Schlüsselwörter chronisch-entzündliche Darmerkrankungen - CED - Diagnose - Therapie - Remission - Remissionserhaltung

Die letzte Aktualisierung der Leitlinie wurde im August 2020 publiziert. Anfang 2021 wurde erneut eine systematische Literaturrecherche durchgeführt, aus der sich nach Diskussion in der Steuergruppe kein Aktualisierungsbedarf ergab. Bei der diesjährigen Überprüfung ergaben sich wichtige Neuerungen in der Diagnostik und Therapie der Colitis ulcerosa, die eine erneute Aktualisierung sinnvoll erschienen ließen. Die überarbeiteten Empfehlungen sind unten aufgeführt. Aufgrund der neuen Studienlage wurde u. a. die Evidenzstärke einzelner Empfehlungen hoch- bzw. abgestuft und die entsprechenden Empfehlungen und Hintergründe ergänzt. Alle Änderungen sind im Anhang detailliert zusammengefasst. Alle anderen Empfehlungen, die nicht verändert wurden, wurden 2022 geprüft.

Background: Vedolizumab (VDZ) drug monitoring strategies in inflammatory bowel disease (IBD) patients have not been systematically investigated so far. We evaluated the correlation between VDZ trough levels (VTL) and the treatment response in IBD.Methods: Fifty-one patients with active IBD on or starting a therapy with VDZ were enrolled in this prospective and observational single centre study. Disease activity indices, blood tests, and anthropometric parameters were assessed over a time period of 6 months. One hundred and fifty-five VDZ serum trough levels were measured directly before the next scheduled application using liquid chromatography mass spectrometry (LC-MS/MS).Results: VDZ treatment was found to be clinically effective (Harvey Bradshaw Index (HBI) dropping from 10 to 5.5 points (p<.0005) in Crohn's disease (CD) patients; partial Mayo score (pMS) from 4.4 to 2.1 points (p<.0005) in ulcerative colitis patients (UC). CRP levels tended to decrease and haemoglobin levels to increase under VDZ therapy. CD patients with a serum CRP level lower than 5mg/l exhibited significantly higher VTL than those with elevated CRP levels (34.9 versus 21.7 mu g/ml, p=.00153). UC patients with haemoglobin levels higher 12g/dl at the time of VTL measurement had significantly higher VTL compared to patients with lower haemoglobin levels (35.4 versus 15.6 mu g/ml, p<.0005).Conclusions: Our data suggest a significant correlation between VTL and response to therapy in IBD patients (higher VTL associated with better response).

SIRS, We read with interest the review article: ‘the management of Crohn’s disease and ulcerative colitis (UC) during pregnancy and lactation’ by Dr Schulze et al. Their report indicates that most of the currently approved IBD medications except methotrexate are not associated with adverse pregnancy outcomes, and may be used to maintain quiescent disease or to induce remission in patients with flares or active disease. Unfortunately, this review makes no mention of leucocytapheresis, which has been reported as an effective therapy in pregnant IBD patients. In the report by Okada et al., a 30-year-old pregnant woman with UC had relapsed during tapering of corticosteroid. Leucocytapheresis was performed without increasing the corticosteroid dose. The patient received a total of four apheresis sessions without complications. She achieved disease remission and a normal pregnancy outcome. In the report by Takahashi et al., three pregnant women with active UC were treated with leucocytapheresis with an Adacolumn [JIMRO Co. Ltd., Takasaki, Japan], up to 10 sessions within 3– 6 weeks. All patients achieved complete remission without any adverse event, and had normal pregnancy outcomes. In the report by D’Ovidio, et al., a 37-year-old pregnant woman with chronically active and steroid-dependent UC refused more aggressive pharmacological intervention. To minimise symptoms and the risk of severe clinical relapse, maintenance leucocytapheresis therapy was performed throughout the pregnancy. The course of pregnancy was uneventful with no side effects; the mother and the baby were both in good health after delivery. Therefore, all these preliminary experiences support leucocytapheresis as an effective nonpharmacologic treatment intervention. We believe that leucocytapheresis may be considered as a potential first-line medication, because experience (albeit in a small number of cases) indicates pregnant patients who respond can avoid pharmacological interventions.

BackgroundInflammatory bowel diseases (IBD) commonly affect young patients in the reproductive phase of their lives. The chronic and relapsing nature of IBD and the potential need for medical or surgical interventions raise concerns about family planning issues.AimTo review the current knowledge on IBD management in pregnant and nursing IBD patients.MethodsA PubMed literature search was performed using the search terms reproduction' and inflammatory bowel disease' and using the headers and main subjects of each section of this article as search terms.ResultsMale and female fertility are not impaired in the majority of IBD patients. In IBD patients with quiescent disease pregnancy outcomes are not impaired in comparison to the general population, however, an increased incidence of pregnancy complications is observed in active IBD patients. As methotrexate (MTX) has been demonstrated to be teratogenic, the use of MTX is contraindicated in patients, who wish to conceive, throughout pregnancy and when nursing. However, normal pregnancies following MTX treatment at conception and later have been reported. Most of the other currently approved IBD medications are not associated with adverse pregnancy outcomes and may be used to maintain quiescent disease or to induce a rapid remission in patients with flares and active disease. Breast-feeding in IBD patients is possible and recommended.ConclusionsThe overall outcome of pregnancies in IBD patients is favourable and not different to healthy controls, thus patients with IBD should not be discouraged from having children.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Einleitung ▼ Intestinale Stenosen sind eine häufige Komplikation im Langzeitverlauf des Morbus Crohn. Bei Diagnosestellung weisen rund 10 % der Patienten Stenosen auf; dieser Anteil steigt im Verlauf an und betrifft nach 10 Jahren bis zu ein Drittel der Patienten [19]. Häufig treten Stenosen in Anastomosenbereichen nach zuvor erfolgter Resektion auf. Wurden früher nahezu alle Stenosen operiert, haben sich in den letzten Jahren auch medikamentös-konservative und endoskopisch-interventionelle Therapieoptionen etabliert. Die Entscheidung, welche Therapie für den Patienten am besten geeignet ist, ist oftmals eine Herausforderung für den behandelnden Arzt und sollte im interdisziplinären Austausch zwischen Gastroenterologen und Chirurgen gefällt werden.