Der Gastroenterologe

, Volume 2, Issue 6, pp 430–439 | Cite as

Intestinale Flora und chronisch-entzündliche Darmerkrankungen

Bedeutung für Pathogenese und Therapie
Schwerpunkt
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Zusammenfassung

Die friedliche Koexistenz mit der luminalen Flora wird im humanen Gastrointestinaltrakt über komplexe Mechanismen vermittelt. In genetisch prädisponierten Individuen kann es als Folge einer Störung der intestinalen Homöostase zu chronischen Entzündungsreaktionen kommen, wie sie typischerweise bei der Colitis ulcerosa sowie beim M. Crohn beobachtet werden. Bei diesen Erkrankungen werden ferner quantitative und qualitative Veränderungen der luminalen Flora beobachtet. Bisherige Studien haben keinen Einzelorganismus mit pathologischer Relevanz identifiziert, wohl aber kommensale Bakterien mit schädlichem sowie andere mit protektivem Effekt auf die intestinale Mukosa. Die Manipulation der intestinalen Flora stellt somit eine potenzielle und vielversprechende therapeutische Option dar. Hier ergeben sich jedoch krankheitsspezifische Unterschiede in der Effektivität einer Therapie mit Antibiotika, Probiotika oder Präbiotika. Zur Optimierung der bioökologischen Therapie sind eine weitergehende Charakterisierung involvierter Mechanismen sowie große klinische Studien notwendig.

Schlüsselwörter

Chronisch-entzündliche Darmerkrankungen Intestinale Flora Antibiotika Probiotika Präbiotika 

Intestinal flora and chronic inflammatory bowel diseases

Implications for pathogenesis and therapy

Abstract

The intestine is adapted to bidirectional host flora exchange and harbours a diverse bacterial community. Genetic alterations may result in a loss of intestinal homeostasis and tolerance towards the microflora, with subsequent dysregulated and perpetuated inflammatory responses – hallmarks of inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease. Furthermore, enteric microflora profiles vary significantly between healthy conditions and active inflammatory bowel disease. Although no significant pathogens that trigger intestinal inflammation have yet been isolated, commensals with favourable and unfavourable properties have been identified. Therefore, manipulation of the intestinal flora represents a promising therapeutic approach. However, disease-specific effectiveness of antibiotic, probiotic, and prebiotic applications has been observed. Further characterisation of the mechanisms involved as well as large trials are warranted to fully quantify the clinical efficacy of bioecological therapy.

Keywords

Inflammatory bowel disease Intestinal microflora Antibiotics Probiotics Prebiotics 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Medizinische Klinik I, St. Josef-HospitalKlinikum der Ruhr-UniversitätBochumDeutschland

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