Dear patients, dear colleagues,
Welcome to the website of our "Chronic Inflammatory Bowel Diseases" working group at the Department of Internal Medicine I.
Our working group specialises in the diagnosis, treatment and management of complications of chronic inflammatory bowel disease.
Our aim is to ensure that you receive the best possible treatment in collaboration with all internal and external colleagues involved.
If you have any further questions about chronic inflammatory bowel disease, please do not hesitate to contact us.
Contact & Appointments
We are available by phone:
Monday to Thursday 13:00 -15:30, Friday 08:00 - 12:00
First consultations:
For new presentations in our outpatient clinic, we require a referral form with the current problem, your current findings and, if available, laboratory values. After sending these documents by fax, email or post, we will contact you and inform you of your appointment for the first visit if our outpatient consultation is the right contact for your case.
Consultation details >
Chronic Inflammatory Bowel Disease Team
Care
Monika Kretschmer, CED-Fachkrankenschwester
Diagnostics, therapy and research for our patients
Diagnostics
The focus of the "chronic inflammatory bowel diseases" department at our clinic is on the diagnosis and treatment of severe forms of chronic inflammatory bowel diseases in particular. This initially includes carrying out all established diagnostic procedures such as endoscopy and all cross-sectional imaging procedures (CT, MRI, PET-CT, conventional radiological procedures). We are supported by colleagues from other specialist departments, such as visceral surgery, dermatology, rheumatology, radiology, pathology and microbiology. This enables us to achieve an extremely high level of diagnostic certainty.
Therapy
We use all scientifically established therapeutic approaches in accordance with the latest guidelines and recommendations of international specialist societies. A specially equipped infusion room has been set up in the M2C ward for the administration of so-called biologicals, i.e. drugs produced by genetic engineering in so-called bioreactors (e.g. "antibody therapy"). A team of experienced nurses and doctors is available to you here.
Research
In order to gain a better understanding of chronic inflammatory bowel diseases, it is helpful that we conduct our own research. Through our research - both in the basic area and in clinical research - we can advance the existingdiagnostic possibilities and contribute directly to the development of new treatment options. It also enables us to offer our patients the latest therapeutic approaches - often before general marketing authorisation is granted
Laboratory parameters:
To date, there is no parameter that can be determined in the blood that can be used to diagnose IBD. Inflammatory parameters such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often elevated in active IBD and show a correlation with disease activity, so that these parameters provide additional information and can be used as progression parameters. However, it must always be borne in mind that these parameters are not specific for IBD. In addition, stool markers such as calprotectin, lysozyme and lactoferrin have been identified, which also correlate with inflammatory activity in the intestine. Although these parameters are also not specific for IBD, they can be used for the differential diagnosis of functional bowel complaints.
Sonography:
Sonography is a non-invasive diagnostic method and can describe the disease activity of IBD very precisely under good examination conditions. Intestinal wall sonography is used to analyse the structure of the intestinal wall. If there is inflammation of the intestinal wall, this leads to a thickening of the intestinal wall with a resulting narrowing of the intestinal lumen and widening of proximal sections of the intestine. These changes can be detected and quantified sonographically. The inflammation of the bowel wall also leads to an increase in blood flow through the bowel wall. This can also be quantified by Doppler sonography and allows conclusions to be drawn about the extent of the disease activity. In addition to the pattern of infection, intestinal wall sonography can therefore detect the maximum extent of IBD and consequently be used as a progression parameter. Furthermore, bowel wall sonography can often also visualise Crohn's-associated complications such as fistulas, abscesses or stenoses with sufficient accuracy.
Endoscopy:
Endoscopy plays an important role in the medical care of patients with chronic inflammatory bowel diseases. Endoscopy is required for the diagnosis and follow-up of chronic inflammatory bowel diseases.
At the onset of the disease, the diagnosis must be confirmed endoscopically and histologically; at the same time, intestinal inflammation from other causes should be ruled out. In the majority of cases, it is also possible to differentiate between Crohn's disease and ulcerative colitis during the initial examination. In addition, the extent and pattern of colitis can be precisely documented endoscopically, which has an impact on the type of drug therapy. Endoscopic examination at the onset of the disease is therefore essential. In addition to a colonoscopy, a gastroscopy may also be necessary to rule out an infestation of the oesophagus, stomach or duodenum in Crohn's disease. As the chronic inflammatory bowel disease progresses, endoscopy is no longer the main focus. Disease activity is mainly determined on the basis of the symptoms. In addition, intestinal wall sonography has become considerably more important in recent years. Sonography is a reliable technique that provides information on inflammatory or scarred bowel wall swelling and recognises complications such as stenoses or fistulas. In our clinic, check-up colonoscopies are therefore not carried out at fixed intervals in Crohn's disease, but rather when there is a change in the symptoms to re-diagnose the spread of the disease before adjusting the therapy or to monitor the success of the therapy with - for example - biologics. In the case of ulcerative colitis, control colonoscopies are performed at regular intervals to prevent colon cancer depending on the spread of the disease in the colon and the duration of the disease. Good preparation of the bowel is essential for a meaningful examination. Colonic irrigation can be carried out by the patient at home the day before the examination. The necessary irrigation solution can be provided by our department. Alternatively, irrigation can also be performed in the clinic on the day of the examination with the help of the nursing staff. Details will be discussed during the medical consultation.
The aim is for the endoscopic examinations to be carried out by the patient's attending physician. As the examination takes place in the clinic, generous sedation with short-acting medication is also possible for outpatient endoscopy. Afterwards, however, patients are no longer fit to drive for the day.
Radiological imaging:
If the full extent of the disease cannot be detected using sonography and endoscopy, it is advisable to perform cross-sectional imaging in the form of computerised tomography or magnetic resonance imaging. This is particularly indicated in patients suspected of having small bowel involvement with fistulas or abscesses. Furthermore, if examination conditions are limited, cross-sectional imaging procedures are significantly superior to sonography. In turn, magnetic resonance imaging is superior to computer tomography in the detection of fistulas and abscesses and, unlike computer tomography, has no radiation exposure.
Standard therapies
The treatment of chronic inflammatory bowel disease depends on the pattern of infection and the activity of the disease. Furthermore, extraintestinal symptoms, side effect profiles, previous medication and concomitant medication must be taken into account. In addition, a basic distinction is made between remission induction therapy for acute relapses and remission maintenance therapy in the relapse-free interval. The following is a brief overview of the standard preparations available and their indications. The necessary drug therapy is determined individually together with the patient during the outpatient visit, the indication, risks and side effects of the therapy are discussed and, if necessary, clinical and laboratory monitoring is determined.
Topical steroids:
Topical steroids are cortisone preparations that are administered orally or rectally and act almost exclusively on the intestine, as they are broken down in the liver after absorption. This means that systemic steroid side effects such as high blood pressure, diabetes and osteoporosis can be largely avoided. The orally available substances include budesonide, which is primarily used in Crohn's disease patients with mild to moderate small bowel and/or proximal colon involvement. In addition, rectal foams containing hydrocortisone are used to treat inflammation in the rectal area, which mainly occurs in patients with ulcerative colitis.
Systemic steroids:
Systemic steroids are mainly used to induce remission in severe relapses of chronic inflammatory bowel disease. Methylprednisolone is the standard preparation here. Ideally, systemic steroids should be discontinued as quickly as possible in order to minimise side effects. Depending on the response to steroids, a distinction is made between different forms of IBD. If the disease remains active 4 weeks after starting steroid therapy, it is referred to as a steroid-refractory course. If the steroid dose cannot be discontinued within 4 months without a relapse occurring, the disease is steroid-dependent. The same applies if the disease activity increases significantly again within 3 months of stopping steroid therapy. As a rule, immunosuppressive or immunomodulating preparations, such as azathioprine, 6-mercaptopurine or TNF-alpha antibodies, are used in addition to steroid therapy to maintain remission.
Aminosalicylates:
The group of aminosalicylates includes sulphasalazine and 5-aminosalicylic acid. Sulfasalazine is in turn a prodrug that is split in the intestine into sulfapyridine and 5-aminosalicylic acid (5-ASA). As sulphapyridine has many side effects in addition to its anti-inflammatory effect, preparations have been developed that contain only 5-ASA. 5-ASA develops its anti-inflammatory effect via various mechanisms. In addition to the inhibition of arachidonic acid metabolism, the neutralisation of radicals and the inhibition of intracellular signalling cascades also play a role. 5-ASA is used for mild to moderately active ulcerative colitis and mild to moderately active Crohn's colitis. It can also be used as a rectal foam or suppository in cases of rectal or left-sided colitis. If there is a good response to therapy, 5-ASA should also be taken for long-term remission maintenance.
Azathioprine/6-mercaptopurine and methotrexate:
Azathioprine (AZA), 6-mercaptopurine (6-MP) and methotrexate (MTX) are immunosuppressants that are used in both Crohn's disease and ulcerative C., particularly for remission-maintaining therapy. Due to their side effect profile, the dose of these preparations must be increased gradually and blood parameters must be checked at regular intervals to monitor tolerability. If there is a good response to therapy and good tolerability, therapy should be continued for several years to maintain remission.
Biologics, e.g. anti-TNFalpha antibodies:
Various antibodies ("biologics") with different mechanisms of action and types of application are available to us today in the treatment of IBD. Important representatives of these immunomodulating antibodies are the anti-TNFalpha antibodies Infliximab and Adalimumab. By neutralising the messenger substance TNF alpha, infliximab and adalimumab have an anti-inflammatory effect and are used both to induce remission in cases of high disease activity and to maintain remission. Another representative of the biologics class is the integrin antibody vedolizumab, which is used in the treatment of ulcerative colitis and Crohn's disease. The anti-IL12/IL23 antibody ustekinumab is another biologic available for the treatment of Crohn's disease.
In principle, an increased risk of infection must be taken into account with any immunosuppressive or immunomodulating therapy, so that chronic infections such as HIV, hepatitis and tuberculosis must be ruled out before starting therapy.
We conduct research for our patients
Our "Inflammatory Bowel Diseases" research group is active in the field of basic research as well as in conducting numerous clinical studies with new substances. Click here to go to our research pages.
You are welcome to contact us about the possibility of participating in a study!
We conduct studies in various "phases":
Phase 2" trials are studies with active substances that have already been investigated in humans, but in which the dose for an optimal effect with the best possible side effect profile still needs to be found.
Phase 3 trials are studies involving the largest possible patient population, which are intended to prove the superiority of an active substance over conventional therapies and often immediately precede the corresponding drug authorisation.
Information on the currently ongoing phase 1 to 3 clinical trials in the indications Crohn's disease, ulcerative colitis and sprue is available on request.
Please contact us by e-mail: CED-Studienambulanz.IM1@uniklinik-ulm.de
Further information on chronic inflammatory bowel diseases
Link to the DCCV patient page with further information for patients and relatives.