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article 
App\Entity\Article {#528
  -id: 2
  -title: "Die rektale Therapie bei Colitis ulcerosa"
  -teaser: "<p>Colitis ulcerosa ist eine chronisch entz&uuml;ndliche Darmerkrankung (CED), die nicht heilbar ist. Durch neue Therapieoptionen haben sich die erreichbaren Therapieziele in den vergangenen Jahren aber weiterentwickelt.</p>"
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    <h2>Einleitung</h2>\r\n
    \r\n
    <p>Colitis ulcerosa ist eine chronisch entz&uuml;ndliche Darmerkrankung (CED), die nicht heilbar ist. Das Hauptziel der Therapie der Colitis ulcerosa war lange &ndash; und ist auch heute noch &ndash; das Erreichen der klinischen Remission. Die Patient*innen sollten rasch von ihren akuten Beschwerden befreit werden, auch wenn eine Heilung der chronischen Entz&uuml;ndung im Darm nicht m&ouml;glich war.<sup>1</sup></p>\r\n
    \r\n
    <p>Durch neue Therapieoptionen haben sich die erreichbaren Therapieziele in den vergangenen Jahren aber weiterentwickelt. Die Behandlung der Colitis ulcerosa &ndash; etwa eine rektale Therapie mit Mesalazin &ndash; kann auch zur Heilung der Darmschleimhaut (Mukosa) beitragen.<sup>1,2</sup></p>\r\n
    \r\n
    <p>&nbsp;</p>\r\n
    \r\n
    <h2>Weshalb ist die Mukosaheilung bei Colitis ulcerosa wichtig?&nbsp;</h2>\r\n
    \r\n
    <p>Von einer Mukosaheilung sprechen Fachleute, wenn keine Entz&uuml;ndungen der Darmschleimhaut mehr nachgewiesen werden k&ouml;nnen &ndash; weder bei der Darmspiegelung noch bei der mikroskopischen Gewebeuntersuchung. Mittlerweile ist bekannt, dass die Mukosaheilung bei Patient*innen mit einer besseren Prognose f&uuml;r Colitis ulcerosa einhergeht.<sup>3,4</sup></p>\r\n
    \r\n
    <p>In Studien hat sich gezeigt, dass die Abheilung der Dickdarmschleimhaut den Verlauf der Krankheit g&uuml;nstig beeinflussen und die Funktionalit&auml;t des Darms erhalten kann. Bei Patient*innen, bei denen eine Mukosaheilung erreicht werden konnte, ist seltener eine Resektion des Darms erforderlich und sie erreichen die klinische Remission h&auml;ufiger, ohne daf&uuml;r Steroidpr&auml;parate zu ben&ouml;tigen. Zudem haben Patient*innen mit Mukosaheilung ein geringeres Risiko, Darmkrebs zu entwickeln, und die krebsbedingte Sterblichkeit sinkt ebenfalls.<sup>1,5,6</sup></p>\r\n
    \r\n
    <p>&nbsp;</p>\r\n
    \r\n
    <h2>Das sind die Vorteile der rektalen Therapie&nbsp;</h2>\r\n
    \r\n
    <p>Die Behandlung mit der 5-Aminosalicyls&auml;ure Mesalazin geh&ouml;rt zu den Grundpfeilern der Therapie der Colitis ulcerosa. Sie kann sowohl oral (Tabletten, Granulat) als auch rektal (Z&auml;pfchen, Schaum, Einlauf) angewendet werden.<sup>1,2</sup></p>\r\n
    \r\n
    <p>Wichtig zu wissen: Pr&auml;parate, die Mesalazin enthalten, entfalten ihre Wirkung immer nur im direkten Kontakt mit der Darmschleimhaut. Durch eine rektale Anwendung l&auml;sst sich deshalb ein besonders guter Therapieeffekt erzielen. Bei etwa der H&auml;lfte der Patient*innen kann mit einer rektalen Therapie mit Mesalazin eine Heilung der Mukosa erreicht werden.<sup>2</sup></p>\r\n
    \r\n
    <p>Dennoch werden rektale Therapien noch zu selten verordnet und angewendet. Dabei wei&szlig; man aus klinischen Studien, dass insbesondere bei der Proctitis ulcerosa und der linksseitigen Colitis ulcerosa rektale Mesalazin-Pr&auml;parate wirksamer sind als Produkte f&uuml;r die orale Einnahme.<sup>1,2</sup></p>\r\n
    \r\n
    <p>Rektale Mesalazin-Pr&auml;parate k&ouml;nnen dabei sowohl zur Akuttherapie als auch zur Vorbeugung von Sch&uuml;ben eingesetzt werden.<sup>1,2</sup></p>\r\n
    \r\n
    <p>&nbsp;</p>\r\n
    \r\n
    <h2>Tipps f&uuml;r die Anwendung der rektalen Therapie&nbsp;&nbsp;</h2>\r\n
    \r\n
    <p>Einlauf statt Tablette? Das klingt am Anfang etwas gew&ouml;hnungsbed&uuml;rftig, aber viele&nbsp;Patient*innen mit Colitis ulcerosa gew&ouml;hnen sich schnell an die rektale Anwendung. Ein gro&szlig;er Vorteil der rektalen Therapie, der viele Betroffene &uuml;berzeugt: Zur Schubvorbeugung muss die rektale Therapie nur f&uuml;r eine Woche im Monat angewendet werden, nicht durchgehend wie die orale Variante.<sup>2 </sup></p>\r\n
    \r\n
    <p>Es gibt einige Tipps, die die Anwendung von Z&auml;pfchen, Einlauf und Schaum erleichtern k&ouml;nnen:&nbsp;</p>\r\n
    \r\n
    <ul>\r\n
    \t<li>Die Patient*innen sollten vorher auf die Toilette gehen, das beste Ergebnis wird erzielt, wenn sie den Darm vor der Anwendung entleert haben.&nbsp;</li>\r\n
    \t<li>Die Flasche oder Dose sollte vor der Anwendung mit der Hand angew&auml;rmt werden.&nbsp;</li>\r\n
    \t<li>Es ist sinnvoll, ein Handtuch unterzulegen.&nbsp;</li>\r\n
    \t<li>Um das Einf&uuml;hren zu erleichtern, kann der Applikator der Flasche oder Dose mit etwas Vaseline bestrichen werden.&nbsp;</li>\r\n
    \t<li>Bei der Anwendung liegen die Patient*innen am besten auf der linken Seite.&nbsp;</li>\r\n
    \t<li>Wichtig: Einl&auml;ufe und Sch&auml;ume m&uuml;ssen mindestens 20 bis 30 Minuten im Dickdarm gehalten werden (das kann am Anfang schwerfallen, wird aber mit der Zeit einfacher).&nbsp;</li>\r\n
    </ul>\r\n
    \r\n
    <p>&nbsp;</p>\r\n
    \r\n
    <h3>Besserer Therapieerfolg durch eine Beratung in der Apotheke&nbsp;</h3>\r\n
    \r\n
    <p>Die korrekte Anwendung der rektalen Therapie spielt eine wichtige Rolle f&uuml;r den Erfolg der Behandlung. Das sorgf&auml;ltige Studium der Anwendungshinweise in der Packungsbeilage ist daf&uuml;r der wichtigste Schritt. Doch viele Betroffene haben weiterf&uuml;hrende Fragen oder ziehen eine pers&ouml;nliche Aufkl&auml;rung vor. Ein Beratungsgespr&auml;ch in der Apotheke kann Klarheit schaffen.&nbsp;</p>\r\n
    \r\n
    <p>Vielen Patient*innen mit Colitis ulcerosa f&auml;llt es allerdings schwer, offen &uuml;ber die Anwendung einer rektalen Therapie zu sprechen und im Detail nachzufragen. Eine empathische Herangehensweise, sehr sachliche Erkl&auml;rungen und, falls vorhanden, ein gesch&uuml;tzter Rahmen (etwa ein separater Raum) k&ouml;nnen den Betroffenen helfen, individuelle Probleme anzusprechen. Sinnvoll ist es zudem, Illustrationen zu Hilfe zu nehmen. Sie erh&ouml;hen das Verst&auml;ndnis, und die Patient*innen k&ouml;nnen bei Unklarheiten auf die Zeichnung &nbsp;zeigen statt Begriffe zu verwenden, die f&uuml;r sie eventuell schambesetzt sind.<sup>7</sup></p>\r\n
    \r\n
    <p>&nbsp;</p>\r\n
    \r\n
    <p><strong>Quellen:&nbsp;</strong></p>\r\n
    \r\n
    <ol>\r\n
    \t<li><a href="https://register.awmf.org/de/leitlinien/detail/021-009" target="_blank">S3-Leitlinie Colitis ulcerosa</a>&nbsp;</li>\r\n
    \t<li><a href="https://de.drfalkpharma.com/de/literatur/informationen-fuer-betroffene/" target="_blank">Dr. Falk Brosch&uuml;re: Rektale Therapie bei chronisch-entz&uuml;ndlichen Darmerkrankungen</a>&nbsp;</li>\r\n
    \t<li><a href="https://www.nature.com/articles/s41575-019-0211-1" target="_blank">Danese S et al. Nat Rev Gastroenterol Hepatol\u{202F}2020; 17:1-2</a>&nbsp;</li>\r\n
    \t<li><a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1296-3494" target="_blank">Kucharzik T et al. Z Gastroenterol 2020; 58: 1209-1232</a>&nbsp;</li>\r\n
    \t<li><a href="https://www.gastrojournal.org/article/S0016-5085(20)35572-4/fulltext?referrer=https%3A%2F%2Fwww.gastrojournal.org%2F" target="_blank">Turner D et al. Gastroenterology 2021;160:1570&ndash;1583</a>&nbsp;</li>\r\n
    \t<li><a href="https://www.mdpi.com/2075-4418/11/9/1570" target="_blank">Cazzato G et al. Diagnostics 2021;11:1570</a>&nbsp;</li>\r\n
    \t<li><a href="https://ptaforum.pharmazeutische-zeitung.de/ausgabe-102017/scham-und-sorgen-nehmen/" target="_blank">https://ptaforum.pharmazeutische-zeitung.de/ausgabe-102017/scham-und-sorgen-nehmen/</a></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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    "file" => "/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/vendor/symfony/http-kernel/DataCollector/RequestDataCollector.php"
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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 
"aUIeDQuFDvOcfu3b71xSbwAAAAA"
REDIRECT_URL 
"/fachartikel/die-rektale-therapie-bei-colitis-ulcerosa"
REMOTE_ADDR 
"192.168.20.3"
REMOTE_PORT 
"43766"
REQUEST_METHOD 
"GET"
REQUEST_SCHEME 
"http"
REQUEST_TIME 
1765940749
REQUEST_TIME_FLOAT 
1765940749.4637
REQUEST_URI 
"/fachartikel/die-rektale-therapie-bei-colitis-ulcerosa"
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 
"aUIeDQuFDvOcfu3b71xSbwAAAAA"
USER 
"dev-plesk"
proxy-nokeepalive 
"1"