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Medikamentöse und endoskopische Therapie bei chronischer Pankreatitis

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SpringerReference Innere Medizin

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Zusammenfassung

Die chronische Pankreatitis ist eine Erkrankung der Bauchspeicheldrüse, bei der durch rezidivierende Entzündungsschübe das Pankreasparenchym durch fibrotisches Bindegewebe ersetzt wird. Schmerzen stellen das Hauptsymptom von Patienten mit chronischer Pankreatitis dar. Die Schmerztherapie bei chronischer Pankreatitis erfolgt nach dem WHO-Stufenschema. Eine Plexus-coeliacus-Blockade oder eine thorakoskopische Splanchnikektomie können zur Therapie von Schmerzen erwogen werden. Die Indikation zur Substitution mit Pankreasenzymen ist klinisch beim Auftreten eines Gewichtsverlusts, einer Steatorrhoe, dyspeptischen Beschwerden mit starkem Meteorismus oder Diarrhoe gegeben. Bei der ernährungsmedizinischen Intervention soll eine ausreichende Versorgung mit Nährstoffen, Vitaminen und Spurenelementen sowie die individuell adäquate Deckung des Energietagesbedarfes zur Vermeidung einer Katabolie angestrebt werden. Analgetikapflichtige Schmerzen können sowohl mittels endoskopischer als auch mittels chirurgischer Verfahren effizient behandelt werden. Im Bezug auf eine langfristige Schmerzreduktion sind chirurgische Verfahren (Drainage) den endoskopischen überlegen, jedoch bei geringerer Morbidität mit einer höheren Letalität assoziiert.

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald, 17475, Greifswald, Deutschland

    Ali Aghdassi

  2. Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald, Körperschaft des öffentlichen Rechts, Ferdinand-Saürbruch-Str., 17475, Greifswald, Deutschland

    Julia Mayerle & Markus M. Lerch

  3. Abteilung Gastroenterologie, Endokrinologie und Ernährungsmedizin, Klinik und Poliklinik für Innere Medizin A, Universität Greifswald, Friedrich-Löffler-Str. 23a, 17475, Greifswald, Deutschland

    Peter Simon

Authors
  1. Ali Aghdassi
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  2. Julia Mayerle
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  3. Markus M. Lerch
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  4. Peter Simon
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Corresponding author

Correspondence to Ali Aghdassi .

Editor information

Editors and Affiliations

  1. Medizinische Klinik I, Universitätsklinikum Schleswig-Hoslstein, Campus Lübeck, Lübeck, Schleswig-Holstein, Germany

    Hendrik Lehnert

  2. TU Dresden Universitätsklinikum Carl Gustav Carus, Dresden, Germany

    Sebastian M. Schellong

  3. FB Gastroenterologie und Hepatologie, Universitätsklinikum Leipzig Medizinische Klinik und Poliklinik II, Leipzig, Sachsen, Germany

    Joachim Mössner

  4. Krankenhaus Barmherzige Brüder, Regensburg, Germany

    Cornel C. Sieber

  5. Nürnberg, Bayern, Germany

    Walter Swoboda

  6. Universitätsklinikum Giessen und Marburg Klinik für Innere Medizin, Marburg, Hessen, Germany

    Andreas Neubauer

  7. Interdisziplinärer Schwerpunkt für Hämos, Universitätsklinikum Gießen und Marburg, Gießen, Germany

    Bettina Kemkes-Matthes

  8. Klinik für Gastroenterologie,Hepatologie, Medizinische Hochschule Hannover, Hannover, Germany

    Michael P. Manns

  9. Sektion für Molekulare und Klinische Inf, Universitätsklinikum Schleswig-Holstein,, Lübeck, Germany

    Jan Rupp

  10. Abt. Kardiologie und Pneumologie, Universitätsklinikum Göttingen Herzzentrum Göttingen, Göttingen, Germany

    Gerd Hasenfuß

  11. Abt. Nephrologie und Klinische Immunologie, Univ.Klinikum Aachen Medizinische Klinik II, Aachen, Germany

    J. Floege

  12. Universitätsklinikum Köln Klinik I für Innere Medizin, Köln, Germany

    Michael Hallek

  13. Klinik für Pneumologie, Medizinische Hochschule Hannover (MHH) Zentrum Innere Medizin, Hannover, Germany

    Tobias Welte

  14. Klinik u. Poliklinik für Innere Medizin, Universitätsmedizin Greifswald, Greifswald, Germany

    Markus Lerch

  15. Dr.-Horst-Schmidt-Kliniken GmbH, Wiesbaden, Germany

    Elisabeth Märker-Hermann

  16. Klinische Toxikologie, Giftinformation, Universitätsklinikum Mainz II. Medizinische Klinik und Poliklinik, Mainz, Germany

    Ludwig Sacha Weilemann

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Aghdassi, A., Mayerle, J., Lerch, M.M., Simon, P. (2015). Medikamentöse und endoskopische Therapie bei chronischer Pankreatitis. In: Lehnert, H., et al. SpringerReference Innere Medizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54676-1_111-1

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  • DOI: https://doi.org/10.1007/978-3-642-54676-1_111-1

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