Zusammenfassung
Gastrointestinale Motilitätsstörungen auf der Intensivstation sind ein häufiges Problem. Die Motilitätsstörungen werden durch unterschiedliche pathophysiologische Störungen entweder im Rahmen der Grundkrankheiten oder bedingt durch die intensivmedizinische Therapie verursacht. Trotz des wachsenden Verständnisses der Physiologie der gastrointestinalen Motilität und der pathophysiologischen Ursachen ist ein selektiver Angriff mit motilitätsmodifizierenden Pharmaka aus Mangel an zugelassenen Alternativen meist nicht möglich. Schluckstörungen, gastroösophagealer Reflux mit konsekutiver Refluxösophagitis und die Gastroparese stellen die häufigsten Störungen im oberen Gastrointestinaltrakt dar. Dysphagie, Übelkeit und Erbrechen sind die führenden Leitsymptome. Darmatonie, verzögerte Darmpassage und Darmparalyse auf der einen und Diarrhöen auf der anderen Seite sind die häufigsten Störungen im Bereich des unteren Gastrointestinaltraktes. Die intestinale Pseudoobstruktion ist eine Sonderform des paralytischen Ileus. Professionelle allgemein-/intensivmedizinische Maßnahmen reduzieren Häufigkeit und Schweregrad von gastrointestinalen Motilitätsstörungen. Diese umfassen die Vermeidung von Stress und Schmerzen, die Meidung und sparsame Verwendung motilitätshemmender Pharmaka, Bilanzierung des Elektrolyt- und Wasserhaushaltes, frühzeitige Mobilisierung und enterale Ernährung. Zur Therapie stehen nur wenige prokinetisch wirkende Substanzen im oberen Gastrointestinaltrakt zur Verfügung. Im unteren Gastrointestinaltrakt finden v. a. die verschiedenen Formen der Laxanzien Verwendung.
Abstract
Gastrointestinal (GI) motility disorders in critically ill patients are a common clinical problem. These disorders can be the consequence of the underlying disease or result from the medical or interventional intensive care treatment. Despite increasing knowledge of the underlying physiology and pathophysiology of the motility disorders, there is a lack in therapeutic alternatives (prokinetics), which can be used and are approved under these conditions. Swallowing disorders, gastroesophageal reflux and gastroparesis due to various underlying causes comprise the most import clinically relevant disorders in the upper GI tract, with dysphagia, nausea, and vomiting being the leading symptoms. Constipation with delayed passage, paralysis, or ileus, on the one hand, as well as diarrhea due to various causes, on the other hand, are the most important clinical disorders in the lower GI tract. Intestinal pseudo-obstruction is a special form of paralytic ileus with an acute or chronic form occurring in various diseases and post-operative conditions. Improvement in the general intensive care management of critically ill patients can dramatically reduce the incidence of gastrointestinal motility disorders. Reduction of stress and pain, cautious use of medications with inhibitory effects on gastrointestinal motility (e.g., opioids, catecholamines), balancing electrolytes and fluid losses, early mobilization, physical therapy, and early enteral feeding can reduce the overall incidence. Besides cholinomimetics, only a few prokinetic substances (domperidone, metclopramide, erythromycin, cholecystokinin (CCK) agonists) are approved and available for treatment in the upper GI tract. In the lower GI tract, decompression and the use of laxatives are most commonly used for treatment; however, newer substances (lubiprostone, prucalopride) are on the horizon.
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Allescher, HD. Gastrointestinale Motilitätsstörungen in der Intensivmedizin. Intensivmed 47, 251–259 (2010). https://doi.org/10.1007/s00390-009-0159-4
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DOI: https://doi.org/10.1007/s00390-009-0159-4
Schlüsselwörter
- Gastrointestinale Motilitätsstörung
- Gastroparese
- Paralytischer Ileus
- Prokinetische Therapie
- Enterale Ernährung