.nlm.nih.gov  
  13. Rath HC, Schultz M, Freitag R, et al. Different subsets of enteric bacteria induce and perpetuate experimental colitis in rats and mice. Infect Immun 2001; 69: 2277-85. PubMed  
  14. Kappelman MD, Bousvaros A. Nutritional concerns in pediatric inflammatory bowel disease patients. Mol Nutr Food Res 2008; 52: 867–874. pubmed.ncbi.nlm.nih.gov  
  15. Frisch M, Pedersen BV, Andersson RE. Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark. BMJ 2009; 338: b716. pubmed.ncbi.nlm.nih.gov  
  16. Nayar M, Rhodes JM. Management of inflammatory bowel disease. Postgrad Med J 2004; 80: 206-13. PubMed  
  17. Siegmund B. Pathogenese chronisch-entzündlicher Darmerkrankungen. Berlin, Heidelberg: Springer, 2020. link.springer.com  
  18. Kornbluth A, Sachar DB, for the Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2004; 99: 1371-85. PubMed  
  19. Rothfuss KS, Stange EF, Herrlinger KR. Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol 2006; 12: 4819-31. PubMed  
  20. Ott C, Schölmerich J. Extraintestinal manifestations and complications in inflammatory bowel diseases. Nat Rev Gastroenterol Hepatol 2013; 10(10): 585-95. pubmed.ncbi.nlm.nih.gov  
  21. van Rheenen PF, De Vijver EV, Fidler F. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010; 341: c3369. BMJ (DOI)  
  22. Yang Z, Clark N, Park KT. Effectiveness and cost-effectiveness of measuring fecal calprotectin in diagnosis of inflammatory bowel disease in adults and children. Clin Gastroenterol Hepatol 2014; 12: 253-62. pmid:23883663 PubMed  
  23. Turvill J. High negative predictive value of a normal faecal calprotectin in patients with symptomatic intestinal disease. Frontline Gastroenterology 2012; 3: 21-28. doi:10.1136/flgastro-2013-100429 www.ncbi.nlm.nih.gov  
  24. Collins P, Rhodes J. Ulcerative colitis: diagnosis and management. BMJ 2006; 333: 340-3. PubMed  
  25. Cima RR, Pemberton JH. Medical and surgical management of chronic ulcerative colitis. Arch Surg 2005; 140: 300-10. PubMed  
  26. Whaley KG, Rosen MJ. Contemporary Medical Management of Acute Severe Ulcerative Colitis. Inflamm Bowel Dis 2019; 25(1): 56-66. pubmed.ncbi.nlm.nih.gov  
  27. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J 1955; 4947: 141-8. pubmed.ncbi.nlm.nih.gov  
  28. Nielsen OH, Vainer B, Rask-Madsen J. Review article: the treatment of inflammatory bowel disease with 6-mercaptopurine or azathioprine. Aliment Pharmacol Ther 2001; 15: 1699-708. PubMed  
  29. Fraser AG, Orchard TR, Jewell DP. The efficacy of azathioprine for the treatment of inflammatory bowel disease: a 30 year review. Gut 2002; 50: 485-9. www.ncbi.nlm.nih.gov  
  30. Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 2009; 374: 1617-25. PubMed  
  31. Fachinformation Azathioprin. Stand Juli 2016. Letzter Zugriff 24.05.2020. www.ratiopharm.de  
  32. arznei-telegramm. ERHÖHTES KREBSRISIKO UNTER JAK-HEMMER TOFACITINIB (XELJANZ). a-t 2021; 52: 15-6. www.arznei-telegramm.de  
  33. Sands BE, Sandborn WJ, Panaccione R, et al. Ustekinumab as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med 2019; 381(139): 1201-14. pubmed.ncbi.nlm.nih.gov  
  34. Janssen. Fachinformation Stelara. Stand 2020. Letzter Zugriff 18.06.2021. s3.eu-central-1.amazonaws.com  
  35. Wang Y, MacDonald JK, Benchimol EI, et al.. Type I interferons for induction of remission in ulcerative colitis. Cochrane Database of Systematic Reviews 2015. doi:10.1002/14651858.CD006790.pub3 DOI  
  36. Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Eng J Med 2005; 353: 2462-76. New England Journal of Medicine  
  37. Jürgens M, Laubender RP, Hartl F. Disease activity, ANCA, and IL23R genotype status determine early response to infliximab in patients with ulcerative colitis. Am J Gastroenterol 2010; 105: 1811-9. PubMed  
  38. Ford AC, Peyrin-Biroulet L.. Opportunistic infections with anti-tumor necrosis factor-alpha therapy in inflammatory bowel disease: meta-analysis of randomized controlled trials. Am J Gastroenterol 2013; 108 (8): 1268-76. pmid:23649185 PubMed  
  39. Sands BE, Peyrin-Biroulet L, Lotfus EV, et al. Vedolizumab versus Adalimumab for Moderate-to-Severe Ulcerative Colitis. NEJM 2019; 381: 1215-26. www.nejm.org  
  40. Moayyedi P, Surette MG, Kim PT, et al. Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology 2015; 149: 102-9. DOI:10.1053/j.gastro.2015.04.001 DOI  
  41. Jahnsen J, Aadland E, Moum B, Schulz T, Sauar J, Lygren I et al. Inflammatory bowel disease, disease course and status 5 years after diagnosis. Gastroenterology 2000; 118 (suppl 2): A118. www.gastrojournal.org  
  42. Bach SP, Mortensen NJM. Revolution and evolution: 30 years of ileoanal pouch surgery. Inflamm Bowel Dis 2006; 12: 131-45. PubMed  
  43. Gisbert JP, Gomollon F, Mate J, Pajares JM. Role of 5-aminosalicylic acid (5-ASA) in treatment of inflammatory bowel disease. A systematic review. Dig Dis Sci 2002; 47: 471 - 88. PubMed  
  44. Klotz U. The role of aminosalicylates at the beginning of the new millenium in the treatment of chronic inflammatory bowel disease. Eur J Clin Pharmacol 2000; 56: 353 - 62. PubMed  
  45. Allgayer H, Kruis W. Aminosalicylates: potential antineoplastic actions in colon cancer prevention. Scand J Gastroenterol 2002; 38: 125 - 31. PubMed  
  46. Eaden J, Abrams K, Ekbom A, Jackson E, Mayberry J. Colorectal cancer prevention in ulcerative colitis: a case-control study. Aliment Pharmacol Ther 2000; 14: 145 - 53. PubMed  
  47. Bernstein CN, Eaden J, Steinhart AH, Munkholm P, Gordon P. Cancer prevention in inflammatory bowel diseases and the chemoprophylatic potential of 5-aminosalicylic acid. Inflamm Bowel Dis 2002; 8: 356 - 61. PubMed  
  48. Zhan YL, Zhan YA, Dai SX. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review. Clin Nutr. 2017. pmid:28587774 PubMed  
  49. Langhorst J, Anthonisen IB, Steder-Neukamm U et al. Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey. Inflamm Bowel Dis 2005; 11: 287–295. pubmed.ncbi.nlm.nih.gov  
  50. Torres J, Boyapati RK, Kennedy NA, et al. Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease. Gastroenterology 2015; 149: 1716-30. pmid:26381892 PubMed  
  51. Moum B, Ekbom A, Vatn M, Elgjo K. Change in the extent of colonoscopic and histological involvement in ulcerative colitis over time. Am J Gastroenterol 1999; 94: 1564-9. PubMed  
  52. Hovde Ø, Småstuen MC, Høivik ML, et al. Mortality and causes of death in ulcerative colitis: Results from 20 years of follow-up in the IBSEN study. Inflamm Bowel Dis 2016; 22(1):141-145. pubmed.ncbi.nlm.nih.gov  
  53. Olsen KØ, Joelsson M, Laurberg S et al. Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis. Br J Surg 1999; 86: 493-5. PubMed  
  54. Cvancarova M, Hovde O, Wanderaas M, et al. Do patients with longstanding IBD have higher cancer risk compared to the general population? Results from the IBSEN study. J Clin Oncol 2015; 33: Abstract 1573. meetinglibrary.asco.org  
  55. Olén O, Erichsen R, Sachs MC, et al. Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. Lancet 2020. doi:10.1016/S0140-6736(19)32545-0. www.thelancet.com  
  56. Collins PD, Mpofu C, Watson AJ, Rhodes JM. Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease. Cochrane Database Syst Rev, issue 2, 2006. www.ncbi.nlm.nih.gov  
  57. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48: 526-35. www.ncbi.nlm.nih.gov  
  58. Sutherland LR. Maintenance therapy for inflammatory bowel disease: what really works. Can J Gastroenterol 1997; 11: 261-4. PubMed  
  59. Kornbluth A, Marion JF, Salomon P, Janowitz HD. How effective is current medical therapy for severe ulcerative and Crohn's colitis? An analytic review of selected trials. J Clin Gastroenterol 1995; 20: 280-4. PubMed  
  60. Turner D, Walsh CM, Steinhart AH et al. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol 2007; 5: 103-10. pubmed.ncbi.nlm.nih.gov  
  61. Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Kolorektales Karzinom. Stand 2017. AWMF-Leitlinie Nr. 021-007OL www.awmf.org  
  62. Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten e.V. (DGVS). Addendum zu den S3-Leitlinien Morbus Crohn und Colitis ulcerosa: Betreuung von Patienten mit chronisch–entzündlichen Darmerkrankungen in der COVID-19 Pandemie – offene Fragen und Antworten. AWMF-Register-Nr. 021 – 030, 021 -009, 021-004. Stand 2020. www.ncbi.nlm.nih.gov  
  • Lino Witte, Dr. med., Arzt in Weiterbildung, Innere Medizin, Frankfurt