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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2021; 75(2): 149–158. doi: 10.48095/ccgh2021149.

Management léčby IBD v těhotenství vyžaduje multidisciplinární přístup

Filip Marek1, Radoslav Hrivnák1, Ivo Rovný1, Petr Jabandžiev2,3, Karolína Poredská4, Vladimír Procházka1, Dominika Ivanecká1, Vít Weinberger5, Petr Janků5, Lumír Kunovský1,4, Zdeněk Kala1, Jiří Dolina6, Daniel Bartušek7

+ Pracoviště

Souhrn

F. Marek, Z. Kala, R. Hrivnák, I. Rovný, P. Jabandžiev, K. Poredská, J. Dolina, V. Procházka, D. Ivanecká, D. Bartušek, V. Weinberger, P. Janků, L. Kunovský

Crohnova nemoc a ulcerózní kolitida jsou chronická zánětlivá onemocnění střev (IBD – inflammatory bowel disease). V článku je shrnut přístup k léčbě gravidních pacientek s IBD od konzervativní terapie přes endoskopii, zobrazovací metody až po indikace k operačnímu řešení. Pacientky s IBD by měly těhotenství plánovat v době remise onemocnění. Pacientky v remisi mohou mít rovněž komplikace v těhotenství, ale riziko komplikací je nižší než u pacientek s aktivním onemocněním. Zavedená medikace (kromě teratogenního metotrexátu) by měla být ponechána. Dle dostupných dat samotné těhotenství nezhoršuje průběh IBD. Při těžkém relapsu či výskytu komplikací IBD je u těchto pacientek nutná multioborová spolupráce gastroenterologa, chirurga, radiologa a gynekologa. Operační řešení je nutné pouze při akutních komplikacích IBD (akutní těžká kolitida nereagující na medikamentózní terapii, perianální absces a komplikace IBD ve smyslu náhlých příhod břišních – perforace, ileózní stav při stenóze a masivním krvácení).

Klíčová slova

Crohnova nemoc, ulcerózní kolitida, idiopatické střevní záněty, gravidita, chirurgie, endoskopie, porod, relaps



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