Index-Systeme bei chronisch entzündlichen Darmerkrankungen und deren Bedeutung für die Chirurgie

Zusammenfassung

Aktivitätsindizes und Scoring-Systeme für Morbus Crohn und Colitis ulcerosa nehmen eine wichtige Rolle in der Beurteilung der Krankheitsaktivität in klinischen Studien ein, speziell in Studien zum Effekt von medikamentösen Therapien. Andererseits wäre es jedoch wünschenswert, auf reliable und reproduzierbare Systeme zur Einschätzung der Krankheitsaktivität bei der chirurgischen Indikationsstellung und Planung zurückgreifen zu können. Der vorliegende Artikel liefert daher eine Übersicht über die derzeit verfügbaren Index- und Score-Systeme zu beiden Krankheiten, dem Morbus Crohn und der Colitis ulcerosa und ihren potenziellen sinnvollen Anwendungsmöglichkeiten bei der Planung und Durchführung chirurgischer Eingriffe.

Abstract

Activity indices and scoring systems for Crohn's Disease and ulcerative colitis represent an important role in disease assessment in clinical studies particularly addressing effects of medical treatment. On the other hand, reliable and reproducible systems of disease activity estimation would be of great value in surgery in order to indicate and plan surgical therapy for both diseases. The present article provides an overview over presently available index and scoring systems for both Crohn's disease and ulcerative colitis and their potential reasonable applicability in surgical therapy planning and performance.

Schlüsselwörter

Morbus Cohn - Colitis ulcerosa - Aktivitäts-Index - Klassifikation - Chirurgie

Key words

Crohn's disease - ulcerative colitis - activity index - classification - surgery

Literatur

• 1 McLeod R S. Surgery for inflammatory bowel diseases.  Dig Dis. 2003;  21 168-179
• 2 Sandborn W J, Feagan B G, Hanauer S B. et al . A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn's disease.  Gastroenterology. 2002;  122 512-530
• 3 D'Haens G, Sandborn W J, Feagan B G. et al . A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis.  Gastroenterology. 2007;  132 763-786
• 4 Munkholm P. Review article: the incidence and prevalence of colorectal cancer in inflammatory bowel disease.  Aliment Pharmacol Ther. 2003;  18 Suppl 2 1-5
• 5 Pohl C, Hombach A, Kruis W. Chronic inflammatory bowel disease and cancer.  Hepatogastroenterology. 2000;  47 57-70
• 6 Berg D F, Bahadursingh A M, Kaminski D L, Longo W E. Acute surgical emergencies in inflammatory bowel disease.  Am J Surg. 2002;  184 45-51
• 7 Hahnloser D, Pemberton J H, Wolff B G, Larson D R, Crownhart B S, Dozois R R. The effect of ageing on function and quality of life in ileal pouch patients: a single cohort experience of 409 patients with chronic ulcerative colitis.  Ann Surg. 2004;  240 615-621
• 8 Heuschen U A, Hinz U, Allemeyer E H. et al . Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis.  Ann Surg. 2002;  235 207-216
• 9 Regimbeau J M, Panis Y, Pocard M. et al . Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease.  Dis Colon Rectum. 2001;  44 769-778
• 10 Sher M E, Weiss E G, Nogueras J J, Wexner S D. Morbidity of medical therapy for ulcerative colitis: what are we really saving?.  Int J Colorectal Dis. 1996;  11 287-293
• 11 Tariverdian M, Leowardi C, Hinz U, Welsch T, Schmidt J, Kienle P. Quality of life after restorative proctocolectomy for ulcerative colitis: Preoperative status and long-term results.  Inflamm Bowel Dis. 2007;  13 1228-1235
• 12 Fichera A, Hurst R D, Michelassi F. Current methods of bowel-sparing surgery in Crohn's disease.  Adv Surg. 2003;  37 231-251
• 13 Rentsch M, Beham A, Schlitt H J, Jauch K W. Crohn's disease activity index and Vienna classification - is it worthwhile to calculate before surgery?.  Dig Surg. 2006;  23 241-249
• 14 Otterson M F, Lundeen S J, Spinelli K S. et al . Radiographic underestimation of small bowel stricturing Crohn's disease: a comparison with surgical findings.  Surgery. 2004;  136 854-860
• 15 van Hees P A, van Elteren P H, van Lier H J, van Tongeren J H. An index of inflammatory activity in patients with Crohn's disease.  Gut. 1980;  21 279-286
• 16 Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn's disease.  Ann Surg. 2000;  231 38-45
• 17 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
• 18 Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P. Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn's disease: a multivariate analysis in 161 consecutive patients.  Dis Colon Rectum. 2007;  50 331-336
• 19 Mahadevan U, Loftus Jr  E V, Tremaine W J. et al . Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complications.  Inflamm Bowel Dis. 2002;  8 311-316
• 20 Yamamoto T, Allan R N, Keighley M R. Risk factors for intra-abdominal sepsis after surgery in Crohn's disease.  Dis Colon Rectum. 2000;  43 1141-1145
• 21 Kiran R P, Delaney C P, Senagore A J. et al . Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn's disease.  Am J Gastroenterol. 2003;  98 1783-1789
• 22 Van Duijvendijk P, Slors J F, Taat C W. et al . Quality of life after total colectomy with ileorectal anastomosis or proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis.  Br J Surg. 2000;  87 590-596
• 23 Heuschen U A, Allemeyer E H, Hinz U. et al . Diagnosing pouchitis: comparative validation of two scoring systems in routine follow-up.  Dis Colon Rectum. 2002;  45 776-786
• 24 Yamamoto T. Factors affecting recurrence after surgery for Crohn's disease.  World J Gastroenterol. 2005;  11 3971-3979
• 25 Chardavoyne R, Flint G W, Pollack S, Wise L. Factors affecting recurrence following resection for Crohn's disease.  Dis Colon Rectum. 1986;  29 495-502