Pathophysiologisch-orientierte Diagnostik und Therapie der Eisenmangelanämie bei chronisch entzündlichen Darmerkrankungen

Zusammenfassung

Die Anämie gilt als die häufigste extraintestinale Komplikation chronisch-entzündlicher Darmerkrankungen (CED). Sie führt bei CED Patienten zu einer erheblichen Beeinträchtigung des Allgemeinempfindens wie auch der Lebensqualität und führt zu einer Zunahme der Hospitalisierungsrate. Als Hauptvertreter gelten die Eisenmangelanämie und die Anämie im Rahmen chronischer Erkrankungen. Die korrekte Erfassung des Eisenstatus bei CED erfordert die Bestimmung des Transferrinrezeptors und des Ferritins in Verbindung mit Entzündungsparametern. Als weithin übliche Behandlung des Eisenmangels gilt die orale Eisensupplementierung. Sie erweist sich bei CED jedoch als wenig effektiv und führt zudem über Bildung reaktiver Sauerstoffradikale zu einer Zunahme der entzündlichen Aktivität. Eine systematische Übersicht zur Anämie bei CED sowie pathogenetische Aspekte zu Diagnostik und Therapie auf dem Boden neuerer evidenzbasierter Studien liegen im Fokus dieses Beitrags.

Abstract

Anaemia is the most frequent extraenteric complication of inflammatory bowel disease (IBD, Crohn’s disease and ulcerative colitis). A disabling complication of IBD, anaemia worsens the patient’s general condition and quality of life, and increases hospitalization rates. The main types of anemia in IBD are iron deficiency anemia and anemia of chronic disease. The combination of the serum transferrin receptor with ferritin concentrations and inflammatory markers allows a reliable assessment of the iron status. Iron deficiency is usually treated with oral iron supplements. However, it is less effective in IBD and may lead to an increased inflammatory activity through the generation of reactive oxygen species. A systematic review of anemia in IBD, its pathogenetic features, epidemiology, diagnosis and therapy based on the evidence from recent studies will be the focus of this article.

Schlüsselwörter

chronisch entzündliche Darmerkrankungen - extraintestinale Manifestationen - Anämie - Eisenmangel - Eisensupplementation

Key words

chronic inflammatory bowel disease - extraintestinal manifestations - anaemia - iron deficiency - iron supplementation

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