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Die Behandlung akuter gastrointestinaler Schmerzen

Treatment of acute gastrointestinal pain

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Zusammenfassung

Ein wichtiges und das häufigste Leitsymptom akuter gastrointestinaler Erkrankungen ist der Bauchschmerz, der vor dem Hintergrund der Lokalisation, assoziierter Symptome und durch die körperliche Untersuchung zu erhebender Befunde entscheidende diagnostische Impulse zu geben vermag. Als symptomatisches Therapiekonzept spricht die Schmerzbehandlung bei akuten gastrointestinalen Erkrankungen, beispielsweise dem akuten Abdomen, der akuten Pankreatitis, der Gallenkolik, dem Ulcus pepticum und der Divertikulitis eine wesentliche Rolle. Zur Schmerztherapie des peptischen Ulkus haben sich der H+-, K+-ATPase-Inhibitor Omeprazol und H2-Rezeptoren-Blocker als rasch wirksam und effektiv erwiesen. Während sich bei mittelschweren bis schweren Schmerzen bei den anderen, oben genannten Krankheitsbildern der intravenöse Einsatz eines Nichtopioidanalgetikums, bei der Gallenkolik ergänzt um Butylscopolamin, bewährt hat, wird bei sehr schweren Schmerzen oder unzureichendem Ansprechen auf ein Nichtopioidanalgetikum ein Opioid intravenös verabreicht. Bei der Schmerztherapie der Gallenkolik und akuten Pankreatitis ist ein den Sphincter Oddi und Gallengangdruck nicht beeinflussendes Opioid wie Buprenorphin, Nalbuphin oder Tramadol einzusetzen. Ein effektives, jedoch nicht weit verbreitetes Therapieprinzip des Kolikschmerzes stellt die Verabreichung eines nichtsteroidalen Antirheumatikums, z.B. Indometacin oder Diclofenac dar.

Abstract

Abdominal pain is an important and the most frequent symptom of acute gastrointestinal diseases; crucial hints on the diagnosis can be gleaned from its location and from associated symptoms and signs. As symptomatic therapy the treatment of pain plays a major role in acute gastrointestinal diseases, e.g. the acute abdomen, acute pancreatitis, biliary colic, peptic ulcer disease and diverticulitis. Acute pain arising from peptic ulcer disease is effectively treated with the H+-, K+-ATPase inhibitor omeprazole or one of the H2-receptor antagonists. While moderate to severe pain caused by these conditions can be effectively treated by intravenous administration of nonopioid analgesic drugs, supplemented by butylscopolamine in a biliary colic, more severe pain or inadequate responsiveness to nonopioid analgesic drugs requires the intravenous administration of a highly potent opioid. Acute severe pain arising from biliary colic and acute pancreatitis should be treated with an opioid that does not influence the sphincter of Oddi or the pressure in the common bile duct, e.g. buprenorphine, nalbuphine or tramadol. An effective but not widely known therapy for colic pain is parenteral administration of a nonsteroidal anti-inflammatory drug, e.g. indomethacin or diclofenac.

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Bierbach, H. Die Behandlung akuter gastrointestinaler Schmerzen. Schmerz 7, 154–159 (1993). https://doi.org/10.1007/BF02530422

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