Z Gastroenterol 2003; 41(1): 36-42
DOI: 10.1055/s-2003-36666
Leitlinien der DGVS
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Remissionserhaltung

Maintaining a RemissionW. E. Fleig1
  • 1Klinik und Poliklinik Innere Medizin I, Universitätsklinikum Kröllwitz, Halle
Further Information

Publication History

Publication Date:
16 January 2003 (online)

Definitionen
Remission

Konsens

Die Remission des M. Crohn wird klinisch definiert. Kriterien für diese Definition sind fehlende klinische Zeichen und Symptome eines M. Crohn (Bauchschmerzen, Diarrhö, Fistelsekretion, andere intestinale und extraintestinale Symptome; C).

Erläuterung

Diese Definition nimmt eine Remission an, sobald Symptome und Zeichen der aktiven Erkrankung verschwunden sind. Während die Definition der chronisch aktiven Erkrankung (siehe dort) einen Verlauf von mindestens 6 Monaten unter adäquater Therapie fordert, ist offen, wie lange unter bzw. nach Akutphasentherapie Symptomfreiheit bestehen muss, um eine stabile klinische Remission annehmen und deshalb folgerichtig die Akutphasentherapie beenden zu können. Diese Unschärfe im Übergang vom ausklingenden akuten Schub zur Remission dürfte einige Wochen betragen. Prospektive Daten zu dieser Problematik existieren nicht.

Literatur

  • 1 Rutgeerts P, Geboes K, Vantrappen G. et al . Predictability of the postoperative course of Crohn’s disease.  Gastroenterology. 1990;  99 956-963 (III)
  • 2 Ludwig D, Wiener S, Bruning A. et al . Mesenteric blood flow is related to disease activity and risk of relapse in Crohn’s disease: a prospective follow-up study.  Am J Gastroenterol. 1999;  94 2942-2950 (III)
  • 3 Brignola C, Campieri M, Bazzocchi G. et al . A laboratory index for predicting relapse in asymptomatic patients with Crohn’s disease.  Gastroenterology. 1986;  91 1490-1494 (III)
  • 4 Brignola C, Iannone P, Belloli C. et al . Prediction of relapse in patients with Crohn’s disease in remission: a simplified index using laboratory tests, enhanced by clinical characteristics.  Eur J Gastroenterol Hepatol. 1994;  6 955-961 (III)
  • 5 Landi B, Anh T N, Cortot A. et al . Endoscopic monitoring of Crohn’s disease treatment: a prospective, randomized clinical trial. The Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives.  Gastroenterology. 1992;  102 1647-1653 (Ib)
  • 6 Silverstein M D, Loftus E V, Sandborn W J. et al . Clinical course and costs of care for Crohn’s disease: Markov model analysis of a population-based cohort.  Gastroenterology. 1999;  117 49-57 (IIb)
  • 7 Sutherland L R, Martin F, Bailey R J. et al . A randomized, placebo-controlled, double-blind trial of mesalamine in the maintenance of remission of Crohn’s disease.  Gastroenterology. 1997;  112 1069-1077 (Ib)
  • 8 Timmer A, Sutherland L R, Martin F. et al . Oral contraceptive use and smoking are risk factors for relapse in Crohn’s disease.  Gastroenterology. 1998;  114 1143-1150 (III)
  • 9 Holdstock G, Savage D, Harman J E. et al . Short report: Should patients with inflammatory bowel disease smoke?.  BMJ. 1984;  288 362 (III)
  • 10 Cottone M, Rosselli M, Orlando A. et al . Smoking habits and recurrence in Crohn’s disease.  Gastroenterology. 1994;  106 643-648 (III)
  • 11 Breuer-Katschinski B D, Hollander N, Goebell H. Effect of cigarette smoking on the course of Crohn’s disease.  Eur J Gastroenterol Hepatol. 1996;  8 225-228 (III)
  • 12 Gendre J P, Mary J Y, Florent C. et al . Oral mesalamine (Pentasa) as maintenance treatment in Crohn’s disease: A multicenter placebo-controlled study.  Gastroenterology. 1993;  104 435-439 (Ib)
  • 13 Sachar D B, Subramani K, Mauer K. et al . Patterns of postoperative recurrence in fistulizing and stenotic Crohn’s disease. A retrospective cohort study of 71 patients.  J Clin Gastroenterol. 1996;  22 114-116 (III)
  • 14 Post S, Herfarth C, Böhm E. et al . The impact of disease pattern, surgical management and individual surgeons on the risk for relaparotomy for recurrent Crohn’s disease.  Ann Surg. 1996;  223 253-260 (III)
  • 15 Munoz-Juarez M, Yamamoto T, Wolff B G. et al . Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn’s disease.  Dis Colon Rectum. 2001;  44 20-25 (Ib)
  • 16 Hashemi M, Novell J R, Lewis A A. Side-to-side stapled anastomosis may delay recurrence in Crohn’s disease.  Dis Colon Rectum. 1998;  41 1293-1296 (IIa)
  • 17 Poggioli G, Stocchi L, Laureti S. et al . Conservative surgical management of terminal ileitis: side-to-side enterocolic anastomosis.  Dis Colon Rectum. 1997;  40 234-237 (III)
  • 18 Cosnes J, Carbonnel F, Carrat F. et al . Oral contraceptive use and the clinical course of Crohn’s disease: a prospective cohort study.  Gut. 1999;  45 218-222 (III)
  • 19 Fazio V W, Marchetti F, Church M. et al . Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. A randomized controlled trial.  Ann Surg. 1996;  224 563-571 (Ib)
  • 20 Malchow H, Ewe K, Brandes J el al. European cooperative Crohn’s disease study (ECCDS): results of drug treatment.  Gastroenterology. 1984;  86 249-266 (Ib)
  • 21 Wyatt J, Vogelsang H, Hubl W. et al . Intestinal permeability and the prediction of relapse in Crohn’s disease.  Lancet. 1993;  341 1437-1439 (III)
  • 22 Peeters M, Geypens B, Claus D. et al . Clustering of increased small intestinal permeability in families with Crohn’s disease.  Gastroenterology. 1997;  113 802-807 (IIb)
  • 23 Tibble J A, Sigthorsson G, Bridger S. et al . Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease.  Gastroenterology. 2000;  119 15-22 (III)
  • 24 Schreiber S, Nikolaus S, Hampe J. et al . Tumour necrosis factor alpha and interleukin 1beta in relapse of Crohn’s disease.  Lancet. 1999;  353 459-461 (III)
  • 25 Nikolaus S, Raedler A, Kuhbacker T. et al . Mechanisms in failure of infliximab for Crohn’s disease.  Lancet. 2000;  356 1475-1479 (III)
  • 26 Meresse B, Rutgeerts P, Malchow H. et al . Low ileal interleukin 10 concentrations are predictive of endoscopic recurrence in patients with Crohn’s disease.  Gut. 2002;  50 25-28 (III)
  • 27 Parsi M A, Achkar J P, Richardson S. et al . Predictors of response to infliximab in patients with Crohn’s disease.  Gastroenterology. 2002;  123 707-713 (III)
  • 28 Pearson D C, May G R, Fick G H. et al . Azathioprine and 6-mercaptopurine in Crohn’s disease. A metaanalysis.  Ann Intern Med. 1995;  123 132-142 (Ia)
  • 29 Bouhnik Y, Lemann M, Mary J C. et al . Long-term follow-up of patients with Crohn’s disease treated with azathioprine or 6-mercaptopurine.  Lancet. 1996;  347 215-219 (Ib)
  • 30 Feagan B G, Rochon J, Fedorak N. et al . Methotrexate for the treatment of Crohn’s disease.  New Engl J Med. 1995;  332 292-297 (Ib)
  • 31 Rutgeerts P, D’Haens G, Targan S. et al . Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease.  Gastroenterology. 1999;  117 761-769 (Ib)
  • 32 Hanauer S B, Feagan B G, Lichtenstein G R. et al . Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial.  Lancet. 2002;  359 1541-1549 (Ib)
  • 33 Stange E F, Schreiber S, Raedler A. et al . Therapie des Morbus Crohn.  Z Gastroenterol. 1997;  35 541-554
  • 34 Messori A, Brignola C, Trallori G. et al . Effectiveness of 5-aminosalicylic acid for maintaining remission in patients with Crohn’s disease: A metaanalysis.  Am J Gastroenterol. 1994;  89 692-698 (Ia)
  • 35 Cammà C, Giunta M, Rosselli M. et al . Mesalamine in the treatment of Crohn’s disease-meta-analysis adjusted for confounding variables.  Gastroenterology. 1997;  113 1465-1473 (Ia)
  • 36 Papi C, Luchetti R, Gili L. et al . Budesonide in the treatment of Crohn’s disease: a meta-analysis.  Aliment Pharmacol Ther. 2000;  14 1419-1428 (Ia)
  • 37 Thomas G A, Swift G L, Green J T. et al . Controlled trial of antituberculous chemotherapy in Crohn’s disease: a five year follow up study.  Gut. 1998;  42 497-500 (Ib)
  • 38 Borgaonkar M R, MacIntosh D G, Fardy J M. A meta-analysis of antimycobacterial therapy for Crohn’s disease.  Am J Gastroenterol. 2000;  95 725-729 (Ia)
  • 39 Feagan B G, McDonald J W, Rochon J. et al . Low-dose cyclosporine for the treatment of Crohn’s disease. The Canadian Crohn’s Relapse Prevention Trial Investigators.  N Engl J Med. 1994;  330 1846-1851 (Ib)
  • 40 Stange E F, Modigliani R, Pena S. et al . European trial of cyclosporine in chronic active Crohn’s disease: a 12-month study. The European Study Group.  Gastroenterology. 1995;  109 774-782 (Ib)
  • 41 Fellermann K, Steffen M, Stein J. et al . Mycophenolate mofetil: lack of efficacy in chronic active inflammatory bowel disease.  Aliment Pharmacol Ther. 2000;  14 171-176 (III)
  • 42 Malchow H A. Crohn’s disease and Escherichia coli. A new approach in therapy to maintain remission of colonic Crohn’s disease?.  J Clin Gastroenterol. 1997;  25 653-658 (III)
  • 43 Belluzzi A, Brignola C, Campieri M. et al . Effect of an enteric-coated fish-oil preparation on relapses in Crohn’s disease.  N Engl J Med. 1996;  334 1557-1560 (Ib)
  • 44 Lorenz-Meyer H, Bauer P, Nicolay C. et al . Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn’s disease. A randomized controlled multicenter trial. Study Group Members (German Crohn’s Disease Study Group).  Scand J Gastroenterol. 1996;  31 778-785 (Ib)
  • 45 Lochs H, Mayer M, Fleig W E. et al . Prophylaxis of postoperative relapse in Crohn’s disease with Pentasa, Results of the European CrohnŽs disease Study VI.  Gastroenterology. 2000;  118 264-273 (Ib)
  • 46 Cottone M, Cammà C. Mesalamine and relapse prevention in Crohn’s disease (Letter).  Gastroenterology. 2000;  118 597 (Ia)
  • 47 Mc L eod RS, Wolff B G, Steinhardt A H. et al . Prophylactic mesalamine treatment decreases postoperative recurrence of Crohn’s disease.  Gastroenterology. 1995;  109 404-413 (Ib)
  • 48 Rutgeerts P, Hiele M, Geboes K. et al . Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection.  Gastroenterology. 1995;  108 1617-1621 (Ib)
  • 49 Smith R C, Rhodes J, Heatley R V. et al . Low dose steroids and clinical relapse in Crohn’s disease: a controlled trial.  Gut. 1978;  19 606-610 (Ib)
  • 50 Ewe K, Böttger T, Buhr H J. et al . Low-dose budesonide treatment for prevention of postoperative recurrence of Crohn’s disease: a multicentre randomized placebo-controlled trial.  Eur J Gastroenterol Hepatol. 1999;  11 277-282 (Ib)
  • 51 Hellers G, Cortot A, Jewell D. et al . Oral budesonide for prevention of postsurgical recurrence in Crohn’s disease.  Gastroenterology. 1999;  116 294-300 (Ib)
  • 52 Colombel J F, Rutgeerts P, Malchow H. et al . Interleukin 10 (Tenovil) in the prevention of postoperative recurrence of Crohn’s disease.  Gut. 2001;  49 42-46 (Ib)
  • 53 Prantera C, Scribano M L, Falasco G. et al . Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: a randomised controlled trial with Lactobacillus GG.  Gut. 2002;  51 405-409 (Ib)
  • 54 Markowitz J, Grancher K, Kohn N. et al . A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease.  Gastroenterology. 2000;  119 895-902 (Ib)
  • 55 Vogelsang H, Granditsch G, Binder C. et al . Consensus of the Chronic Inflammatory Bowl Disease Study Group of the Austrian Society of Gastroenterology and Hepatology on the topic of „diagnosis and therapy of chronic inflammatory bowel diseases in adolescence”.  Z Gastroenterol. 2000;  38 791-794
  • 56 Mogadam M, Korelitz B I, Ahmed S W. et al . The course of inflammatory bowel disease during pregnancy and postpartum.  Am J Gastroenterol. 1981;  75 265-269 (III)
  • 57 Habal F M, Hui G, Greenberg G R. Oral 5-aminosalicylic acid for imflammatory bowel disease in pregnancy: safety and clinical course.  Gastroenterology. 1993;  105 1057-1062 (III)
  • 58 Alstead E M, Ritchie J K, Lennard-Jones J E. et al . Safety of azathioprin in pregnancy in inflammatory bowel disease.  Gastroenterology. 1990;  97 443-446 (III)
  • 59 Present D H, Meltzer S J, Krumholz M P. et al . 6-Mercaptopurine in the management of inflammatory bowel disease.  Am Col Phys. 1989;  111 641-649 (III)
  • 60 Srinivasan R. Infliximab treatment and pregnancy outcome in active Crohn’s disease.  Am J Gastroenterol. 2001;  96 2274-2275
    >