Der Schmerz

, Volume 28, Issue 3, pp 289–293 | Cite as

Schmerztherapie beim Reizdarmsyndrom

Schwerpunkt

Zusammenfassung

Das Reizdarmsyndrom (RDS) zählt zu den häufigsten Erkrankungen des Gastrointestinaltrakts. Charakteristisch sind chronische abdominale Schmerzen, die in der Regel mit Stuhlgangveränderungen einhergehen, ohne dass sich in der Routinediagnostik eine Ursache nachweisen ließe. Nach führendem Leitsymptom ist eine Unterteilung in einen obstipations-/diarrhö-/blähungs- oder schmerzdominanten Typ sinnvoll. Das Verständnis der komplexen und multifaktoriellen Pathogenese und Pathophysiologie des RDS hat sich in den letzten Jahren erheblich erweitert. Grundlegend gestört sind u. a. die gastrointestinale Motilität, viszerale Sensorik sowie das mukosale Immunsystem. Wichtig für Arzt und Patient ist einerseits die rasche, sorgfältige Diagnosefindung durch Ausschluss relevanter Differenzialdiagnosen, andererseits aber auch eine klare Vermittlung der Diagnose als eigenständige, nicht bedrohliche Erkrankung. Beide Komponenten bilden die unabdingbare Basis für ein erfolgreiches Management dieser chronischen, die Lebensqualität oft schwerwiegend beeinträchtigenden Erkrankung. Die Schmerztherapie stützt sich auf allgemeine Behandlungsprinzipien sowie eine symptomorientierte medikamentöse Behandlung, wobei auch die anderen Symptome des Beschwerdekomplexes Berücksichtigung finden. Hierfür stehen mehrere Substanzen zur Verfügung, die als Bedarfs- oder Dauermedikation angewendet werden können. Auch eine Kombinationstherapie ist möglich. Adjuvante bzw. supportive Effekte lassen sich mitunter mit nichtmedikamentösen (Allgemein-)Maßnahmen erzielen, die allein aber meist nicht zu einer befriedigenden Gesamtlinderung führen. Zu den medikamentösen Therapieoptionen zählen Spasmolytika, Stuhlregulierung, Phytotherapeutika und Probiotika. Insbesondere bei psychischen Komorbiditäten können Antidepressiva eingesetzt werden. Zu den modernen, effektiveren und besser evidenzbasierten Therapieansätzen gehören der Guanylatcyclase-C-Agonist Linaclotid beim Obstipations-RDS, das lokal wirksame Antibiotikum Rifaximin beim Blähungs-RDS und 5-HT3-Antagonisten beim Diarrhö-RDS. In therapierefraktären Fällen oder bei psychischen Komorbiditäten sollten psychotherapeutische Aspekte in eine interdisziplinäre Betreuung eingeschlossen werden.

Schlüsselwörter

Therapiemanagement Spasmolytika Linaclotid Probiotika Psychotherapie 

Pain therapy in irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases. It is characterized by chronic abdominal pain, typically associated with altered bowel habits that cannot be explained by structural abnormalities in routine diagnostic workup. Based on the predominant symptom, IBS can be divided into different subtypes: IBS with predominant constipation, diarrhea, bloating, or pain. Knowledge about the complex and multifactorial IBS pathophysiology has increased tremendously in recent years, e.g., IBS may be related to alterations in gastrointestinal motility, visceral sensitivity, and the mucosal immune system. It is important, both for the patient and the physician, that IBS diagnosis is made quickly and thoroughly based on the typical symptom complex and exclusion of relevant differential diagnoses and to reassure the patient that IBS is a chronic, but benign disease. These components are the fundamental basis for a good patient–physician relationship and for a successful long-term management of this potentially very compromising disorder. IBS therapy is based on general measures as well as symptom-oriented medical therapy, where improvement of abdominal pain is one of the main goals in treating IBS patients. Several pain treatment options are available, which may be used long-term or on demand and which may be combined with other therapies. General medical approaches include antispasmodics, improvement of bowel function, phytotherapy, and probiotics. Especially in patients with psychological comorbidities, antidepressants may be used. Modern drug treatments include the GC-C agonist linaclotide in IBS with predominant constipation, the locally acting antibiotic rifaximin in IBS with bloating, and 5-HT3 antagonists in IBS with predominant diarrhea. Psychotherapy should be included in an interdisciplinary approach in refractory cases or in psychological comorbidity.

Keywords

Therapy management Antispasmodics Linaclotide Probiotics Psychotherapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. de Greck: keine; V. Andresen: Beratung und Vorträge für die Firmen: Aptalis, AbbVie, Almirall, Mundipharma, Shire, Falk, NPS, Norgine; P. Layer: Beratung und Vorträge für die Firmen: Aptalis, AbbVie, Almirall, Mundipharma, Shire, Norgine, Falk, NPS. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Medizinische KlinikIsraelitisches Krankenhaus, Lehrkrankenhaus der Universität HamburgHamburgDeutschland

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