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DOI: 10.1055/s-0028-1109323
© Georg Thieme Verlag KG Stuttgart · New York
Evidenzbasierte und interdisziplinär konsentierte Versorgungspfade für Patientinnen und Patienten mit Morbus Crohn oder Colitis ulcerosa
Evidence-Based and Consented Pathways for Patients with Inflammatory Bowel Diseases (IBD)Publikationsverlauf
                     Manuskript eingetroffen: 12.11.2008
                     
                     Manuskript akzeptiert: 16.2.2009
                     
Publikationsdatum:
16. Juni 2009 (online)

Zusammenfassung
Morbus Crohn und Colitis ulcerosa sind charakterisiert durch rezidivierende Schübe, ein frühes Manifestationsalter und Einschränkungen in Aktivitäten und Teilhabe. Sie erfordern eine wohnortnahe, krankheitsbegleitende und problemorientierte Versorgung. Die entwickelten Versorgungspfade sollen die Wege für kooperatives Handeln zwischen den verschiedenen Versorgungssektoren, ärztlichen und nicht-ärztlichen Berufsgruppen, Einrichtungen und Kostenträgern ebnen.
Grundlage sind die S3-Leitlinien der beiden Krankheitsbilder, klinische Überlegungen, Interviews mit Fachleuten, systematisch gesuchte Evidenz und Ergebnisse einer Betroffenenbefragung.
Die Probleme der Erkrankten wurden erfasst, abgegrenzt und operationalisiert. Allen relevanten Problemsituationen wurden medizinische und nicht-medizinische Leistungen und Leistungserbringer zugeordnet. Abhängig von der Schwere des Krankheitsverlaufs wurde die Koordination der Versorgungsaufgaben den verschiedenen medizinischen Versorgungsebenen und -sektoren zugeteilt. Ein regelmäßiges umfassendes Assessment im Rahmen der medizinischen Betreuung soll erforderliche individuelle Interventionen feststellen. Weitere Säulen sind die leitliniengerechte medizinische Versorgung, eine bedarfsgerechte Information und Schulung der Kranken mit dem Ziel einer Befähigung zu partizipativer Entscheidungsfindung und Selbstmanagement sowie die Anregung zu Forschung und Entwicklung.
Die Versorgungspfade sind evidenzbasiert und interdisziplinär konsentiert (S3). Ihre Anwendbarkeit soll im Rahmen einer Implementierung evaluiert werden.
Abstract
Crohn’s disease and ulcerative colitis are diseases characterized by remission and relapse, an early age of onset and restrictions on activities and participation. IBD patients need a comprehensive, easily accessible and problem-oriented health care. This requires the integration and coordination of different health care sectors, medical and non-medical professionals, social and health care facilities and funding agencies.
The pathways to guide patients through integrated health care were based on clinical considerations, interviews with patients and specialists, systematically searched evidence and results of a questionnaire survey. Within a systematic assessment-assignment approach relevant problems were identified and subsequently related to different medical and non-medical professionals, health care services and medical sectors.
The pathways further imply (1) medical care according to evidence-based guideline recommendations, (2) patient education programs to foster shared decision making and self-management and (3) suggestions for further research.
The pathways were consented in a consensus conference using nominal group process methods. Their feasibility and effect will be evaluated within a regional implementation project.
Schlüsselwörter
chronisch-entzündliche Darmerkrankungen - Morbus Crohn - Colitis ulcerosa - evidenzbasierte Versorgung - Leitlinien
Key words
inflammatory bowel diseases - Crohn’s disease - ulcerative colitis - evidence based care - guidelines
Literatur
- 1 
            Roy M A. 
            Inflammatory bowel disease. 
            Surgical Clinics of North America. 
            1997; 
            77 (6) 
            1419-1431 
            
            Reference Ris Wihthout Link
- 2 
            Sandler R S, Golden A L. 
            Epidemiology of Crohn’s disease. 
            J Clin Gastroenterol. 
            1986; 
            8 (2) 
            160-165 
            
            Reference Ris Wihthout Link
- 3 
            Shivananda S, Lennard-Jones J, Logan R. et al .
            Incidence of inflammatory bowel disease across Europe: is there a difference between
            north and south? Results of the European collaboration study on inflammatory bowel
            disease (EC-IBD). 
            Gut. 
            1996; 
            39 
            690-697 
            
            Reference Ris Wihthout Link
- 4 
            Irvine E J. 
            A critical Review of epidemiological studies in inflammatory bowel disease. 
            Scan J Gatroenterol. 
            2001; 
            36 (1) 
            2-15 
            
            Reference Ris Wihthout Link
- 5 
            Drossman D A, Patrick D L, Mitchell C M. et al .
            Health-related quality of life in inflammatory bowel disease – functional status and
            patients worries and concerns. 
            Dig Dis Sci. 
            1989; 
            34 (9) 
            1379-1386 
            
            Reference Ris Wihthout Link
- 6 
            Berklev T, Jahnsen J, Schulz T. et al .
            Course of disease, drug treatment and health-related quality of life in patients with
            inflammatory bowel disease 5 years after initial diagnosis. 
            Eur J Gastroenterol Hepatol. 
            2005; 
            17 
            1037-1045 
            
            Reference Ris Wihthout Link
- 7 
            Raspe H, Lühmann D. 
            Klinische und Versorgungsleitlinien. 
            Z ärztl Fortbilb Qual sich. 
            2002; 
            96 
            212 
            
            Reference Ris Wihthout Link
- 8 
            Stange E F, Schreiber S, Fölsch U. et al .
            Diagnostik und Therapie des Morbus Crohn. 
            Z Gastroenterol. 
            2003; 
            41 
            19-68 (Sonderdruck) 
            
            Reference Ris Wihthout Link
- 9 
            Hoffmann J C, Zeitz M, Bischoff S C. et al .
            Diagnostik und Therapie der Colitis Ulcerosa: Ergebnisse einer evidenzbasierten Konsensuskonferenz. 
            Z Gastroenterol. 
            2004; 
            42 
            984-1032 
            
            Reference Ris Wihthout Link
- 10 
            Goebell H. 
            Stellenwert von Aktivitätsindizes bei der Begutachtung von chronisch-entzündlichen
            Darmkrankheiten. 
            Med Sach. 
            2000; 
            96 (6) 
            176-178 
            
            Reference Ris Wihthout Link
- 11 
            Baumgart D C, Sandborn W J. 
            Inflammatory bowel disease: clinical aspects and established and evolving therapies. 
            Lancet. 
            2007; 
            369 
            1627-40 
            
            Reference Ris Wihthout Link
- 12 World Health Organisation .International Classification of functioning, disability and health. Geneva; WHO 2001 
            Reference Ris Wihthout Link
- 13 
            Klaus J, Armbrecht G, Steinkamp M. et al .
            High prevalance of osteoporotic vertebral fractures in patients with Crohn’s disease. 
            Gut. 
            2002; 
            51 
            654-658 
            
            Reference Ris Wihthout Link
- 14 
            Reinshagen M, Tirpitz von C. 
            Osteoporosis and other extraintestinal symptoms and complications of inflammatory
            bowel disease. 
            Dig Dis. 
            2003; 
            21 
            138-145 
            
            Reference Ris Wihthout Link
- 15 
            Mintz R, Feller E, Bahr R L. et al .
            Ocular manifestations of inflammatory bowel disease. 
            Inflamm Bowel Dis. 
            2004; 
            10 
            135-139 
            
            Reference Ris Wihthout Link
- 16 
            Schulte C MS. 
            Review article: bone disease in inflammatory bowel disease. 
            Aliment Pharmacol Ther. 
            2004; 
            20 
            43-49 
            
            Reference Ris Wihthout Link
- 17 
            Itin P H, Rufli T. 
            Hautsymptome bei Erkrankungen im Bereich des Magen-Darm-Trakts. 
            Therapeutischen Umschau. 
            1995; 
            52 
            236-242 
            
            Reference Ris Wihthout Link
- 18 
            Fornaciari G, Salvarani C, Beltrami M. et al .
            Muscoloskeletal manifestations in inflammatory bowel disease. 
            Can J Gastroenterol. 
            2001; 
            15 
            399-403 
            
            Reference Ris Wihthout Link
- 19 
            Palm Ø, Moum B, Jahnsen J. et al .
            The prevalence and incidence of peripheral arthritis in patients with inflammatory
            bowel disease, a prospective population-based study/the IBSEN study). 
            Rheumatology. 
            2001; 
            40 
            1256-1261 
            
            Reference Ris Wihthout Link
- 20 
            Husain A, Triadafilopoulos G. 
            Communicating with patients with inflammatory bowel disease. 
            Inflamm Bowel Dis. 
            2004; 
            10 
            444-450 
            
            Reference Ris Wihthout Link
- 21 
            Deter H C, Rapf M, Gladisch R. et al .
            Psychodiagnostische Verlaufsuntersuchungen vom Morbus-Crohn-Patienten während der
            internistischen Intensivbehandlung. 
            Z Gastroenterol. 
            1993; 
            31 
            703-710 
            
            Reference Ris Wihthout Link
- 22 
            North C S, Alpers D H. 
            A review of studies of psychiatric factors in Crohn’s disease: etiologic implications. 
            Annals of Clinical Psychiatry. 
            1994; 
            6 (2) 
            117-124 
            
            Reference Ris Wihthout Link
- 23 
            Küchenhoff J, Manz R, Mathes L. 
            Was beeinflusst den Krankheitsverlauf des Morbus Crohn?. 
            Nervenarzt. 
            1995; 
            66 
            41-48 
            
            Reference Ris Wihthout Link
- 24 
            Feiereis H. 
            Zur Psychotherapie des M. Crohn. 
            Langenbecks Arch Chir. 
            1984; 
            Kongressbericht 
            364 
            
            Reference Ris Wihthout Link
- 25 
            Irvine E J. 
            Review article: patients’ fears and unmet needs in inflammatory bowel disease. 
            Aliment Pharmacol Ther. 
            2004; 
            20 (Suppl 4) 
            54-59 
            
            Reference Ris Wihthout Link
- 26 
            Irvine E J. 
            Quality of life in inflammatory bowel disease: Bias and other factors affecting scores. 
            Scand J Gastroenterol. 
            1995; 
            30 (Suppl 208) 
            136-40 
            
            Reference Ris Wihthout Link
- 27 
            Nordin K, Påhlman L, Larsson K. et al .
            Health-related quality of life and psychological distress in a population-based sample
            of swedish patients with inflammatory bowel disease. 
            Scand J Gastroenterol. 
            2002; 
            37 
            450-457 
            
            Reference Ris Wihthout Link
- 28 
            Porcelli P, Zaka S, Centonze S. et al .
            Psychological distress and levels of disease activity in inflammatory bowel disease. 
            Ital J Gastroenterol. 
            1994; 
            26 
            111-115 
            
            Reference Ris Wihthout Link
- 29 
            Guthrie E, Jackson J, Shaffer J. et al .
            Psychological disorder and severity of inflammatory bowel disease predict health-related
            quality of life in ulcerative colitis and Crohn’s disease. 
            Am J Gastroenterol. 
            2002; 
            97 
            1994-1999 
            
            Reference Ris Wihthout Link
- 30 
            Acosta-Ramírez D, Pagán-Ocasio V, Torres E A. et al .
            Profile of the inflammatory bowel disease patient with depressive disorder. 
            PRHSJ. 
            2001; 
            20 (3) 
            215-220 
            
            Reference Ris Wihthout Link
- 31 
            Andrews H, Barczak P, Allan R N. 
            Psychiatric illness in patients with inflammatory bowel disease. 
            Gut. 
            1987; 
            28 
            1600-1604 
            
            Reference Ris Wihthout Link
- 32 
            Farrokhyar F, Marshall J K, Easterbrook B. et al .
            Functional gastrointestinal disorders and mood disorders in patients with inactive
            inflammatory bowel disease: prevalence and impact on health. 
            Inflamm Bowel Dis. 
            2006; 
            12 (1) 
            38-46 
            
            Reference Ris Wihthout Link
- 33 
            Maunder R G, Greenberg G R. 
            Comparison of a disease activity index and patients’ self-reported symptom severity
            in ulcerative colitis. 
            Inflamm Bowel disease. 
            2004; 
            10 
            632-636 
            
            Reference Ris Wihthout Link
- 34 
            Leibig T, Wilke E, Feiereis H. 
            Zur Persönlichkeitsstruktur von Patienten mit Colitis ulcerosa und Morbus Crohn, eine
            testpsychologische Untersuchung während der Krankheitsremission. 
            Zsch psychosom Med. 
            1985; 
            31 
            380-392 
            
            Reference Ris Wihthout Link
- 35 
            Maunder R G, Lancee W J, Hunter J J. et al .
            Attachment insecurity moderates the relationship between disease activity and depressive
            symptoms in ulcerative colitis. 
            Inflamm Bowel Dis. 
            2005; 
            11 
            919-926 
            
            Reference Ris Wihthout Link
- 36 
            Mittermaier C, Dejaco C, Waldhoer T. et al .
            Impact of depressive mood on relapse in patients with inflammatory bowel disease:
            a prospective 18-month follow-up study. 
            Psychosom Med. 
            2004; 
            66 
            79-84 
            
            Reference Ris Wihthout Link
- 37 
            Kurina L M, Golacre M J, Yeates D. et al .
            Depression and anxiety in people with inflammatory bowel disease. 
            J Epidemiol Community Health. 
            2001; 
            55 
            716-720 
            
            Reference Ris Wihthout Link
- 38 
            Simrén M, Axelsson J, Gillberg R. et al .
            Quality of life in inflammatory bowel disease in remission: the impact of IBS-like
            symptoms and associated psychological factors. 
            Am J Gastroenterol. 
            2002; 
            97 
            389-396 
            
            Reference Ris Wihthout Link
- 39 
            Addolorato G, Capristo E, Stefanini G F. et al .
            Inflammatory bowel disease: a study of the association between anxiety and depression,
            physical morbidity and nutritional status. 
            Scan J Gastroenterol. 
            1997; 
            32 
            1013-1021 
            
            Reference Ris Wihthout Link
- 40 
            Porcelli P, Leoci C, Guerra V. 
            A prospective study of relationship between disease activity and psychologic distress
            in patients with inflammatory bowel disease. 
            Scand J Gastroenterol. 
            1996; 
            31 
            792-796 
            
            Reference Ris Wihthout Link
- 41 
            Mardini H E, Kip K E, Wilson J W. 
            Crohn’s disease: a two-year prospective study of the association between psychological
            distress and disease activity. 
            Dig Dis Sci. 
            2004; 
            49 (3) 
            492-497 
            
            Reference Ris Wihthout Link
- 42 
            North C S, Alpers D H, Helzer J E. et al .
            Do life events or depression exacerbate inflammatory bowel disease?. 
            Annals of Internal Medicine. 
            1991; 
            114 
            381-386 
            
            Reference Ris Wihthout Link
- 43 
            Porcelli P, Leoci C, Guerra V. et al .
            A longitudinal study of alexithymia and psychological distress in inflammatory bowel
            disease. 
            J Psychsom Res. 
            1996; 
            41 (6) 
            569-573 
            
            Reference Ris Wihthout Link
- 44 
            Arapakis G, Lyketsos C G, Gerolymatos K. et al .
            Low dominance and high intropunitiveness in ulcerative colitis and irritable bowel
            syndrom. 
            Psychother Psychosom. 
            1986; 
            46 
            171-176 
            
            Reference Ris Wihthout Link
- 45 
            Riley S A, Mani V, Goodman M J. et al .
            Why do patients with ulcerative colitis relapse?. 
            Gut. 
            1990; 
            31 
            179-183 
            
            Reference Ris Wihthout Link
- 46 
            Helzer J E, Chammas S, Norland C C. et al .
            A study of the association between Crohn’s disease and psychiatric illness. 
            Gastroenterology. 
            1984; 
            86 
            324-30 
            
            Reference Ris Wihthout Link
- 47 
            Robertson D AF, Ray J, Diamond I. et al .
            Personality profile and affective state of patients with inflammatory bowel disease. 
            Gut. 
            1989; 
            30 
            623-626 
            
            Reference Ris Wihthout Link
- 48 
            Magni G, Bernasconi G, Mauro P. et al .
            Psychiatric diagnosis in ulcerative colitis – a controlled study. 
            British Journal of Psychiatry. 
            1991; 
            158 
            413-415 
            
            Reference Ris Wihthout Link
- 49 
            Tarter R E, Switala J, Carra J. et al .
            Inflammatory bowel disease: psychiatric status of patients before and after disease
            onset. 
            Int J Psychiatry in Medicine. 
            1987; 
            17 
            173-181 
            
            Reference Ris Wihthout Link
- 50 
            Schwarz S p, Blanchard E B, Berreman C F. et al .
            Psychological aspects of irritable bowel syndrom: comparison with inflammatory bowel
            disease and nonpatient controls. 
            Behav Res Ther. 
            1993; 
            31 
            297-304 
            
            Reference Ris Wihthout Link
- 51 
            Cabré E, Gassull M A. 
            Nutritional and metabolic issues in inflammatory bowel disease. 
            Curr Opin Clin Nutr Metabol Care. 
            2003; 
            6 
            569-576 
            
            Reference Ris Wihthout Link
- 52 
            Spiller G A, Freeman H J. 
            Recent advances in dietary fiber and colorectal disease. 
            Am J Clin Nutr. 
            1981; 
            34 
            1145-1152 
            
            Reference Ris Wihthout Link
- 53 
            Burke A, Lichtenstein G R, Rombeau J L. 
            Nutrition and ulcerative colitis. 
            Bailliére’s Clinical Gastroenterology. 
            1997; 
            11 (1) 
            153-174 
            
            Reference Ris Wihthout Link
- 54 
            Russel M G, Engels L G, Muris J W. et al .
            `Modern life` in the epidemiology of infammatory bowel disease: a case-control study
            with special emphasis on nutritional factors. 
            Eur J Gastroenterol Hepatol. 
            1998; 
            10 
            243-249 
            
            Reference Ris Wihthout Link
- 55 
            Jowett S L, Seal C J, Pearce M S. et al .
            Influence of dietary factors on the clinical course of ulcerative colitis: a prospective
            cohort study. 
            Gut. 
            2004; 
            53 
            1479-1484 
            
            Reference Ris Wihthout Link
- 56 
            Brandes J W, Lorenz-Meyer H. 
            Zuckerfreie Diät: Eine neue Perspektive zur Behandlung des Morbus Crohn. 
            Z Gastroenterologie. 
            1981; 
            19 
            1-12 
            
            Reference Ris Wihthout Link
- 57 
            Bjørkkjær T, Brunborg L A, Arslan G. et al .
            Reduced joint pain after short-term duodenal administration of seal oil in patients
            with inflammatory bowel disease: comparison with soy oil. 
            Scan J Gastroenterol. 
            2004; 
            39 
            1088-1094 
            
            Reference Ris Wihthout Link
- 58 
            Arslan G, Brunborg L A, Frøyland L. et al .
            Effect of duodenal seal oil administration in patients with inflammatory bowel disease. 
            Lipids. 
            2002; 
            37 
            935-940 
            
            Reference Ris Wihthout Link
- 59 
            Ganguli S C, Cawdron R, Irvine E J. 
            Alternative medicine use by canadian ambulatory gastroenterology patients: Secular
            trend or epidemic?. 
            Am J Gastroneterol. 
            2004; 
            99 (2) 
            319-326 
            
            Reference Ris Wihthout Link
- 60 
            Moser G, Tillinger W, Sachs G. et al .
            Relationship between the use of unconventional therapies and disease-related concerns:
            a study of patients with inflammatory bowel disease. 
            J Psychosom Res. 
            1996; 
            40 (5) 
            503-509 
            
            Reference Ris Wihthout Link
- 61 
            Burgmann T, Rawsthorne P, Bernstein C N. 
            Predictors of alternative and complementary medicine use in inflammatory bowel disease:
            do measures of conventional health care utilization relate to use?. 
            Am J Gastroenterol. 
            2004; 
            99 (5) 
            889-893 
            
            Reference Ris Wihthout Link
- 62 
            Langmead L, Chitnis M, Rampton D S. 
            Use of complementary therapies by patients with IBD may indicate psychosocial distress. 
            Inflamm Bowel Dis. 
            2002; 
            8 
            174-179 
            
            Reference Ris Wihthout Link
- 63 
            Hilsden R J, Verhoef M J, Best A. et al .
            Complementary and alternative medicine use by Canadian patients with inflammatory
            bowel disease: results from a national survey. 
            Am J Gastroenterol. 
            2003; 
            98 
            1563-1568 
            
            Reference Ris Wihthout Link
- 64 
            Joos S, Brinkhaus B, Maluche C. et al .
            Acupuncture and moxibustion in the treatment of active Crohn’s disease: a randomized
            controlled study. 
            Digestion. 
            2004; 
            69 
            131-139 
            
            Reference Ris Wihthout Link
- 65 
            Cottone M. 
            Stress and physical activity: are they risk factors for IBD?. 
            Ital J Gastroenterol Hepatol. 
            1998; 
            30 
            252-3 
            
            Reference Ris Wihthout Link
- 66 
            Levenstein S. 
            Stress and ulcerative colitis: convincing the doubting thomases. 
            AJG. 
            2003; 
            98 
            2112-2114 
            
            Reference Ris Wihthout Link
- 67 
            Hershfield N. 
            Hans Selye, inflammatory bowel disease and placebo response. 
            Can J Gastroenterol. 
            1997; 
            11 (7) 
            623-625 
            
            Reference Ris Wihthout Link
- 68 
            Farrell R J, Peppercorn M A. 
            Ulcerative colitis. 
            Lancet. 
            2002; 
            359 
            331-340 
            
            Reference Ris Wihthout Link
- 69 
            Drossmann D A. 
            Presidential address: gastrointestinal illness and the biopsychosocial model. 
            Psychosom Med. 
            1998; 
            60 
            258-267 
            
            Reference Ris Wihthout Link
- 70 
            Niess J H, Mönnikes H, Dignass A U. et al .
            Review on the influence of stress on immun mediators, neuropeptides and hormones with
            relevance for inflammatory bowel disease. 
            Digestion. 
            2002; 
            65 
            131-140 
            
            Reference Ris Wihthout Link
- 71 
            LeResche L, Dworkin S F. 
            The role of stress in inflammatory bowel disease, including peridontal disease: review
            of concepts and current finding. 
            Peridentology. 
            2002; 
            30 
            91-103 
            
            Reference Ris Wihthout Link
- 72 
            Levenstein S, Prantera C, Varva V. et al .
            Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled
            in remission. 
            Am J Gastroenterol. 
            2000; 
            95 
            1213-1220 
            
            Reference Ris Wihthout Link
- 73 
            Bitton A, Sewitch M J, Peppercorn M A. et al .
            Psychosocial determinant of relapse in ulcerative colitis: a longitudinal study. 
            Am J Gastroenterol. 
            2003; 
            98 
            2203-2208 
            
            Reference Ris Wihthout Link
- 74 
            Li J, Nørgárd B, Hansen Precht D. et al .
            Psychological stress and inflammatory bowel disease: a follow-up study in parents
            who lost a child in Denmark. 
            Am J Gastroenterol. 
            2004; 
            99 (6) 
            1129-1133 
            
            Reference Ris Wihthout Link
- 75 
            Wietersheim von J, Overbeck A, Kiel K. et al .
            Die Bedeutung rezidivauslösender Ereignisse bei Patienten mit chronisch entzündlichen
            Darmerkrankungen. Ergebnisse einer prospektiven Längsschnittstudie über 3 Jahre. 
            Psychother Psychosom med Psychol. 
            1994; 
            44 
            58-64 
            
            Reference Ris Wihthout Link
- 76 
            Kosarz P, Traue H C. 
            Alltagsstress und Colitis ulcerosa. 
            Psychother Psychosom med Psychol. 
            1997; 
            47 
            117-122 
            
            Reference Ris Wihthout Link
- 77 
            Maunder R G. 
            Evidence that stress contributes the inflammatory bowel disease: evaluation, synthesis,
            and future directions. 
            Inflamm Bowel Dis. 
            2005; 
            11 (6) 
            600-608 
            
            Reference Ris Wihthout Link
- 78 
            Greene B R, Blanchard E D, Wan C K. 
            Long-term monitoring od psychosocial stress amd symptomatology in inflammatory bowel
            disease. 
            Behav Res Ther. 
            1994; 
            32 (2) 
            217-226 
            
            Reference Ris Wihthout Link
- 79 
            Garrett V D, Brantley P J, Jones G N. et al .
            The relation between daily stress and Crohn’s disease. 
            J Behav Med. 
            1991; 
            14 (1) 
            87-96 
            
            Reference Ris Wihthout Link
- 80 
            Head K A, Jurenka J S. 
            Inflammatory bowel disease part I: Ulcerative Colitis – pathophysiology and conventional
            and alternative treatment options. 
            Altern Med Rev. 
            2003; 
            8 (3) 
            247-283 
            
            Reference Ris Wihthout Link
- 81 
            Krishnan A, Korzenik J R. 
            Inflammatory bowel disease and environmental influences. 
            Gastroenterol Clin N Am. 
            2002; 
            31 
            21-39 
            
            Reference Ris Wihthout Link
- 82 
            Danese S, Sans M, Fiocchi C. 
            Inflammatory bowel disease: the role of environmental factors. 
            Autoimmunity Reviews. 
            2004; 
            3 
            394-400 
            
            Reference Ris Wihthout Link
- 83 Peppercorn M A. Definition of and risk factors for inflammatory bowel disease. 2006 www.uptodate.com 
            Reference Ris Wihthout Link
- 84 Snapper S B, Podolsky D K. Epidemiology and genetic and environmental factors in inflammatory bowel disease. 2006 www.uptodate.com 
            Reference Ris Wihthout Link
- 85 
            Loftus E V. 
            Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental
            influences. 
            Gastroenterology. 
            2004; 
            126 
            1504-1517 
            
            Reference Ris Wihthout Link
- 86 
            Irvine E J, Farrokhyar F, Swarbrick E T. 
            A critical review of epidemiological studies in inflammatory bowel disease. 
            Scan J Gastroenterol. 
            2001; 
            1 
            2-15 
            
            Reference Ris Wihthout Link
- 87 
            Nakamura Y, Kobayashi M, Nagai M. et al .
            A case-control study of ulcerative colitis in Japan. 
            J Clin Gastroenterol. 
            1994; 
            18 (1) 
            72-79 
            
            Reference Ris Wihthout Link
- 88 
            Joachim G. 
            Inflammatory bowel disease: effects on lifestyle. 
            Journal of Advanced Nursing. 
            1987; 
            12 
            483-487 
            
            Reference Ris Wihthout Link
- 89 
            Hagerstown M D. 
            Inflammatory bowel disease impact and patient characteristics. 
            Gastroenterology nursing. 
            1993; 
            15 
            147-154 
            
            Reference Ris Wihthout Link
- 90 
            Kinash R G, Fischer D G, Luckie B E. et al .
            Coping patterns and related characteristics in patients with IBD. 
            Rehabilitation Nursing. 
            1993; 
            18 
            12-19 
            
            Reference Ris Wihthout Link
- 91 
            Herrmann U, Rose M, Klapp B F. et al .
            Personale Ressourcen und Coping von Patienten mit chronisch entzündlichen Darmerkrankungen
            (CED). 
            Z Med Psychol. 
            2005; 
            14 
            59-65 
            
            Reference Ris Wihthout Link
- 92 
            Martin A, Leone L, Castagliuolo I. et al .
            What do patients want to know about their inflammatory bowel disease. 
            Ital J Gastroenterol. 
            1992; 
            24 
            477-480 
            
            Reference Ris Wihthout Link
- 93 
            O’Sullivan M A, Mahmud N, Kelleher D P. et al .
            Patient knowledge and educational needs in irritable bowel syndrome. 
            Eur J Gastroenterol Hepatol. 
            2000; 
            12 
            39-43 
            
            Reference Ris Wihthout Link
- 94 
            Polglase A L, McDermott F T, Hughes E SR. 
            Ulcerative colitis and Crohn’s disease – What your patient want to know. 
            Australian Family Physician. 
            1984; 
            13 
            422-424 
            
            Reference Ris Wihthout Link
- 95 
            Zander W. 
            Psychosomatische Grundlagenforschung: Theoretische Überlegungen und experimentelle
            Untersuchungen. 
            Zschr psychosom Med. 
            1982; 
            28 
            126-128 
            
            Reference Ris Wihthout Link
- 96 
            Moser G. 
            Psychosomatik in der Gastroenterologie. 
            Wien Med Wschr. 
            2000; 
            150 
            209-212 
            
            Reference Ris Wihthout Link
- 97 
            Frenzer A, Binek J, Hammer B. 
            Soziale Folgen und Lebensqualität bei Patienten mit chronisch entzündlichen Darmerkrankungen. 
            Schweiz Med Wochenschr. 
            1996; 
            126 
            97S-99S 
            
            Reference Ris Wihthout Link
- 98 
            Lask B. 
            Psychological aspects of inflammatory bowel disease. 
            Wien Med Wschr. 
            1986; 
            98 
            544-546 
            
            Reference Ris Wihthout Link
- 99 
            Ringel Y, Drossmann D A. 
            Psychosocial aspects of Crohn’s disease. 
            Surgical Clinics of North America. 
            2001; 
            81 
            231-252 
            
            Reference Ris Wihthout Link
- 100 
            Küchenhoff J. 
            Biopsychosoziale Wechselwirkungen im Krankheitsverlauf des Morbus Crohn. 
            Zsch psychosom Med. 
            1995; 
            43 
            306-328 
            
            Reference Ris Wihthout Link
- 101 
            Karlinger K, Györke T, Makö E. et al .
            The epidemiology and the pathogenesis of inflammatory bowel disease. 
            Eur J Radiol. 
            2000; 
            35 
            154-167 
            
            Reference Ris Wihthout Link
- 102 
            Dudley-Brown S. 
            Prevention of psychological distress in persons with inflammatory bowel disease. 
            Issues in Mental Health Nursing. 
            2002; 
            23 
            403-422 
            
            Reference Ris Wihthout Link
- 103 
            Casati J, Toner B B. 
            Psychosocial aspects of inflammatory bowel disease. 
            Biomed & Pharmacother. 
            2000; 
            54 
            388-93 
            
            Reference Ris Wihthout Link
- 104 
            Murray J B. 
            Psychological factors in ulcerative colitis. 
            The Journal of General Psychology. 
            1984; 
            110 
            201-221 
            
            Reference Ris Wihthout Link
- 105 
            Gerbert B. 
            Psychological aspects of Crohn’s disease. 
            J Behav Med. 
            1980; 
            3 
            41-58 
            
            Reference Ris Wihthout Link
- 106 
            Timmer A. 
            Environmental influence on inflammatory bowel disease manifestation. 
            Dig Dis. 
            2003; 
            21 
            91-104 
            
            Reference Ris Wihthout Link
- 107 
            Ringel Y, Drossmann D A. 
            Psychosocial aspects of Crohn’s disease. 
            Surgical Clinics of North America. 
            2001; 
            81 (1) 
            231-252 
            
            Reference Ris Wihthout Link
- 108 
            Zuckerman M J, Briones D F. 
            Inflammatory bowel disease: overview and psychosomatics. 
            Texa Medicine. 
            1989; 
            85 
            32-36 
            
            Reference Ris Wihthout Link
- 109 
            Enck P, Schäfer R. 
            Psychosoziale Faktoren beim M. Crohn – eine Übersicht. 
            Z Gastroenterol. 
            1996; 
            34 
            708-713 
            
            Reference Ris Wihthout Link
- 110 
            Sewitch M J, Abrahamowicz M, Bitton A. et al .
            Psychosocial correlates of patient-physician discordance in inflammatory bowel disease. 
            Am J Gastroenterol. 
            2002; 
            97 
            2174-2183 
            
            Reference Ris Wihthout Link
- 111 
            Turnbull G K, Vallis T M. 
            Quality of life in inflammatory bowel disease: the interaction of disease activity
            with psychosocial function. 
            Am J Gastroenterol. 
            1995; 
            90 
            1450-1454 
            
            Reference Ris Wihthout Link
- 112 
            Petrak F, Hardt J, Clement T. et al .
            Impaired health-related quality of life in inflammatory bowel disease: psychosocial
            impact and coping styles in a national German sample. 
            Scand J Gastroenterol. 
            2001; 
            36 
            375-382 
            
            Reference Ris Wihthout Link
- 113 
            Walker E A, Gelfand M D, Gelfant A N. et al .
            The relationship of current psychiatric disorders to functional disability and distress
            in patients with inflammatory bowel disease. 
            General Hospital Psychiatry. 
            1996; 
            18 
            220-229 
            
            Reference Ris Wihthout Link
- 114 
            Schwartz R A, Schwartz I K. 
            Psychiatric disorders associated with Crohn’s disease. 
            Psychiatry in Medicine. 
            1982; 
            12 
            67-73 
            
            Reference Ris Wihthout Link
- 115 
            Mussell M, Böcker U, Nagel N. et al .
            Predictors of disease-related concers and other aspects of health-related quality
            of life in outpatients with inflammatory bowel disease. 
            Eur J Gastroenterol Hepatol. 
            2004; 
            16 
            1273-1280 
            
            Reference Ris Wihthout Link
- 116 
            Paar G H, Bezzenberger U, Lorenz-Meyer H. 
            Über den Zusammenhang von psychosazialem Stress und Krankheitsaktivität bei Patienten
            mit Morbus Crohn und Colitis ulcerosa. 
            Z Gastroenterologie. 
            1988; 
            26 
            648-657 
            
            Reference Ris Wihthout Link
- 117 
            Turnbull G K, Vallis T M. 
            Quality of life in inflammatory bowel disease: the interaction of disease activity
            with psychosocial function. 
            Am J Gastroenterol. 
            1995; 
            90 (9) 
            1450-1454 
            
            Reference Ris Wihthout Link
- 118 
            Eijk van der I, Vlachonikolis I G, Munkholm P. et al .
            The role of qualitiy of care in health-related quality of life in patients with IBD. 
            Inflamm Bowel Dis. 
            2004; 
            10 
            392-398 
            
            Reference Ris Wihthout Link
- 119 
            Gerson M J, Schonholtz J, Grega C H. et al .
            The importance of the family context in inflammatory bowel disease. 
            Mt Sinai J Med. 
            1998; 
            65 
            398-403 
            
            Reference Ris Wihthout Link
- 120 
            Van Hemert A, Hengeveld M W, Bolk J H. et al .
            Psychiatric disorders in relation to medical illness among patients of a general medical
            out-patient clinic. 
            Psychological Medicine. 
            1993; 
            23 
            167-173 
            
            Reference Ris Wihthout Link
- 121 
            Tanaka M, Kazuma K. 
            Ulcerative colitis: factors affecting difficulties of life and psychological well
            being of patients in remission. 
            J Clin Nurs. 
            2005; 
            14 
            65-73 
            
            Reference Ris Wihthout Link
- 122 
            Sewitch M J, Abrahamowicz M, Bitton A. et al .
            Psychological distress, social support and disease activity in patients with inflammatory
            bowel disease. 
            Am J Gastroenterol. 
            2001; 
            96 (5) 
            1470-1479 
            
            Reference Ris Wihthout Link
- 123 
            Sainsbury A, Heatley R V. 
            Review article: psychosocial factors in the quality of life of patients with inflammatory
            bowel disease. 
            Aliment Pharmacol Ther. 
            2005; 
            21 
            499-508 
            
            Reference Ris Wihthout Link
- 124 
            Levenstein S. 
            Embracing complexity: what determines quality of life in inflammatory bowel disease. 
            Eur J Gastroenterol Hepatol. 
            2004; 
            16 
            1253-1255 
            
            Reference Ris Wihthout Link
- 125 
            Mussell M, Böcker U, Nagel N. et al .
            Predictors of disease-related concerns and other aspects of health-related quality
            of life in outpatients with inflammatory bowel disease. 
            Eur J Gastroenterol Hepatol. 
            2004; 
            16 
            1273-1280 
            
            Reference Ris Wihthout Link
- 126 
            Cuntz U. et al .
            Determinanten der subjektiven Belastung durch Darmerkrankungen. 
            Psychther Psychosom med Psychol. 
            1999; 
            49 
            493-500 
            
            Reference Ris Wihthout Link
- 127 
            Barrett S ML, Standen P J, Lee A S. et al .
            Personality, smoking and inflammatory bowel disease. 
            Eur J Gastroenterol Hepatol. 
            1996; 
            8 
            651-655 
            
            Reference Ris Wihthout Link
- 128 
            Janke K H, Klump B, Gregor M. et al .
            Determinants of life satisfaction in inflammatory bowel disease. 
            Inflamm Bowel Dis. 
            2005; 
            11 
            272-286 
            
            Reference Ris Wihthout Link
- 129 
            Pizzi L T, Weston C M, Goldfarb N I. et al .
            Impact of chronic conditions on quality of life in patients with inflammatory bowel
            disease. 
            Inflamm Bowel Dis. 
            2006; 
            12 
            47-52 
            
            Reference Ris Wihthout Link
- 130 
            Deter H C, Manz R, Becker M. et al .
            Soziale Unterstützung in der Beziehung zu körperlichen und seelischen Befunden bei
            Morbus Crohn-Patineten. 
            Zsch psychosom Med. 
            1991; 
            37 
            45-59 
            
            Reference Ris Wihthout Link
- 131 
            Birtwistle J. 
            The role of cigarette and nicotine in the onset and treatment of ulcerative colitis. 
            Postgrad Med J. 
            1996; 
            72 
            714-718 
            
            Reference Ris Wihthout Link
- 132 
            Timmer A, Sutherland L R, Martin F. et al .
            Smoking, use of oral contraceptives, and medical induction of remission were rsik
            factors for relapse in Crohn’s disease. 
            Gut. 
            1999; 
            44 
            311-312 
            
            Reference Ris Wihthout Link
- 133 
            Forbes A. 
            Smoking and inflammatory bowel disease. 
            Eur J Gastroenterol Hepatol. 
            1996; 
            8 
            761-763 
            
            Reference Ris Wihthout Link
- 134 
            Zijlstra F J. 
            Smoking and nicotine in inflammatory bowel disease: good or bad for cytokines?. 
            Mediators of Inflammation. 
            1998; 
            7 
            153-155 
            
            Reference Ris Wihthout Link
- 135 
            Sercombe J. 
            Inflammatory bowel disease and smoking. 
            Professional Nurse. 
            2000; 
            15 (7) 
            439-442 
            
            Reference Ris Wihthout Link
- 136 
            Miner P B. 
            Factors influencing the relapse of patients with inflammatory bowel disease. 
            Am J Gastroenterol. 
            1997; 
            92 (12) 
            1S-4S 
            
            Reference Ris Wihthout Link
- 137 
            Birrenbach T, Böcker U. 
            Inflammatory bowel disease and smoking – a review of epidemiology, pathophysiology,
            and therapeutic implications. 
            Inflamm Bowel Dis. 
            2004; 
            10 
            848-859 
            
            Reference Ris Wihthout Link
- 138 
            Picco M F, Bayless T M. 
            Tobacco consumption and disease duration are associated with fistulizing and stricturing
            behaviors in the first 8 years of Crohn’s disease. 
            Am J Gastroenterol. 
            2003; 
            98 
            363-368 
            
            Reference Ris Wihthout Link
- 139 
            Russel M G, Nieman F H, Bergers J M. et al .
            South Limburg IBD Study Group: Cigarette smoking and quality of life in patients with
            inflammatory bowel disease. 
            Eur J Gestroenterol Hepatol. 
            1996; 
            8 
            1075-1081 
            
            Reference Ris Wihthout Link
- 140 
            Bustamante M, Nos P, Hoyos M. et al .
            Relationship between smoking and colonic involment in inflammatory bowel disease. 
            Rev Esp Enferm Dig. 
            1998; 
            90 (12) 
            837-840 
            
            Reference Ris Wihthout Link
- 141 
            Thomas G AO, Rhodes J, Green J T. et al .
            Role of smoking in inflammatory bowel disease: implications for therapy. 
            Postgrad Med J. 
            2000; 
            76 
            273-279 
            
            Reference Ris Wihthout Link
- 142 
            Ashley M J. 
            Smoking and disease of the gastrointestinal system: An epidemiological review with
            special references to sex differences. 
            Can J Gastroenterol. 
            1997; 
            11 (4) 
            345-352 
            
            Reference Ris Wihthout Link
- 143 
            Cosnes J, Carbonnel F, Carrat F. et al .
            Effects of current and former cigarette smoking on the clinical course of Crohn’s
            disease. 
            Aliment Pharmacol Ther. 
            1999; 
            13 
            1403-1411 
            
            Reference Ris Wihthout Link
- 144 
            Abraham N, Selby W, Lazarus R. et al .
            Is smoking an indirect risk factor for the development of ulcerative colitis? An age-
            and sex-matched case-control study. 
            J Gastroenterol Hepatol. 
            2003; 
            18 
            139-146 
            
            Reference Ris Wihthout Link
- 145 
            Yamamoto T, Keighley M RB. 
            Smoking and disease recurrence after operation for Crohn’s disease. 
            British Journal of Surgery. 
            2000; 
            87 
            398-404 
            
            Reference Ris Wihthout Link
- 146 
            Manguso F, Sanges M, Staiano T. et al .
            Cigarette smoking and appendectomy are risk factors for extraintestinal manifestations
            in ulcerative colitis. 
            Am J Gastroenterol. 
            2004; 
            99 (2) 
            327-334 
            
            Reference Ris Wihthout Link
- 147 
            Radford-Smith G L, Edwards J E, Purdie D M. et al .
            Protective role of appendicectomy on onset and severity of ulcerative colitis and
            Crohn’s disease. 
            Gut. 
            2002; 
            51 
            808-813 
            
            Reference Ris Wihthout Link
- 148 
            Johnson G J, Cosnes J, Mansfield J C. 
            Review article: smoking cessation as primary therapy to modify the course of Crohn’disease. 
            Aliment Pharmacol Ther. 
            2005; 
            21 
            921-931 
            
            Reference Ris Wihthout Link
- 149 
            Breuer-Katschinski B D, Holländer N, Goebell H. 
            Effect of cigarette smoking on the course of chrohn’s disease. 
            Eur J Gastroenterol Hepatol. 
            1996; 
            8 (3) 
            225-228 
            
            Reference Ris Wihthout Link
- 150 
            Corrao G, Tragnone A, Caprilli R. et al .
            Risk of inflammatory bowel disease attributable to smoking, oral contraception and
            breastfeeding in Italy: a nationwide case-control study. 
            Int J Epidemiol. 
            1998; 
            27 
            397-404 
            
            Reference Ris Wihthout Link
- 151 
            Medina C, Vergara M, Casellas F. et al .
            Influence of smoking habit in the surgery of inflammatory bowel disease. 
            Rev Esp Enferm Dig. 
            1998; 
            90 (11) 
            775-778 
            
            Reference Ris Wihthout Link
- 152 
            Odes H S, Fich A, Reif S. et al .
            Effects of current cigarette smoking on clinical course of Crohn’s disease and Ulcerative
            colitis. 
            Dig Dis Sci. 
            2001; 
            46 (8) 
            1717-1721 
            
            Reference Ris Wihthout Link
- 153 
            Fraga X F, Vergara M, Medina C. et al .
            Effect of smoking on the presentation and clinical course of inflammatory bowel disease. 
            Eur J Gastroenterol Hepatol. 
            1997; 
            9 
            683-687 
            
            Reference Ris Wihthout Link
- 154 
            Kane S V, Flicker M, Katz-Nelson F. 
            Tobacco use is associated with accelerated clinical recurrence of Crohn’s disease
            after surgically induced remission. 
            J Clin Gastroenterol. 
            2005; 
            39 
            32-35 
            
            Reference Ris Wihthout Link
- 155 
            Sicilia B. 
            Environmental rsik factors and Crohn’s disease: a population-based, case-control study
            in Spain. 
            Digest Liver Dis. 
            2001; 
            33 
            762-767 
            
            Reference Ris Wihthout Link
- 156 
            Cosnes J, Mion-Larmurier I, Afchain P. et al .
            Gender differences in the response of colitis to smoking. 
            Clin Gastroenterol Hepatol. 
            2004; 
            2 
            41-48 
            
            Reference Ris Wihthout Link
- 157 
            Cosnes J, Carbonnel F, Beaugerie L. et al .
            Effects of cigarette smoking on the long-term course of Crohn’s disease. 
            Gastroenterology. 
            1996; 
            110 
            424-431 
            
            Reference Ris Wihthout Link
- 158 
            Cosnes J, Beaugerie L, Carbonnel F. et al .
            Smoking cessation and the course of Crohn’s disease: an intervention study. 
            Gastroenterology. 
            2001; 
            120 
            1093-1099 
            
            Reference Ris Wihthout Link
- 159 
            Timmer A, Sutherland L R, Martin F. 
            Oral contraceptive use and smoking are risk factors for relapse in Crohn’s disease. 
            Gastroenterology. 
            1998; 
            114 
            1143-1150 
            
            Reference Ris Wihthout Link
- 160 
            Rooy E C, Toner B B, Maunder R G. et al .
            Concerns of patients with inflammatory bowel disease: results from a clinical population. 
            Am J Gastroenterol. 
            2001; 
            96 
            1816-1821 
            
            Reference Ris Wihthout Link
- 161 
            Drossman D A, Patrick D L, Mitchell C M. et al .
            : Health-related quality of life in inflammatory bowel disease – functional status
            and patients worries and concerns. 
            Dig Dis Sci. 
            1989; 
            34 (9) 
            1379-1386 
            
            Reference Ris Wihthout Link
- 162 
            Blondel-Kucharski de F, Chircop C, Marquis P. et al .
            Health-realted quality of life in Crohn’s disease: a prospective longitudinal study
            in 231 patients. 
            Am J Gastroenterol. 
            2001; 
            96 
            2915-2920 
            
            Reference Ris Wihthout Link
- 163 
            Ananthakrishnan A N. 
            Does it Matter Where You Are Hospitalized for Inflammatory Bowel Disease? A Nationwide
            Analysis of Hospital Volume. 
            Digestive Disease Week. 
            2008; 
            Abstract #T1167 
            , www.ddw.org; Stand: 21.7.2008
            
            Reference Ris Wihthout Link
- 164 Indikationskatalog für Anschlussrehabilitation (AHB), Stand: 11.1.2008. http://www.deutsche-rentenversicherung-bund.de; Stand: 21.7.2008 
            Reference Ris Wihthout Link
- 165 Qualitätsberichte der Reha-Zentren der Deutschen Rentenversicherung Bund. www.deutsche-rentenversicherung-bund.de 
            Reference Ris Wihthout Link
- 166 Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung e.V .Verzeichnis der Rehabilitationskliniken bei Morbus Crohn und Colitis ulcerosa. DCCV 2007 
            Reference Ris Wihthout Link
- 167 
            Jaghult S, Larson J, Wredling R. et al .
            A multiprofessional education programme for patients with inflammatory bowel disease:
            a randomized controlled trial. 
            Scand J Gastroenterol. 
            2007; 
            42 (12) 
            1452-1459 
            
            Reference Ris Wihthout Link
- 168 
            Oxelmark L, Magnusson A, Lofberg R. et al .
            Group-based intervention program in inflammatory bowel disease patients: effects on
            quality of life. 
            Inflamm Bowel Dis. 
            2007; 
            13 (2) 
            182-190 
            
            Reference Ris Wihthout Link
- 169 
            Waters B M, Jensen L, Fedorak R N. 
            Effects of formal education for patients with inflammatory bowel disease: a randomized
            controlled trial. 
            Can J Gastroenterol. 
            2005; 
            19 (4) 
            235-244 
            
            Reference Ris Wihthout Link
- 170 
            Bregenzer N, Lange A, Furst A. et al .
            Patient education in inflammatory bowel disease does not influence patients knowledge
            and long-term psychosocial well-being. 
            Z Gastroenterol. 
            2005; 
            43 (4) 
            367-371 
            
            Reference Ris Wihthout Link
- 171 
            Brown S A. 
            Studies of educational interventions and outcomes in diabetic adults: a meta-Analysis
            revisited. 
            Patient Educ Couns. 
            1990; 
            16 
            189-215 
            
            Reference Ris Wihthout Link
- 172 
            Devine E C, Pearcy J. 
            Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive
            pulmonary disease. 
            Patient Educ Couns. 
            1996; 
            29 
            167-178 
            
            Reference Ris Wihthout Link
- 173 
            Devine E C, Reifschneider E. 
            A meta-analysis of the effects of psychoeducational care in adults with hypertension. 
            Nurs Res. 
            1995; 
            44 (4) 
            237-245 
            
            Reference Ris Wihthout Link
- 174 
            Mazzuca S A. 
            Does patient education in chronic disease have therapeutic value?. 
            J Chron Dis. 
            1982; 
            35 
            521-529 
            
            Reference Ris Wihthout Link
- 175 
            Roter D L, Hall J A, Merisca R. et al .
            Effectiveness of the interventions to improve patient compliance: a meta-analysis. 
            Med Care. 
            1998; 
            36 (8) 
            1138-1161 
            
            Reference Ris Wihthout Link
- 176 
            Quan H, Present J W, Sutherland L R. 
            Evaluation of educational programs in Inflammatory bowel disease. 
            Inflamm Bowel Dis. 
            2003; 
            9 (6) 
            356-362 
            
            Reference Ris Wihthout Link
- 177 
            Verma S, Tsai H H, Giaffer M H. 
            Does better disease-related education improve quality of life? A survey of IBD patients. 
            Dig Dis Sci. 
            2001; 
            46 (4) 
            865-869 
            
            Reference Ris Wihthout Link
- 178 
            Jones S C, Gallacher B, Lobo A J. et al .
            A patient knowledge questionnaire in Inflammatory bowel disease. 
            J Clin Gastroenterol. 
            1993; 
            17 (1) 
            21-24 
            
            Reference Ris Wihthout Link
- 179 
            Rezailashkajani M, Roshandel D, Ansari S. et al .
            Knowledge of disease and health information needs of the patients with inflammatory
            bowel disease in a developing country. 
            Int J Colorectal Dis. 
            2006; 
            21 (5) 
            433-40 
            
            Reference Ris Wihthout Link
- 180 
            Gensichen J, Muth C, Buttzlaff M. et al .
            Die Zukunft ist chronisch: Das Chronic Care-Modell in der deutschen Primärversorgung.
            Übergreifende Behandlungsrinzipien einer proaktiven Versorgung für chronische Kranke. 
            Z ärztl Fortbild Qual Gesundhwes. 
            2006; 
            100 
            365-374 
            
            Reference Ris Wihthout Link
- 181 Classen M, Dierkesmann R, Heimpel H. et al .Rationelle Diagnostik und Therapie in der Inneren Medizin. München, Jena; Urban und Fischer 2001 
            Reference Ris Wihthout Link
- 182 
            Moser G. 
            Bedeutung von Stress und Depression bei chronisch entzündlichen Darmerkrankungen. 
            J Gastroenterol Hepatol Erkr. 
            2005; 
            3 (2) 
            26-30 
            
            Reference Ris Wihthout Link
- 183 
            Kunzendorf S, Jantschek G, Straubinger K. et al .
            The Luebeck Interview for Psychosocial Screening in Patients with Inflammatory Bowel
            Disease. 
            Inflamm Bowel Dis. 
            2007; 
            13 (1) 
            33-41 
            
            Reference Ris Wihthout Link
- 184 
            Bjorkkjaer T, Brun J G, Valen M. et al .
            Short-term duodenal seal oil administration normalised n-6 to n-3 fatty acid ratio
            in rectal mucosa and ameliorated bodily pain in patients with inflammatory bowel disease. 
            Lipids Health Dis. 
            2006; 
            5 
            6 
            
            Reference Ris Wihthout Link
- 185 
            Cozzi F, Podswiadek M, Cardianle G. et al .
            Mud-bath treatment in spondylitis associated with inflammatory bowel disease – a pilot
            randomised clinical trial. 
            Joint Bone Spine. 
            2007; 
            74 (5) 
            436-439 
            
            Reference Ris Wihthout Link
- 186 
            Goldberg R J, Katz J. 
            A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation
            for inflammatory joint pain. 
            Pain. 
            2007; 
            129 (1 – 2) 
            210-223 
            
            Reference Ris Wihthout Link
- 187 
            Koretz R L, Avenell A, Lipman T O. et al .
            Does enteral nutrition affect clinical outcome? A systematic review of the randomized
            trials. 
            Am J Gastroenterol. 
            2007; 
            102 (2) 
            412-429 
            
            Reference Ris Wihthout Link
- 188 
            Duffy L C, Zielezny M A, Marshall J R. et al .
            Relevance of major stress events as an indicator of disease activity prevalence in
            inflammatory bowel disease. 
            Behav Med. 
            1991; 
            17 (3) 
            101-10 
            
            Reference Ris Wihthout Link
- 189 
            Hjortswang H, Järnerat G, Curman B. et al .
            The influence of demographic and disease-related factors on health-related quality
            of life in patients with ulcerative colitis. 
            Eur J Gastroenterol Hepatol. 
            2003; 
            15 
            1011-1020 
            
            Reference Ris Wihthout Link
- 190 
            Hjortswang H, Ström M, Almer S. 
            Health-related quality of life in Swedish patients with ulcerative colitis. 
            Am J Gastroenterol. 
            1998; 
            93 
            2203-2211 
            
            Reference Ris Wihthout Link
- 191 
            Ng V, Millard W, Lebrun. et al .
            Low-intensity exercise improves quality of life in patients with Crohn’s disease. 
            Clin J Sport Med. 
            2007; 
            17 (5) 
            384-388 
            
            Reference Ris Wihthout Link
- 192 
            Langhorst J, Mueller T, Luedtke R. et al .
            Effects of a comprehensive lifestyle modification program on quality-of-life in patients
            with ulcerative colitis: a twelve-month follow-up. 
            Scand J Gastroenterol. 
            2007; 
            42 (6) 
            734-745 
            
            Reference Ris Wihthout Link
- 193 
            Elsenbruch S, Langhorst J, Popkirowa K. et al .
            Effects of mind-body therapy on quality of life and neuroendocrine and cellular immune
            functions in patients with ulcerative colitis. 
            Psychother Psychosom. 
            2005; 
            74 (5) 
            277-287 
            
            Reference Ris Wihthout Link
- 194 
            Oliveira S, Zaltman C, Elia C. et al .
            Quality-of-life measurement in patients with inflammatory bowel disease receiving
            social support. 
            Inflamm Bowel Dis. 
            2007; 
            13 (4) 
            470-474 
            
            Reference Ris Wihthout Link
- 195 ÄZQ, AWMF .Deutsches Instrument zur methodischen Leitlinienbewertung. 2005 www.delbi.de 
            Reference Ris Wihthout Link
- 196 Becker E, Horn S, Hussla B. et al .Sozialmedizinische Leistungsbeurteilung bei chronisch entzündlichen Darmerkrankungen. Deutsche Gesellschaft für Sozialmedizin, autorisiert für elektronische Veröffentlichung AWMF online März 2005 
            Reference Ris Wihthout Link
- 197 
            Carter M J, Lobo A J, Travis S PL. et al .
            Guideline of the management of inflammatory bowel disease in adults. 
            Gut. 
            2004; 
            53 (suppl V) 
            v1-v16 
            
            Reference Ris Wihthout Link
- 198 
            Caprilli R, Gassull M A, Escher J C. et al .
            European evidence based consensus on the diagnosis and management of Crohn’s disease:
            special situations. 
            Gut. 
            2006; 
            55 (Suppl I) 
            i36-i58 
            
            Reference Ris Wihthout Link
- 199 
            Stange E F, Travis S PL, Vermeire S. et al .
            European evidence based consensus on the diagnosis and management of Crohn’s disease:
            definitions and diagnosis. 
            Gut. 
            2006; 
            55 (Suppl I) 
            i1-i15 
            
            Reference Ris Wihthout Link
- 200 
            Travis S PL, Stange E F, Lemann M. et al .
            European evidence based consensus on the diagnosis and management of Crohn’s disease:
            current management. 
            Gut. 
            2006; 
            55 (Suppl I) 
            i16-i35 
            
            Reference Ris Wihthout Link
- 201 Centre for Evidence-based Medicine .Oxford Centre for Evidence-based Medicine Levels of Evidence. 2001 www.cebm.net 
            Reference Ris Wihthout Link
- 202 
            Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften .
            Das Leitlinien-Manual: Entwicklung und Implementierung von Leitlinien in der Medizin. 
            Z Ärztl Fortbild Qualitätssich. 
            2001; 
            95 (Suppl 1) 
            1-84 
            
            Reference Ris Wihthout Link
- 203 Scottish Intercollegiate Guidelines Network .Postal Address: SIGN, 28 Thistle Street, Edinburgh EH 2 1EN. www.sign.ac.uk 
            Reference Ris Wihthout Link
Prof. Dr. med. Dr. phil. Heiner Raspe
         Institut für Sozialmedizin, UK S-H
         
         Beckergrube 43 – 47
         
         23552 Lübeck
         
         Telefon: 04 51/7 99 - 25 20
         
         Fax: 04 51/7 99 - 25 22
         
         eMail: heiner.raspe@uk-sh.de
         
         
 
     
      
    