Gerinnungssystem und chronisch entzündliche Darmerkrankungen: Therapeutische und pathophysiologische Implikationen

Zusammenfassung

Mehrere Beobachtungen legen einen Zusammenhang zwischen der Ätiopathogenese chronisch entzündlicher Darmerkrankungen und Störungen des Gerinnungssystems nahe. Die bei M. Crohn und Colitis ulcerosa nachweisbare Aktivierung des Gerinnungssystems ist wahrscheinlich nicht nur Ursache einer erhöhten Inzidenz thrombembolischer Komplikationen, sondern möglicherweise auch ein wesentliches Element der pathophysiologischen Veränderungen in den kleinen Gefäßen der Darmwand. Allerdings ist bis dato noch unklar, ob die beobachteten Störungen des Gerinnungssystems eine (Teil-)-Ursache oder lediglich die Folge des systemischen Entzündungsprozesses bei chronisch entzündlichen Darmerkrankungen sind. In jüngerer Vergangenheit wurde im Rahmen mehrerer Studien auf den Nutzen der Therapie mit unfraktioniertem und niedermolekularem Heparin hingewiesen. Aus diesen klinischen Studien wiederum lassen sich eine Reihe pathophysiologisch relevanter Konzepte ableiten.

Abstract

Several observations are compatible with an association between an haemostatic imbalance and the pathogenesis of inflammatory bowel disease. The prothrombotic state in Crohn’s disease and ulcerative colitis is probably not simply the cause of an increased susceptibility for thrombembolic complications, but might also reflect an important element of the pathogenetic changes observed in the small vessels of the intestinal wall. However, it is still unclear whether alterations in the coagulation system are the cause or the aftermath of the systemic inflammatory response observed in inflammatory bowel disease. Several recent observations describe therapeutic efficacy of unfractioned or low-molecular weight heparin in patients with active ulcerative colitis and Crohn’s disease. Based on these clinical observations new concepts concerning the pathophysiology of inflammatory bowel disease have emerged.

Schlüsselwörter

Heparin - Colitis ulcerosa - M. Crohn

Key words

Heparin - ulcerative colitis - Crohn’s disease

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