Übersichtsarbeit · Review Article
Interdisziplinäres Vorgehen bei Stenosen und Fisteln bei Morbus CrohnHoffmann J.C.
Medizinische Klinik I mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Charité, Campus Benjamin Franklin, Berlin, Deutschland
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Crohn's disease is characterized by gastrointestinal inflammation, stenosis, and/or fistulae. While fistulae and stenosis affect only one third of Crohn's disease patients, these are the most severely affected and their management is considered to be a interdisciplinary challenge. Therefore, these patients are often cared for at specialized centers. Diagnostic tests in patients with suspected stenosis are aiming at differentiating inflammatory stenosis from tumor stenosis, complicated stenosis with fistulae and noninflammatory strictures. Both complicated stenosis as well as suspected tumor stenosis are clear indications for operative resection. In contrast, inflammatory stenosis should be treated conservatively, e. g. by corticosteroids. Strictures can be treated either by endoscopic balloon dilatation, operative resection or stricturoplasty. While longer remission rate stand in favor for surgery, endoscopic dilatation is less costly and carries a lower complication rate. Treatment of fistulas usually needs both a surgical evaluation and drainage as well as drug therapy. Because of that patients with complicated fistulae usually benefit from an interdisciplinary inpatient service. Drugs which are clearly effective in fistulous disease are infliximab, azathioprine/6-mercaptopurine, and tacrolimus, less effective is metronidazol.
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