title: [Treatment of inflammatory bowel disease in intensive care medicine].
abstract: In patients with inflammatory bowel disease (IBD) complications of both IBD and                     immunosuppressive therapy may be life-threatening conditions requiring intensive                     care therapy. These patients oftentimes present themselves with severe bloody                     diarrhoea, and infectious colitis, pseudomembranous colitis or intestinal                     ischemia must be included in the differential diagnosis. Steroids,                     immunosuppressants such as azathioprine, 6-mercaptopurine, methotraxate or                     ciclosporine, as well as biologicals, which act as TNF-alpha antagonists, are                     commonly used for maintenance therapy and treatment of acute exacerbations of                     IBD. Due to immunosuppressive therapy potentially life-threatening infections                     and reactivations of latent infections like tuberculosis or cytomegalovirus                     (CMV) can occur. Fistulas, abscesses, perforations and intestinal obstructions                     are typical complications of Crohn's disease in the intensive care setting,                     whereas clinical presentation in ulcerative colitis is characterised by its                     acute exacerbation and the toxic dilatation of the colon, potentially resulting                     in toxic megacolon with high risk of perforation or severe bleeding. Most                     important for an effective therapy in the critically ill patient with                     inflammatory bowel disease are the control of the underlying disease, the                     empiric antibiotic therapy in case of infectious complications, transcutaneous                     drainage of abscesses, bowel decompression in toxic megacolon and the early                     interdisciplinary assessment of the abdomen.
authors.affiliation: Medizinische Klinik III, Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin, Universitätsklinikum der RWTH Aachen. akoch@ukaachen.de
authors.forename: A
authors.initials: A
authors.lastname: Koch
authors.forename: F
authors.initials: F
authors.lastname: Tacke
authors.forename: K L
authors.initials: KL
authors.lastname: Streetz
authors.forename: C
authors.initials: C
authors.lastname: Trautwein
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis / Q000628:therapy; D015746:Abdominal Pain / Q000209:etiology; D000038:Abscess / Q000175:diagnosis / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D003422:Critical Care; D003424:Crohn Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004322:Drainage; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000175:diagnosis / Q000628:therapy; D008532:Megacolon, Toxic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D009392:Nephrectomy; D012003:Rectal Fistula / Q000175:diagnosis / Q000628:therapy; D012772:Shock, Septic / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents