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article 
App\Entity\Article {#528
  -id: 8
  -title: "Bei Morbus Crohn und Colitis ulcerosa kommt es auf die Galenik der Medikamente an"
  -teaser: "<p>Der Morbus Crohn und die Colitis ulcerosa sind die h&auml;ufigsten Formen chronisch entz&uuml;ndlicher Darmerkrankungen (CED). Daneben gibt es die seltenere Form der mikroskopischen Colitis.</p>"
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    <p>Der Morbus Crohn und die Colitis ulcerosa sind die h&auml;ufigsten Formen chronisch entz&uuml;ndlicher Darmerkrankungen (CED). Daneben gibt es die seltenere Form der mikroskopischen Colitis. Die Therapieziele sind bei allen CED gleich: Die Beschwerden der Patient*innen sollen gelindert und die Entz&uuml;ndung im Darm zur&uuml;ckgedr&auml;ngt werden. Die zu diesem Zweck eingesetzten Medikamente sind vielf&auml;ltig, nicht nur in ihren Wirkstoffen, sondern auch in den verf&uuml;gbaren Darreichungsformen. Welche f&uuml;r den jeweiligen Patienten oder die jeweilige Patientin am besten geeignet ist, h&auml;ngt neben der Auspr&auml;gung der Erkrankung auch von den Pr&auml;ferenzen der Betroffenen ab.<sup>1,2</sup></p>\r\n
    \r\n
    <h2>Welche Darreichungen gibt es zur Behandlung von CED?</h2>\r\n
    \r\n
    <p>Bei der Behandlung von CEDwird unterschieden zwischen Medikamenten, die systemisch (im gesamten K&ouml;rper) wirken, und Medikamenten, die gezielt auf der entz&uuml;ndeten Schleimhaut wirken sollen. Diese werden als topische Medikamente bezeichnet.</p>\r\n
    \r\n
    <h3>Topische Therapien</h3>\r\n
    \r\n
    <p>Bei leichten bis moderaten Formen der CED kommen topisch wirkende Medikamente mit den Wirkstoffen Mesalazin (Colitis ulcerosa) oder Budesonid (Akutherapie von Morbus Crohn und Colitis ulcerosa) zum Einsatz.</p>\r\n
    \r\n
    <p>Dabei handelt es sich zum einen um rektale Darreichungen wie Klysmen, Rektalschaum oder Z&auml;pfchen. Aber auch Tabletten, Kapseln und Granulat zum Schlucken k&ouml;nnen topisch wirken, sprich direkt am Ort der Entz&uuml;ndung im Darm. Diese Pr&auml;parate wurden galenisch so modifiziert, dass sie den Wirkstoff erst dort freisetzen, wo er gebraucht wird, n&auml;mlich im Darm.<sup>1,2,3</sup></p>\r\n
    \r\n
    <h3>Systemische Medikamente</h3>\r\n
    \r\n
    <p>Systemisch wirkende Medikamente sind zum Beispiel klassische Steroidpr&auml;parate wie Prednison, aber auch Antik&ouml;rpertherapien (Biologika). Antik&ouml;rper wie zum Beispiel TNF-&alpha;-Blocker k&ouml;nnen aufgrund ihrer Molek&uuml;lgr&ouml;&szlig;e nur als Injektion oder Infusion verabreicht werden.</p>\r\n
    \r\n
    <p>Noch relativ neue Medikamente, die in der Behandlung von CED eingesetzt werden, sind die sogenannten Small Molecules (zum Beispiel JAK-Inhibitoren). Im Gegensatz zu den Biologika handelt es sich bei ihnen &ndash; wie die englische Bezeichnung bereits andeutet &ndash; um kleine Molek&uuml;le. Sie k&ouml;nnen als Tablette eingenommen werden und wirken ebenfalls systemisch.<sup>1,2</sup></p>\r\n
    \r\n
    <h2>Weshalb ist die Darreichungsform bei der Therapiewahl wichtig?</h2>\r\n
    \r\n
    <p>Das Ziel der CED-Therapie ist, den Wirkstoff in m&ouml;glichst hoher Konzentration auf die entz&uuml;ndeten Stellen der Darmschleimhaut zu bringen. Bei der Colitis ulcerosa ist das vor allem der Dickdarm und bei Morbus Crohn in der Regel der &Uuml;bergangsbereich vom D&uuml;nndarm zum Dickdarm (Ileoz&ouml;kalbereich). Und diese Bereiche lassen sich mit einigen Darreichungen besser erreichen als mit anderen: Bei der Colitis ulcerosa wirkt &ndash; je nachdem, wo die Entz&uuml;ndung im Dickdarm sitzt &ndash; entweder eine rektale Therapie (mit Z&auml;pfchen, Klysmen, Rektalsch&auml;umen) oder eine orale Therapie (mit Tabletten oder Granulaten) am besten. Beim Morbus Crohn wird dagegen in der Regel eine orale Therapie durchgef&uuml;hrt, weil die Entz&uuml;ndung im Darm mit rektalen Therapien nicht erreicht werden kann.<sup>1,2,3,4</sup></p>\r\n
    \r\n
    <p>Manchmal entspricht die f&uuml;r das jeweilige Krankheitsbild am besten geeignete Darreichungsform allerdings nicht dem Wunsch der Patient*innen. Dies gilt insbesondere f&uuml;r die rektalen Darreichungsformen. Z&auml;pfchen, Klysmen und Rektalsch&auml;ume sind zwar bei distaler Entz&uuml;ndung (n&auml;her am Anus liegend) sehr wirksam, bei den Patient*innen aber nicht unbedingt beliebt. Rektale Therapien werden deshalb in der Therapie der Colitis ulcerosa tendenziell zu selten eingesetzt.<sup>3,4</sup></p>\r\n
    \r\n
    <h2>Wie beeinflusst die Galenik die Wirkstofffreisetzung?</h2>\r\n
    \r\n
    <p>Ein Wirkstoff ist noch kein Medikament. Er muss erst in eine Form gebracht werden, die die Einnahme in einer bestimmten Dosierung erm&ouml;glicht, etwa eine Tablete oder ein Granulat. Die Wissenschaft von der Herstellung gebrauchsfertiger Medikamente wird als Galenik bezeichnet. Und die Galenik kann auch beeinflussen, wann und wo ein Wirkstoff nach der Einnahme aus dem Medikament freigesetzt wird5.</p>\r\n
    \r\n
    <p>Bei CED sollen orale Medikamente mit Wirkstoffen wie Mesalazin oder Budesonid die Passage durch Mund, Speiser&ouml;hre, Magen und obere D&uuml;nndarmabschnite m&ouml;glichst unversehrt &uuml;berstehen. Erst am &Uuml;bergang von D&uuml;nndarm zu Dickdarm beziehungsweise im Dickdarm sollen die Wirkstoffe freigesetzt werden, damit sie dort gezielt an den entz&uuml;ndeten Stellen wirken k&ouml;nnen. Dies gelingt zum einen, indem die Medikamente mit einem magensaftresistenten &Uuml;berzug versehen werden. Auf diese Weise setzen die Tabletten oder das Granulat den Wirkstoff erst frei, wenn sie Darmabschnitte erreicht haben, in denen ein bestimmter pH-Wert herrscht. Wirkstoffverluste im Magen und in den oberen D&uuml;nndarmabschnitten werden dadurch vermieden.<sup>6,7</sup></p>\r\n
    \r\n
    <p>Aber selbst im Darm angekommen, sollen die Medikamente ihren Wirkstoff nicht auf einmal abgeben. Granulat-Pellets erm&ouml;glichen durch ihre spezielle Galenik, dass der Wirkstoff Mesalazin w&auml;hrend der Passage des Dickdarms verz&ouml;gert freigesetzt wird, sodass alle Abschnite im gleichen Ma&szlig;e mit Wirkstoff versorgt werden. M&ouml;glich ist dies, da der Wirkstoff Mesalazin in winzige, etwa einen Millimeter gro&szlig;e Pellets verpackt ist, die aus mehreren Schichten aufgebaut sind. Ganz au&szlig;en befindet sich eine quellende Gleitschicht, die das Schlucken erleichtert. Als N&auml;chstes folgt der magensaftresistente &Uuml;berzug, der daf&uuml;r sorgt, dass sich die Pellets nicht schon im Magen aufl&ouml;sen. Aber die Granulat-Pellets verf&uuml;gen zus&auml;tzlich &uuml;ber einen weiteren galenischen Kniff: Im Inneren der Pellets befindet sich der Wirkstoff Mesalazin eingebunden in einen Polymer-Matrix-Kern, der f&uuml;r eine zus&auml;tzlich verz&ouml;gerte Freisetzung sorgt.<sup>6,7</sup></p>\r\n
    \r\n
    <h2>Wie beeinflusst die Galenik die Vertr&auml;glichkeit?</h2>\r\n
    \r\n
    <p>Der Wirkstoff Budesonid entfaltet seine antientz&uuml;ndliche Aktivit&auml;t im Darm und wird danach in der Leber rasch abgebaut &ndash; 90 Prozent davon werden in der Leber inaktiviert. Durch die nur geringe systemische Belastung kommt es zu signifikant weniger steroidassoziierten Nebenwirkungen.<sup>8</sup></p>\r\n
    \r\n
    <p>Der Wirkstoff Mesalazin in Form von Tabletten oder Granulat-Pellets wird erst im Dickdarm freigesetzt. Die Gesamtbelastung des K&ouml;rpers mit dem Wirkstoff ist deshalb geringer als bei Medikamenten mit systemischer Freisetzung. Dies kann zu einer besseren Vertr&auml;glichkeit beitragen.<sup>6,7</sup></p>\r\n
    \r\n
    <p>Empfehlenswert sind Medikamente, die ihren Wirkstoff in Abh&auml;ngigkeit vom pH-Wert freisetzen, deshalb insbesondere f&uuml;r Patient*innen mit langer Magenverweilzeit, langsamem Transit im D&uuml;nndarm und krankheitsbedingtem Durchfall. Auch Patient*innen, die besonders anf&auml;llig f&uuml;r systemische Nebenwirkungen sind, k&ouml;nnen von dem galenischen Schutz in Magen und D&uuml;nndarm profitieren.<sup>6</sup></p>\r\n
    \r\n
    <p><strong>Quellen:</strong></p>\r\n
    \r\n
    <ol>\r\n
    \t<li>Aktualisierte S3-Leitlinie Colitis ulcerosa (Version 6.1).</li>\r\n
    \t<li>Aktualisierte S3-Leitlinie &bdquo;Diagnostik und Therapie des Morbus Crohn&ldquo; der Deutschen Gesellschaft f&uuml;r Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS).</li>\r\n
    \t<li>Klotz U. The Pharmacological Profile and Clinical Use of Mesalazine (5-~minosalicylic Acid). Arzneimittelforschung 2012 Feb;62(2):53&ndash;8.</li>\r\n
    \t<li>Seibold F, Fournier N, Beglinger C, et al. Topical therapy is underused in patients with ulcerative colitis. Journal of Crohn&rsquo;s and Colitis (2014) 8, 56&ndash;63.</li>\r\n
    \t<li>Zimmermann I. Galenik oder wie aus einem Wirkstoff ein Arzneimittel wird. Teil I: Einf&uuml;hrung und chemische sowie physikalisch-chemische Prinzipien. Chemie in unserer Zeit 1989 Aug; 23 (4): 114&ndash;120.</li>\r\n
    \t<li>Deissler H, Krammer H, Gillessen A. pH‐dependent vs. constant release of mesalazine in the treatment of ulcerative colitis: Do drug delivery concepts determine therapeutic efficacy? (Review). Biomed Rep. 2021 Nov;15(5):96.</li>\r\n
    \t<li><a href="https://www.deutsche-apotheker-zeitung.de/daz-az/2002/daz-13-2002/uid-5760">https://www.deutsche-apotheker-zeitung.de/daz-az/2002/daz-13-2002/uid-5760</a>.</li>\r\n
    \t<li>Vetter C, et al. Topisches Steroid Budesonid: Signifikant weniger Nebenwirkungen. Dtsch Arztebl 2003; 100(37): A-2393.</li>\r\n
    </ol>
    """
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:71
Show trace 
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:72
Show trace 
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:73
Show trace 
[
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Flashes

Flashes

Key Value
error 
[
  "Sie müssen eingeloggt sein um diesen Artikel lesen zu können!"
]

Server Parameters

Server Parameters

Defined in .env

Key Value
APP_ENV 
"dev"
APP_SECRET 
"a1d687c7188a8bbff1cb1e7504f8f22f"
DATABASE_URL 
"mysql://apofalk-academy:0az5otq1qeT1QVQK@127.0.0.1:3306/apofalk-academy"
GOOGLE_CAPTCHA_KEY 
"6LeMd_8qAAAAAIYtrI1v6HmANQgT4wNKYuMnDZ0c"
MAILER_DSN 
"smtp://apofalk@creatediv-ld.de:trU5MSwFK643w9o1@mail.your-server.de:587"
MAILER_NAME 
"apofalk.de"
MAILER_USER 
"info@creatediv.de"
MESSENGER_TRANSPORT_DSN 
"doctrine://default?auto_setup=0"
POINTS_FOR_ELEARNING 
"20"
POINTS_FOR_QUIZ 
"10"
POINTS_NEEDED_FOR_CLUB 
"60"
WKHTMLTOPDF_PATH 
"/usr/local/bin/wkhtmltopdf"

Defined as regular env variables

Key Value
APP_DEBUG 
"1"
CONTEXT_DOCUMENT_ROOT 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public"
CONTEXT_PREFIX 
""
DOCUMENT_ROOT 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public"
FCGI_ROLE 
"RESPONDER"
GATEWAY_INTERFACE 
"CGI/1.1"
HOME 
"/var/www/vhosts/dev-plesk.creatediv.local"
HTTP_ACCEPT 
"*/*"
HTTP_ACCEPT_ENCODING 
"gzip, br, zstd, deflate"
HTTP_CONNECTION 
"close"
HTTP_HOST 
"apofalk-academy.dev-plesk.creatediv.local"
HTTP_USER_AGENT 
"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)"
HTTP_X_ACCEL_INTERNAL 
"/internal-nginx-static-location"
HTTP_X_FORWARDED_FOR 
"216.73.216.96"
HTTP_X_FORWARDED_HOST 
"apofalk-academy.dev-creatediv.de"
HTTP_X_FORWARDED_SERVER 
"apofalk-academy.dev-creatediv.de"
HTTP_X_REAL_IP 
"192.168.20.3"
PATH 
"/usr/local/sbin:/usr/local/bin:/usr/sbin:/usr/bin:/sbin:/bin:/snap/bin"
PHP_SELF 
"/index.php"
QUERY_STRING 
""
REDIRECT_STATUS 
"200"
REDIRECT_UNIQUE_ID 
"aUIe9st5bn0T54auxAYYUwAAAAU"
REDIRECT_URL 
"/fachartikel/bei-morbus-crohn-und-colitis-ulcerosa-kommt-es-auf-die-galenik-der-medikamente-an"
REMOTE_ADDR 
"192.168.20.3"
REMOTE_PORT 
"40972"
REQUEST_METHOD 
"GET"
REQUEST_SCHEME 
"http"
REQUEST_TIME 
1765940982
REQUEST_TIME_FLOAT 
1765940982.4532
REQUEST_URI 
"/fachartikel/bei-morbus-crohn-und-colitis-ulcerosa-kommt-es-auf-die-galenik-der-medikamente-an"
SCRIPT_FILENAME 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public/index.php"
SCRIPT_NAME 
"/index.php"
SERVER_ADDR 
"192.168.20.6"
SERVER_ADMIN 
"[no address given]"
SERVER_NAME 
"apofalk-academy.dev-plesk.creatediv.local"
SERVER_PORT 
"80"
SERVER_PROTOCOL 
"HTTP/1.0"
SERVER_SIGNATURE 
"<address>Apache Server at apofalk-academy.dev-plesk.creatediv.local Port 80</address>\n"
SERVER_SOFTWARE 
"Apache"
SYMFONY_DOTENV_VARS 
"APP_ENV,APP_SECRET,DATABASE_URL,MESSENGER_TRANSPORT_DSN,MAILER_DSN,MAILER_NAME,MAILER_USER,WKHTMLTOPDF_PATH,GOOGLE_CAPTCHA_KEY,POINTS_NEEDED_FOR_CLUB,POINTS_FOR_QUIZ,POINTS_FOR_ELEARNING"
UNIQUE_ID 
"aUIe9st5bn0T54auxAYYUwAAAAU"
USER 
"dev-plesk"
proxy-nokeepalive 
"1"