Z Gastroenterol 2009; 47(6): 541-562
DOI: 10.1055/s-0028-1109323
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Evidenzbasierte und interdisziplinär konsentierte Versorgungspfade für Patientinnen und Patienten mit Morbus Crohn oder Colitis ulcerosa

Evidence-Based and Consented Pathways for Patients with Inflammatory Bowel Diseases (IBD)H. Raspe1 , S. Conrad1 , C. Muche-Borowski1
  • 1Institut für Sozialmedizin, Universität Lübeck
Further Information

Publication History

Manuskript eingetroffen: 12.11.2008

Manuskript akzeptiert: 16.2.2009

Publication Date:
16 June 2009 (online)

Zusammenfassung

Morbus Crohn und Colitis ulcerosa sind charakterisiert durch rezidivierende Schübe, ein frühes Manifestationsalter und Einschränkungen in Aktivitäten und Teilhabe. Sie erfordern eine wohnortnahe, krankheitsbegleitende und problemorientierte Versorgung. Die entwickelten Versorgungspfade sollen die Wege für kooperatives Handeln zwischen den verschiedenen Versorgungssektoren, ärztlichen und nicht-ärztlichen Berufsgruppen, Einrichtungen und Kostenträgern ebnen.

Grundlage sind die S3-Leitlinien der beiden Krankheitsbilder, klinische Überlegungen, Interviews mit Fachleuten, systematisch gesuchte Evidenz und Ergebnisse einer Betroffenenbefragung.

Die Probleme der Erkrankten wurden erfasst, abgegrenzt und operationalisiert. Allen relevanten Problemsituationen wurden medizinische und nicht-medizinische Leistungen und Leistungserbringer zugeordnet. Abhängig von der Schwere des Krankheitsverlaufs wurde die Koordination der Versorgungsaufgaben den verschiedenen medizinischen Versorgungsebenen und -sektoren zugeteilt. Ein regelmäßiges umfassendes Assessment im Rahmen der medizinischen Betreuung soll erforderliche individuelle Interventionen feststellen. Weitere Säulen sind die leitliniengerechte medizinische Versorgung, eine bedarfsgerechte Information und Schulung der Kranken mit dem Ziel einer Befähigung zu partizipativer Entscheidungsfindung und Selbstmanagement sowie die Anregung zu Forschung und Entwicklung.

Die Versorgungspfade sind evidenzbasiert und interdisziplinär konsentiert (S3). Ihre Anwendbarkeit soll im Rahmen einer Implementierung evaluiert werden.

Abstract

Crohn’s disease and ulcerative colitis are diseases characterized by remission and relapse, an early age of onset and restrictions on activities and participation. IBD patients need a comprehensive, easily accessible and problem-oriented health care. This requires the integration and coordination of different health care sectors, medical and non-medical professionals, social and health care facilities and funding agencies.

The pathways to guide patients through integrated health care were based on clinical considerations, interviews with patients and specialists, systematically searched evidence and results of a questionnaire survey. Within a systematic assessment-assignment approach relevant problems were identified and subsequently related to different medical and non-medical professionals, health care services and medical sectors.

The pathways further imply (1) medical care according to evidence-based guideline recommendations, (2) patient education programs to foster shared decision making and self-management and (3) suggestions for further research.

The pathways were consented in a consensus conference using nominal group process methods. Their feasibility and effect will be evaluated within a regional implementation project.

Literatur

  • 1 Roy M A. Inflammatory bowel disease.  Surgical Clinics of North America. 1997;  77 (6) 1419-1431
  • 2 Sandler R S, Golden A L. Epidemiology of Crohn’s disease.  J Clin Gastroenterol. 1986;  8 (2) 160-165
  • 3 Shivananda S, Lennard-Jones J, Logan R. et al . Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European collaboration study on inflammatory bowel disease (EC-IBD).  Gut. 1996;  39 690-697
  • 4 Irvine E J. A critical Review of epidemiological studies in inflammatory bowel disease.  Scan J Gatroenterol. 2001;  36 (1) 2-15
  • 5 Drossman D A, Patrick D L, Mitchell C M. et al . Health-related quality of life in inflammatory bowel disease – functional status and patients worries and concerns.  Dig Dis Sci. 1989;  34 (9) 1379-1386
  • 6 Berklev T, Jahnsen J, Schulz T. et al . Course of disease, drug treatment and health-related quality of life in patients with inflammatory bowel disease 5 years after initial diagnosis.  Eur J Gastroenterol Hepatol. 2005;  17 1037-1045
  • 7 Raspe H, Lühmann D. Klinische und Versorgungsleitlinien.  Z ärztl Fortbilb Qual sich. 2002;  96 212
  • 8 Stange E F, Schreiber S, Fölsch U. et al . Diagnostik und Therapie des Morbus Crohn.  Z Gastroenterol. 2003;  41 19-68 (Sonderdruck)
  • 9 Hoffmann J C, Zeitz M, Bischoff S C. et al . Diagnostik und Therapie der Colitis Ulcerosa: Ergebnisse einer evidenzbasierten Konsensuskonferenz.  Z Gastroenterol. 2004;  42 984-1032
  • 10 Goebell H. Stellenwert von Aktivitätsindizes bei der Begutachtung von chronisch-entzündlichen Darmkrankheiten.  Med Sach. 2000;  96 (6) 176-178
  • 11 Baumgart D C, Sandborn W J. Inflammatory bowel disease: clinical aspects and established and evolving therapies.  Lancet. 2007;  369 1627-40
  • 12 World Health Organisation .International Classification of functioning, disability and health. Geneva; WHO 2001
  • 13 Klaus J, Armbrecht G, Steinkamp M. et al . High prevalance of osteoporotic vertebral fractures in patients with Crohn’s disease.  Gut. 2002;  51 654-658
  • 14 Reinshagen M, Tirpitz von C. Osteoporosis and other extraintestinal symptoms and complications of inflammatory bowel disease.  Dig Dis. 2003;  21 138-145
  • 15 Mintz R, Feller E, Bahr R L. et al . Ocular manifestations of inflammatory bowel disease.  Inflamm Bowel Dis. 2004;  10 135-139
  • 16 Schulte C MS. Review article: bone disease in inflammatory bowel disease.  Aliment Pharmacol Ther. 2004;  20 43-49
  • 17 Itin P H, Rufli T. Hautsymptome bei Erkrankungen im Bereich des Magen-Darm-Trakts.  Therapeutischen Umschau. 1995;  52 236-242
  • 18 Fornaciari G, Salvarani C, Beltrami M. et al . Muscoloskeletal manifestations in inflammatory bowel disease.  Can J Gastroenterol. 2001;  15 399-403
  • 19 Palm Ø, Moum B, Jahnsen J. et al . The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based study/the IBSEN study).  Rheumatology. 2001;  40 1256-1261
  • 20 Husain A, Triadafilopoulos G. Communicating with patients with inflammatory bowel disease.  Inflamm Bowel Dis. 2004;  10 444-450
  • 21 Deter H C, Rapf M, Gladisch R. et al . Psychodiagnostische Verlaufsuntersuchungen vom Morbus-Crohn-Patienten während der internistischen Intensivbehandlung.  Z Gastroenterol. 1993;  31 703-710
  • 22 North C S, Alpers D H. A review of studies of psychiatric factors in Crohn’s disease: etiologic implications.  Annals of Clinical Psychiatry. 1994;  6 (2) 117-124
  • 23 Küchenhoff J, Manz R, Mathes L. Was beeinflusst den Krankheitsverlauf des Morbus Crohn?.  Nervenarzt. 1995;  66 41-48
  • 24 Feiereis H. Zur Psychotherapie des M. Crohn.  Langenbecks Arch Chir. 1984;  Kongressbericht 364
  • 25 Irvine E J. Review article: patients’ fears and unmet needs in inflammatory bowel disease.  Aliment Pharmacol Ther. 2004;  20 (Suppl 4) 54-59
  • 26 Irvine E J. Quality of life in inflammatory bowel disease: Bias and other factors affecting scores.  Scand J Gastroenterol. 1995;  30 (Suppl 208) 136-40
  • 27 Nordin K, Påhlman L, Larsson K. et al . Health-related quality of life and psychological distress in a population-based sample of swedish patients with inflammatory bowel disease.  Scand J Gastroenterol. 2002;  37 450-457
  • 28 Porcelli P, Zaka S, Centonze S. et al . Psychological distress and levels of disease activity in inflammatory bowel disease.  Ital J Gastroenterol. 1994;  26 111-115
  • 29 Guthrie E, Jackson J, Shaffer J. et al . Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn’s disease.  Am J Gastroenterol. 2002;  97 1994-1999
  • 30 Acosta-Ramírez D, Pagán-Ocasio V, Torres E A. et al . Profile of the inflammatory bowel disease patient with depressive disorder.  PRHSJ. 2001;  20 (3) 215-220
  • 31 Andrews H, Barczak P, Allan R N. Psychiatric illness in patients with inflammatory bowel disease.  Gut. 1987;  28 1600-1604
  • 32 Farrokhyar F, Marshall J K, Easterbrook B. et al . Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health.  Inflamm Bowel Dis. 2006;  12 (1) 38-46
  • 33 Maunder R G, Greenberg G R. Comparison of a disease activity index and patients’ self-reported symptom severity in ulcerative colitis.  Inflamm Bowel disease. 2004;  10 632-636
  • 34 Leibig T, Wilke E, Feiereis H. Zur Persönlichkeitsstruktur von Patienten mit Colitis ulcerosa und Morbus Crohn, eine testpsychologische Untersuchung während der Krankheitsremission.  Zsch psychosom Med. 1985;  31 380-392
  • 35 Maunder R G, Lancee W J, Hunter J J. et al . Attachment insecurity moderates the relationship between disease activity and depressive symptoms in ulcerative colitis.  Inflamm Bowel Dis. 2005;  11 919-926
  • 36 Mittermaier C, Dejaco C, Waldhoer T. et al . Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study.  Psychosom Med. 2004;  66 79-84
  • 37 Kurina L M, Golacre M J, Yeates D. et al . Depression and anxiety in people with inflammatory bowel disease.  J Epidemiol Community Health. 2001;  55 716-720
  • 38 Simrén M, Axelsson J, Gillberg R. et al . Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors.  Am J Gastroenterol. 2002;  97 389-396
  • 39 Addolorato G, Capristo E, Stefanini G F. et al . Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity and nutritional status.  Scan J Gastroenterol. 1997;  32 1013-1021
  • 40 Porcelli P, Leoci C, Guerra V. A prospective study of relationship between disease activity and psychologic distress in patients with inflammatory bowel disease.  Scand J Gastroenterol. 1996;  31 792-796
  • 41 Mardini H E, Kip K E, Wilson J W. Crohn’s disease: a two-year prospective study of the association between psychological distress and disease activity.  Dig Dis Sci. 2004;  49 (3) 492-497
  • 42 North C S, Alpers D H, Helzer J E. et al . Do life events or depression exacerbate inflammatory bowel disease?.  Annals of Internal Medicine. 1991;  114 381-386
  • 43 Porcelli P, Leoci C, Guerra V. et al . A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease.  J Psychsom Res. 1996;  41 (6) 569-573
  • 44 Arapakis G, Lyketsos C G, Gerolymatos K. et al . Low dominance and high intropunitiveness in ulcerative colitis and irritable bowel syndrom.  Psychother Psychosom. 1986;  46 171-176
  • 45 Riley S A, Mani V, Goodman M J. et al . Why do patients with ulcerative colitis relapse?.  Gut. 1990;  31 179-183
  • 46 Helzer J E, Chammas S, Norland C C. et al . A study of the association between Crohn’s disease and psychiatric illness.  Gastroenterology. 1984;  86 324-30
  • 47 Robertson D AF, Ray J, Diamond I. et al . Personality profile and affective state of patients with inflammatory bowel disease.  Gut. 1989;  30 623-626
  • 48 Magni G, Bernasconi G, Mauro P. et al . Psychiatric diagnosis in ulcerative colitis – a controlled study.  British Journal of Psychiatry. 1991;  158 413-415
  • 49 Tarter R E, Switala J, Carra J. et al . Inflammatory bowel disease: psychiatric status of patients before and after disease onset.  Int J Psychiatry in Medicine. 1987;  17 173-181
  • 50 Schwarz S p, Blanchard E B, Berreman C F. et al . Psychological aspects of irritable bowel syndrom: comparison with inflammatory bowel disease and nonpatient controls.  Behav Res Ther. 1993;  31 297-304
  • 51 Cabré E, Gassull M A. Nutritional and metabolic issues in inflammatory bowel disease.  Curr Opin Clin Nutr Metabol Care. 2003;  6 569-576
  • 52 Spiller G A, Freeman H J. Recent advances in dietary fiber and colorectal disease.  Am J Clin Nutr. 1981;  34 1145-1152
  • 53 Burke A, Lichtenstein G R, Rombeau J L. Nutrition and ulcerative colitis.  Bailliére’s Clinical Gastroenterology. 1997;  11 (1) 153-174
  • 54 Russel M G, Engels L G, Muris J W. et al . `Modern life` in the epidemiology of infammatory bowel disease: a case-control study with special emphasis on nutritional factors.  Eur J Gastroenterol Hepatol. 1998;  10 243-249
  • 55 Jowett S L, Seal C J, Pearce M S. et al . Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study.  Gut. 2004;  53 1479-1484
  • 56 Brandes J W, Lorenz-Meyer H. Zuckerfreie Diät: Eine neue Perspektive zur Behandlung des Morbus Crohn.  Z Gastroenterologie. 1981;  19 1-12
  • 57 Bjørkkjær T, Brunborg L A, Arslan G. et al . Reduced joint pain after short-term duodenal administration of seal oil in patients with inflammatory bowel disease: comparison with soy oil.  Scan J Gastroenterol. 2004;  39 1088-1094
  • 58 Arslan G, Brunborg L A, Frøyland L. et al . Effect of duodenal seal oil administration in patients with inflammatory bowel disease.  Lipids. 2002;  37 935-940
  • 59 Ganguli S C, Cawdron R, Irvine E J. Alternative medicine use by canadian ambulatory gastroenterology patients: Secular trend or epidemic?.  Am J Gastroneterol. 2004;  99 (2) 319-326
  • 60 Moser G, Tillinger W, Sachs G. et al . Relationship between the use of unconventional therapies and disease-related concerns: a study of patients with inflammatory bowel disease.  J Psychosom Res. 1996;  40 (5) 503-509
  • 61 Burgmann T, Rawsthorne P, Bernstein C N. Predictors of alternative and complementary medicine use in inflammatory bowel disease: do measures of conventional health care utilization relate to use?.  Am J Gastroenterol. 2004;  99 (5) 889-893
  • 62 Langmead L, Chitnis M, Rampton D S. Use of complementary therapies by patients with IBD may indicate psychosocial distress.  Inflamm Bowel Dis. 2002;  8 174-179
  • 63 Hilsden R J, Verhoef M J, Best A. et al . Complementary and alternative medicine use by Canadian patients with inflammatory bowel disease: results from a national survey.  Am J Gastroenterol. 2003;  98 1563-1568
  • 64 Joos S, Brinkhaus B, Maluche C. et al . Acupuncture and moxibustion in the treatment of active Crohn’s disease: a randomized controlled study.  Digestion. 2004;  69 131-139
  • 65 Cottone M. Stress and physical activity: are they risk factors for IBD?.  Ital J Gastroenterol Hepatol. 1998;  30 252-3
  • 66 Levenstein S. Stress and ulcerative colitis: convincing the doubting thomases.  AJG. 2003;  98 2112-2114
  • 67 Hershfield N. Hans Selye, inflammatory bowel disease and placebo response.  Can J Gastroenterol. 1997;  11 (7) 623-625
  • 68 Farrell R J, Peppercorn M A. Ulcerative colitis.  Lancet. 2002;  359 331-340
  • 69 Drossmann D A. Presidential address: gastrointestinal illness and the biopsychosocial model.  Psychosom Med. 1998;  60 258-267
  • 70 Niess J H, Mönnikes H, Dignass A U. et al . Review on the influence of stress on immun mediators, neuropeptides and hormones with relevance for inflammatory bowel disease.  Digestion. 2002;  65 131-140
  • 71 LeResche L, Dworkin S F. The role of stress in inflammatory bowel disease, including peridontal disease: review of concepts and current finding.  Peridentology. 2002;  30 91-103
  • 72 Levenstein S, Prantera C, Varva V. et al . Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission.  Am J Gastroenterol. 2000;  95 1213-1220
  • 73 Bitton A, Sewitch M J, Peppercorn M A. et al . Psychosocial determinant of relapse in ulcerative colitis: a longitudinal study.  Am J Gastroenterol. 2003;  98 2203-2208
  • 74 Li J, Nørgárd B, Hansen Precht D. et al . Psychological stress and inflammatory bowel disease: a follow-up study in parents who lost a child in Denmark.  Am J Gastroenterol. 2004;  99 (6) 1129-1133
  • 75 Wietersheim von J, Overbeck A, Kiel K. et al . Die Bedeutung rezidivauslösender Ereignisse bei Patienten mit chronisch entzündlichen Darmerkrankungen. Ergebnisse einer prospektiven Längsschnittstudie über 3 Jahre.  Psychother Psychosom med Psychol. 1994;  44 58-64
  • 76 Kosarz P, Traue H C. Alltagsstress und Colitis ulcerosa.  Psychother Psychosom med Psychol. 1997;  47 117-122
  • 77 Maunder R G. Evidence that stress contributes the inflammatory bowel disease: evaluation, synthesis, and future directions.  Inflamm Bowel Dis. 2005;  11 (6) 600-608
  • 78 Greene B R, Blanchard E D, Wan C K. Long-term monitoring od psychosocial stress amd symptomatology in inflammatory bowel disease.  Behav Res Ther. 1994;  32 (2) 217-226
  • 79 Garrett V D, Brantley P J, Jones G N. et al . The relation between daily stress and Crohn’s disease.  J Behav Med. 1991;  14 (1) 87-96
  • 80 Head K A, Jurenka J S. Inflammatory bowel disease part I: Ulcerative Colitis – pathophysiology and conventional and alternative treatment options.  Altern Med Rev. 2003;  8 (3) 247-283
  • 81 Krishnan A, Korzenik J R. Inflammatory bowel disease and environmental influences.  Gastroenterol Clin N Am. 2002;  31 21-39
  • 82 Danese S, Sans M, Fiocchi C. Inflammatory bowel disease: the role of environmental factors.  Autoimmunity Reviews. 2004;  3 394-400
  • 83 Peppercorn M A. Definition of and risk factors for inflammatory bowel disease. 2006 www.uptodate.com
  • 84 Snapper S B, Podolsky D K. Epidemiology and genetic and environmental factors in inflammatory bowel disease. 2006 www.uptodate.com
  • 85 Loftus E V. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences.  Gastroenterology. 2004;  126 1504-1517
  • 86 Irvine E J, Farrokhyar F, Swarbrick E T. A critical review of epidemiological studies in inflammatory bowel disease.  Scan J Gastroenterol. 2001;  1 2-15
  • 87 Nakamura Y, Kobayashi M, Nagai M. et al . A case-control study of ulcerative colitis in Japan.  J Clin Gastroenterol. 1994;  18 (1) 72-79
  • 88 Joachim G. Inflammatory bowel disease: effects on lifestyle.  Journal of Advanced Nursing. 1987;  12 483-487
  • 89 Hagerstown M D. Inflammatory bowel disease impact and patient characteristics.  Gastroenterology nursing. 1993;  15 147-154
  • 90 Kinash R G, Fischer D G, Luckie B E. et al . Coping patterns and related characteristics in patients with IBD.  Rehabilitation Nursing. 1993;  18 12-19
  • 91 Herrmann U, Rose M, Klapp B F. et al . Personale Ressourcen und Coping von Patienten mit chronisch entzündlichen Darmerkrankungen (CED).  Z Med Psychol. 2005;  14 59-65
  • 92 Martin A, Leone L, Castagliuolo I. et al . What do patients want to know about their inflammatory bowel disease.  Ital J Gastroenterol. 1992;  24 477-480
  • 93 O’Sullivan M A, Mahmud N, Kelleher D P. et al . Patient knowledge and educational needs in irritable bowel syndrome.  Eur J Gastroenterol Hepatol. 2000;  12 39-43
  • 94 Polglase A L, McDermott F T, Hughes E SR. Ulcerative colitis and Crohn’s disease – What your patient want to know.  Australian Family Physician. 1984;  13 422-424
  • 95 Zander W. Psychosomatische Grundlagenforschung: Theoretische Überlegungen und experimentelle Untersuchungen.  Zschr psychosom Med. 1982;  28 126-128
  • 96 Moser G. Psychosomatik in der Gastroenterologie.  Wien Med Wschr. 2000;  150 209-212
  • 97 Frenzer A, Binek J, Hammer B. Soziale Folgen und Lebensqualität bei Patienten mit chronisch entzündlichen Darmerkrankungen.  Schweiz Med Wochenschr. 1996;  126 97S-99S
  • 98 Lask B. Psychological aspects of inflammatory bowel disease.  Wien Med Wschr. 1986;  98 544-546
  • 99 Ringel Y, Drossmann D A. Psychosocial aspects of Crohn’s disease.  Surgical Clinics of North America. 2001;  81 231-252
  • 100 Küchenhoff J. Biopsychosoziale Wechselwirkungen im Krankheitsverlauf des Morbus Crohn.  Zsch psychosom Med. 1995;  43 306-328
  • 101 Karlinger K, Györke T, Makö E. et al . The epidemiology and the pathogenesis of inflammatory bowel disease.  Eur J Radiol. 2000;  35 154-167
  • 102 Dudley-Brown S. Prevention of psychological distress in persons with inflammatory bowel disease.  Issues in Mental Health Nursing. 2002;  23 403-422
  • 103 Casati J, Toner B B. Psychosocial aspects of inflammatory bowel disease.  Biomed & Pharmacother. 2000;  54 388-93
  • 104 Murray J B. Psychological factors in ulcerative colitis.  The Journal of General Psychology. 1984;  110 201-221
  • 105 Gerbert B. Psychological aspects of Crohn’s disease.  J Behav Med. 1980;  3 41-58
  • 106 Timmer A. Environmental influence on inflammatory bowel disease manifestation.  Dig Dis. 2003;  21 91-104
  • 107 Ringel Y, Drossmann D A. Psychosocial aspects of Crohn’s disease.  Surgical Clinics of North America. 2001;  81 (1) 231-252
  • 108 Zuckerman M J, Briones D F. Inflammatory bowel disease: overview and psychosomatics.  Texa Medicine. 1989;  85 32-36
  • 109 Enck P, Schäfer R. Psychosoziale Faktoren beim M. Crohn – eine Übersicht.  Z Gastroenterol. 1996;  34 708-713
  • 110 Sewitch M J, Abrahamowicz M, Bitton A. et al . Psychosocial correlates of patient-physician discordance in inflammatory bowel disease.  Am J Gastroenterol. 2002;  97 2174-2183
  • 111 Turnbull G K, Vallis T M. Quality of life in inflammatory bowel disease: the interaction of disease activity with psychosocial function.  Am J Gastroenterol. 1995;  90 1450-1454
  • 112 Petrak F, Hardt J, Clement T. et al . Impaired health-related quality of life in inflammatory bowel disease: psychosocial impact and coping styles in a national German sample.  Scand J Gastroenterol. 2001;  36 375-382
  • 113 Walker E A, Gelfand M D, Gelfant A N. et al . The relationship of current psychiatric disorders to functional disability and distress in patients with inflammatory bowel disease.  General Hospital Psychiatry. 1996;  18 220-229
  • 114 Schwartz R A, Schwartz I K. Psychiatric disorders associated with Crohn’s disease.  Psychiatry in Medicine. 1982;  12 67-73
  • 115 Mussell M, Böcker U, Nagel N. et al . Predictors of disease-related concers and other aspects of health-related quality of life in outpatients with inflammatory bowel disease.  Eur J Gastroenterol Hepatol. 2004;  16 1273-1280
  • 116 Paar G H, Bezzenberger U, Lorenz-Meyer H. Über den Zusammenhang von psychosazialem Stress und Krankheitsaktivität bei Patienten mit Morbus Crohn und Colitis ulcerosa.  Z Gastroenterologie. 1988;  26 648-657
  • 117 Turnbull G K, Vallis T M. Quality of life in inflammatory bowel disease: the interaction of disease activity with psychosocial function.  Am J Gastroenterol. 1995;  90 (9) 1450-1454
  • 118 Eijk van der I, Vlachonikolis I G, Munkholm P. et al . The role of qualitiy of care in health-related quality of life in patients with IBD.  Inflamm Bowel Dis. 2004;  10 392-398
  • 119 Gerson M J, Schonholtz J, Grega C H. et al . The importance of the family context in inflammatory bowel disease.  Mt Sinai J Med. 1998;  65 398-403
  • 120 Van Hemert A, Hengeveld M W, Bolk J H. et al . Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic.  Psychological Medicine. 1993;  23 167-173
  • 121 Tanaka M, Kazuma K. Ulcerative colitis: factors affecting difficulties of life and psychological well being of patients in remission.  J Clin Nurs. 2005;  14 65-73
  • 122 Sewitch M J, Abrahamowicz M, Bitton A. et al . Psychological distress, social support and disease activity in patients with inflammatory bowel disease.  Am J Gastroenterol. 2001;  96 (5) 1470-1479
  • 123 Sainsbury A, Heatley R V. Review article: psychosocial factors in the quality of life of patients with inflammatory bowel disease.  Aliment Pharmacol Ther. 2005;  21 499-508
  • 124 Levenstein S. Embracing complexity: what determines quality of life in inflammatory bowel disease.  Eur J Gastroenterol Hepatol. 2004;  16 1253-1255
  • 125 Mussell M, Böcker U, Nagel N. et al . Predictors of disease-related concerns and other aspects of health-related quality of life in outpatients with inflammatory bowel disease.  Eur J Gastroenterol Hepatol. 2004;  16 1273-1280
  • 126 Cuntz U. et al . Determinanten der subjektiven Belastung durch Darmerkrankungen.  Psychther Psychosom med Psychol. 1999;  49 493-500
  • 127 Barrett S ML, Standen P J, Lee A S. et al . Personality, smoking and inflammatory bowel disease.  Eur J Gastroenterol Hepatol. 1996;  8 651-655
  • 128 Janke K H, Klump B, Gregor M. et al . Determinants of life satisfaction in inflammatory bowel disease.  Inflamm Bowel Dis. 2005;  11 272-286
  • 129 Pizzi L T, Weston C M, Goldfarb N I. et al . Impact of chronic conditions on quality of life in patients with inflammatory bowel disease.  Inflamm Bowel Dis. 2006;  12 47-52
  • 130 Deter H C, Manz R, Becker M. et al . Soziale Unterstützung in der Beziehung zu körperlichen und seelischen Befunden bei Morbus Crohn-Patineten.  Zsch psychosom Med. 1991;  37 45-59
  • 131 Birtwistle J. The role of cigarette and nicotine in the onset and treatment of ulcerative colitis.  Postgrad Med J. 1996;  72 714-718
  • 132 Timmer A, Sutherland L R, Martin F. et al . Smoking, use of oral contraceptives, and medical induction of remission were rsik factors for relapse in Crohn’s disease.  Gut. 1999;  44 311-312
  • 133 Forbes A. Smoking and inflammatory bowel disease.  Eur J Gastroenterol Hepatol. 1996;  8 761-763
  • 134 Zijlstra F J. Smoking and nicotine in inflammatory bowel disease: good or bad for cytokines?.  Mediators of Inflammation. 1998;  7 153-155
  • 135 Sercombe J. Inflammatory bowel disease and smoking.  Professional Nurse. 2000;  15 (7) 439-442
  • 136 Miner P B. Factors influencing the relapse of patients with inflammatory bowel disease.  Am J Gastroenterol. 1997;  92 (12) 1S-4S
  • 137 Birrenbach T, Böcker U. Inflammatory bowel disease and smoking – a review of epidemiology, pathophysiology, and therapeutic implications.  Inflamm Bowel Dis. 2004;  10 848-859
  • 138 Picco M F, Bayless T M. Tobacco consumption and disease duration are associated with fistulizing and stricturing behaviors in the first 8 years of Crohn’s disease.  Am J Gastroenterol. 2003;  98 363-368
  • 139 Russel M G, Nieman F H, Bergers J M. et al . South Limburg IBD Study Group: Cigarette smoking and quality of life in patients with inflammatory bowel disease.  Eur J Gestroenterol Hepatol. 1996;  8 1075-1081
  • 140 Bustamante M, Nos P, Hoyos M. et al . Relationship between smoking and colonic involment in inflammatory bowel disease.  Rev Esp Enferm Dig. 1998;  90 (12) 837-840
  • 141 Thomas G AO, Rhodes J, Green J T. et al . Role of smoking in inflammatory bowel disease: implications for therapy.  Postgrad Med J. 2000;  76 273-279
  • 142 Ashley M J. Smoking and disease of the gastrointestinal system: An epidemiological review with special references to sex differences.  Can J Gastroenterol. 1997;  11 (4) 345-352
  • 143 Cosnes J, Carbonnel F, Carrat F. et al . Effects of current and former cigarette smoking on the clinical course of Crohn’s disease.  Aliment Pharmacol Ther. 1999;  13 1403-1411
  • 144 Abraham N, Selby W, Lazarus R. et al . Is smoking an indirect risk factor for the development of ulcerative colitis? An age- and sex-matched case-control study.  J Gastroenterol Hepatol. 2003;  18 139-146
  • 145 Yamamoto T, Keighley M RB. Smoking and disease recurrence after operation for Crohn’s disease.  British Journal of Surgery. 2000;  87 398-404
  • 146 Manguso F, Sanges M, Staiano T. et al . Cigarette smoking and appendectomy are risk factors for extraintestinal manifestations in ulcerative colitis.  Am J Gastroenterol. 2004;  99 (2) 327-334
  • 147 Radford-Smith G L, Edwards J E, Purdie D M. et al . Protective role of appendicectomy on onset and severity of ulcerative colitis and Crohn’s disease.  Gut. 2002;  51 808-813
  • 148 Johnson G J, Cosnes J, Mansfield J C. Review article: smoking cessation as primary therapy to modify the course of Crohn’disease.  Aliment Pharmacol Ther. 2005;  21 921-931
  • 149 Breuer-Katschinski B D, Holländer N, Goebell H. Effect of cigarette smoking on the course of chrohn’s disease.  Eur J Gastroenterol Hepatol. 1996;  8 (3) 225-228
  • 150 Corrao G, Tragnone A, Caprilli R. et al . Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study.  Int J Epidemiol. 1998;  27 397-404
  • 151 Medina C, Vergara M, Casellas F. et al . Influence of smoking habit in the surgery of inflammatory bowel disease.  Rev Esp Enferm Dig. 1998;  90 (11) 775-778
  • 152 Odes H S, Fich A, Reif S. et al . Effects of current cigarette smoking on clinical course of Crohn’s disease and Ulcerative colitis.  Dig Dis Sci. 2001;  46 (8) 1717-1721
  • 153 Fraga X F, Vergara M, Medina C. et al . Effect of smoking on the presentation and clinical course of inflammatory bowel disease.  Eur J Gastroenterol Hepatol. 1997;  9 683-687
  • 154 Kane S V, Flicker M, Katz-Nelson F. Tobacco use is associated with accelerated clinical recurrence of Crohn’s disease after surgically induced remission.  J Clin Gastroenterol. 2005;  39 32-35
  • 155 Sicilia B. Environmental rsik factors and Crohn’s disease: a population-based, case-control study in Spain.  Digest Liver Dis. 2001;  33 762-767
  • 156 Cosnes J, Mion-Larmurier I, Afchain P. et al . Gender differences in the response of colitis to smoking.  Clin Gastroenterol Hepatol. 2004;  2 41-48
  • 157 Cosnes J, Carbonnel F, Beaugerie L. et al . Effects of cigarette smoking on the long-term course of Crohn’s disease.  Gastroenterology. 1996;  110 424-431
  • 158 Cosnes J, Beaugerie L, Carbonnel F. et al . Smoking cessation and the course of Crohn’s disease: an intervention study.  Gastroenterology. 2001;  120 1093-1099
  • 159 Timmer A, Sutherland L R, Martin F. Oral contraceptive use and smoking are risk factors for relapse in Crohn’s disease.  Gastroenterology. 1998;  114 1143-1150
  • 160 Rooy E C, Toner B B, Maunder R G. et al . Concerns of patients with inflammatory bowel disease: results from a clinical population.  Am J Gastroenterol. 2001;  96 1816-1821
  • 161 Drossman D A, Patrick D L, Mitchell C M. et al . : Health-related quality of life in inflammatory bowel disease – functional status and patients worries and concerns.  Dig Dis Sci. 1989;  34 (9) 1379-1386
  • 162 Blondel-Kucharski de F, Chircop C, Marquis P. et al . Health-realted quality of life in Crohn’s disease: a prospective longitudinal study in 231 patients.  Am J Gastroenterol. 2001;  96 2915-2920
  • 163 Ananthakrishnan A N. Does it Matter Where You Are Hospitalized for Inflammatory Bowel Disease? A Nationwide Analysis of Hospital Volume.  Digestive Disease Week. 2008;  Abstract #T1167 , www.ddw.org; Stand: 21.7.2008
  • 164 Indikationskatalog für Anschlussrehabilitation (AHB), Stand: 11.1.2008. http://www.deutsche-rentenversicherung-bund.de; Stand: 21.7.2008
  • 165 Qualitätsberichte der Reha-Zentren der Deutschen Rentenversicherung Bund. www.deutsche-rentenversicherung-bund.de
  • 166 Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung e.V .Verzeichnis der Rehabilitationskliniken bei Morbus Crohn und Colitis ulcerosa. DCCV 2007
  • 167 Jaghult S, Larson J, Wredling R. et al . A multiprofessional education programme for patients with inflammatory bowel disease: a randomized controlled trial.  Scand J Gastroenterol. 2007;  42 (12) 1452-1459
  • 168 Oxelmark L, Magnusson A, Lofberg R. et al . Group-based intervention program in inflammatory bowel disease patients: effects on quality of life.  Inflamm Bowel Dis. 2007;  13 (2) 182-190
  • 169 Waters B M, Jensen L, Fedorak R N. Effects of formal education for patients with inflammatory bowel disease: a randomized controlled trial.  Can J Gastroenterol. 2005;  19 (4) 235-244
  • 170 Bregenzer N, Lange A, Furst A. et al . Patient education in inflammatory bowel disease does not influence patients knowledge and long-term psychosocial well-being.  Z Gastroenterol. 2005;  43 (4) 367-371
  • 171 Brown S A. Studies of educational interventions and outcomes in diabetic adults: a meta-Analysis revisited.  Patient Educ Couns. 1990;  16 189-215
  • 172 Devine E C, Pearcy J. Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive pulmonary disease.  Patient Educ Couns. 1996;  29 167-178
  • 173 Devine E C, Reifschneider E. A meta-analysis of the effects of psychoeducational care in adults with hypertension.  Nurs Res. 1995;  44 (4) 237-245
  • 174 Mazzuca S A. Does patient education in chronic disease have therapeutic value?.  J Chron Dis. 1982;  35 521-529
  • 175 Roter D L, Hall J A, Merisca R. et al . Effectiveness of the interventions to improve patient compliance: a meta-analysis.  Med Care. 1998;  36 (8) 1138-1161
  • 176 Quan H, Present J W, Sutherland L R. Evaluation of educational programs in Inflammatory bowel disease.  Inflamm Bowel Dis. 2003;  9 (6) 356-362
  • 177 Verma S, Tsai H H, Giaffer M H. Does better disease-related education improve quality of life? A survey of IBD patients.  Dig Dis Sci. 2001;  46 (4) 865-869
  • 178 Jones S C, Gallacher B, Lobo A J. et al . A patient knowledge questionnaire in Inflammatory bowel disease.  J Clin Gastroenterol. 1993;  17 (1) 21-24
  • 179 Rezailashkajani M, Roshandel D, Ansari S. et al . Knowledge of disease and health information needs of the patients with inflammatory bowel disease in a developing country.  Int J Colorectal Dis. 2006;  21 (5) 433-40
  • 180 Gensichen J, Muth C, Buttzlaff M. et al . Die Zukunft ist chronisch: Das Chronic Care-Modell in der deutschen Primärversorgung. Übergreifende Behandlungsrinzipien einer proaktiven Versorgung für chronische Kranke.  Z ärztl Fortbild Qual Gesundhwes. 2006;  100 365-374
  • 181 Classen M, Dierkesmann R, Heimpel H. et al .Rationelle Diagnostik und Therapie in der Inneren Medizin. München, Jena; Urban und Fischer 2001
  • 182 Moser G. Bedeutung von Stress und Depression bei chronisch entzündlichen Darmerkrankungen.  J Gastroenterol Hepatol Erkr. 2005;  3 (2) 26-30
  • 183 Kunzendorf S, Jantschek G, Straubinger K. et al . The Luebeck Interview for Psychosocial Screening in Patients with Inflammatory Bowel Disease.  Inflamm Bowel Dis. 2007;  13 (1) 33-41
  • 184 Bjorkkjaer T, Brun J G, Valen M. et al . Short-term duodenal seal oil administration normalised n-6 to n-3 fatty acid ratio in rectal mucosa and ameliorated bodily pain in patients with inflammatory bowel disease.  Lipids Health Dis. 2006;  5 6
  • 185 Cozzi F, Podswiadek M, Cardianle G. et al . Mud-bath treatment in spondylitis associated with inflammatory bowel disease – a pilot randomised clinical trial.  Joint Bone Spine. 2007;  74 (5) 436-439
  • 186 Goldberg R J, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain.  Pain. 2007;  129 (1 – 2) 210-223
  • 187 Koretz R L, Avenell A, Lipman T O. et al . Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials.  Am J Gastroenterol. 2007;  102 (2) 412-429
  • 188 Duffy L C, Zielezny M A, Marshall J R. et al . Relevance of major stress events as an indicator of disease activity prevalence in inflammatory bowel disease.  Behav Med. 1991;  17 (3) 101-10
  • 189 Hjortswang H, Järnerat G, Curman B. et al . The influence of demographic and disease-related factors on health-related quality of life in patients with ulcerative colitis.  Eur J Gastroenterol Hepatol. 2003;  15 1011-1020
  • 190 Hjortswang H, Ström M, Almer S. Health-related quality of life in Swedish patients with ulcerative colitis.  Am J Gastroenterol. 1998;  93 2203-2211
  • 191 Ng V, Millard W, Lebrun. et al . Low-intensity exercise improves quality of life in patients with Crohn’s disease.  Clin J Sport Med. 2007;  17 (5) 384-388
  • 192 Langhorst J, Mueller T, Luedtke R. et al . Effects of a comprehensive lifestyle modification program on quality-of-life in patients with ulcerative colitis: a twelve-month follow-up.  Scand J Gastroenterol. 2007;  42 (6) 734-745
  • 193 Elsenbruch S, Langhorst J, Popkirowa K. et al . Effects of mind-body therapy on quality of life and neuroendocrine and cellular immune functions in patients with ulcerative colitis.  Psychother Psychosom. 2005;  74 (5) 277-287
  • 194 Oliveira S, Zaltman C, Elia C. et al . Quality-of-life measurement in patients with inflammatory bowel disease receiving social support.  Inflamm Bowel Dis. 2007;  13 (4) 470-474
  • 195 ÄZQ, AWMF .Deutsches Instrument zur methodischen Leitlinienbewertung. 2005 www.delbi.de
  • 196 Becker E, Horn S, Hussla B. et al .Sozialmedizinische Leistungsbeurteilung bei chronisch entzündlichen Darmerkrankungen. Deutsche Gesellschaft für Sozialmedizin, autorisiert für elektronische Veröffentlichung AWMF online März 2005
  • 197 Carter M J, Lobo A J, Travis S PL. et al . Guideline of the management of inflammatory bowel disease in adults.  Gut. 2004;  53 (suppl V) v1-v16
  • 198 Caprilli R, Gassull M A, Escher J C. et al . European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations.  Gut. 2006;  55 (Suppl I) i36-i58
  • 199 Stange E F, Travis S PL, Vermeire S. et al . European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis.  Gut. 2006;  55 (Suppl I) i1-i15
  • 200 Travis S PL, Stange E F, Lemann M. et al . European evidence based consensus on the diagnosis and management of Crohn’s disease: current management.  Gut. 2006;  55 (Suppl I) i16-i35
  • 201 Centre for Evidence-based Medicine .Oxford Centre for Evidence-based Medicine Levels of Evidence. 2001 www.cebm.net
  • 202 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften . Das Leitlinien-Manual: Entwicklung und Implementierung von Leitlinien in der Medizin.  Z Ärztl Fortbild Qualitätssich. 2001;  95 (Suppl 1) 1-84
  • 203 Scottish Intercollegiate Guidelines Network .Postal Address: SIGN, 28 Thistle Street, Edinburgh EH 2 1EN. www.sign.ac.uk

Prof. Dr. med. Dr. phil. Heiner Raspe

Institut für Sozialmedizin, UK S-H

Beckergrube 43 – 47

23552 Lübeck

Phone: 04 51/7 99 - 25 20

Fax: 04 51/7 99 - 25 22

Email: heiner.raspe@uk-sh.de