Diversitätsfaktoren in der Gastroenterologie

Diversitätsfaktoren werden zunehmend als wichtige Einflussgröße für Pathogenese, klinische Manifestation und Therapie von Erkrankungen der Gastroenterologie und Hepatologie erkannt und sollten bei Diagnostik- und Therapieentscheidungen berücksichtigt werden. Am Beispiel chronisch-entzündlicher Darmerkrankungen wird in dieser Übersicht diskutiert, wie Diversitätsfaktoren, z.B. biologisches Geschlecht oder ethnische Herkunft, den Krankheitsverlauf beeinflussen. Diversitätsfaktoren stellen im klinischen Alltag wichtige Bausteine auf dem Weg zu einer personalisierten Medizin dar.

Abstract

Factors related to patient diversity may play a major role in the pathogenesis and clinical manifestation of intestinal and liver diseases and should be considered during diagnostic workup and therapeutic decisions. Here we discuss how diversity factors such as gender, ethnicity, age and socioeconomic parameters may affect the manifestation and disease course of inflammatory bowel diseases (IBD, i.e. Crohn’s disease and ulcerative colitis). Consideration of such factors may help to pave the path towards personalized medicine approaches in clinical practice.

Kernaussagen

• CED können sich im fortgeschrittenen Alter manifestieren. Aufgrund möglicher Differenzialdiagnosen erfolgt die Diagnosestellung häufig verspätet. Ein besonderes Augenmerk bei der Pharmakotherapie älterer Patienten sollte auf die damit einhergehenden Infektionsrisiken gelegt werden.

• Ethnische Faktoren beeinflussen die Prognose und den Krankheitsverlauf bei MC. Diese Faktoren lassen sich im klinischen Alltag nicht immer von soziökonomischen Faktoren und einem erschwerten Zugang zum Gesundheitssystem trennen.

• Genetische Faktoren wie der HLA-Genotyp determinieren das Risiko für einen sekundären Wirkverlust einer TNF-Antikörpertherapie durch die Bildung sog. Anti-Drug-Antikörper.

• Geschlecht: Hormonelle Faktoren könnten einerseits das Risiko für CED und die Krankheitsaktivität beeinflussen. Andererseits werden Frauen seltener leitliniengerecht und weniger konsequent behandelt als Männer. Vor einer Pharmakotherapie jüngerer Frauen mit CED sollten frühzeitig ein möglicher Kinderwunsch und mögliche Einflüsse der Erkrankung und Therapie auf eine Schwangerschaft thematisiert werden. Besonders Frauen mit CU haben während und unmittelbar nach einer Schwangerschaft ein erhöhtes Schubrisiko.

Schlüsselwörter

Alter - Morbus Crohn - Colitis ulcerosa - Infektrisiko - personalisierte Medizin

Keywords

age - Crohn’s disease - ulcerative colitis - risk factors for infection - personalized medicine

Publication History

Article published online:
24 April 2023

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