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Therapeutische Modulation der Darmmikrobiota beim Reizdarmsyndrom

Von Probiotika bis zur fäkalen Mikrobiota-Therapie

Therapeutic modulation of intestinal microbiota in irritable bowel syndrome. From probiotics to fecal microbiota therapy

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MMW - Fortschritte der Medizin Aims and scope

Zusammenfassung

Hintergrund

Eine gestörte Darmmikrobiota (Dysbiose) spielt eine zentrale Rolle in der Pathogenese funktioneller Darmerkrankungen, insbesondere des Reizdarmsyndroms.

Methode

In der Übersichtsarbeit sind vier derzeitige Optionen zur Behandlung des Reizdarmsyndroms dargestellt, die über eine Modulation der Darmmikrobiota wirken.

Ergebnisse und Schlussfolgerungen

Probiotika wirken sehr unterschiedlich auf die einzelnen Symptome des Reizdarms. Die Wahl des geeigneten Präparats sollte sich deshalb nach den klinischen Symptomen richten. Rifaximin ist bei ausgewählten Patienten wirksam. Einige Patienten profitieren auch von der Wiederholung dieser Antibiotikatherapie. Eine FODMAP-reduzierte Diät hat in Studien eine signifikante Linderung der Reizdarmsymptome gezeigt. Die fäkale Mikrobiota-Therapie (FMT) ist eine vielversprechende Behandlungsmöglichkeit. Derzeit fehlen allerdings entsprechende placebokontrollierte Studien, um die engültige Wirksamkeit dieser Methode beurteilen zu können.

Abstract

Background

An abnormal intestinal microbiota (dysbiosis) plays a central role in the pathogenesis of the irritable bowel syndrome.

Method

An overview of four current options for the treatment of irritable bowel syndrome, which are characterized by modulation of intestinal microbiota, is given.

Results and conclusions

Probiotics have very different effects on the individual symptoms of the irritable bowel. The choice of the appropriate preparation should therefore be based on the clinical symptomatology. The antibiotic rifaximin is effective in selected patients. Some patients also benefit from the repetition of this therapy. A FODMAP-reduced diet has shown significant alleviation of irritable bowel symptoms in studies. The fecal microbiota therapy (FMT) is a promising treatment option. At present, however, there are no such placebo-controlled studies to assess the effectiveness of this method.

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Literatur

  1. Konturek PC. Reizdarmsyndrom: Diagnostik und therapeutische Optionen. Internist Prax 2014; 54: 269–279.

    Google Scholar 

  2. Keller J, Wedel T, Seidl H, et al. S3 guideline of the German Society for Digestive and Metabolic Diseases (DGVS) and the German Society for Neurogastroenterology and Motility (DGNM) to the definition, pathophysiology, diagnosis and treatment of intestinal motility. Z Gastroenterol 2011; 49(3): 374–390.

    Article  CAS  PubMed  Google Scholar 

  3. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol 2014; 6: 71–78.

    PubMed  PubMed Central  Google Scholar 

  4. Camilleri M. Review article: biomarkers and personalised therapy in functional lower gastrointestinal disorders. Aliment Pharmacol Ther 2015; 42(7): 818–828.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Marchesi JR, Adams DH, Fava F, et al. The gut microbiota and host health: a new clinical frontier. Gut 2016; 65(2): 330–339.

    Article  PubMed  Google Scholar 

  6. Li D, Wang P, Wang P, Hu X, Chen F. The gut microbiota: a treasure for human health. Biotechnol Adv 2016; 34(7): 1210–1224.

    Article  PubMed  Google Scholar 

  7. Fung TC, Olson CA, Hsiao EY. Interactions between the microbiota, immune and nervous systems in health and disease. Nat Neurosci 2017; 20(2): 145–155.

    Article  CAS  PubMed  Google Scholar 

  8. Konturek PC, Zopf Y. Gut microbiome and psyche: paradigm shift in the concept of brain-gut axis. MMWFortschr Med 2016; 158(S4): 12–16.

    Google Scholar 

  9. Schroeder BO, Bäckhed F. Signals from the gut microbiota to distant organs in physiology and disease. Nat Med 2016; 22(10): 1079–1089.

    Article  CAS  PubMed  Google Scholar 

  10. Konturek PC, Brzozowski T, Burnat G, et al. Role of brain-gut axis in healing of gastric ulcers. J Physiol Pharmacol 2004; 55(1 Pt 2): 179–192.

    CAS  PubMed  Google Scholar 

  11. Hyland NP, Cryan JF. Microbe-host interactions: Influence of the gut microbiota on the enteric nervous system. Dev Biol 2016; 417(2): 182–187.

    Article  CAS  PubMed  Google Scholar 

  12. Stilling RM, van de Wouw M, Clarke G, Stanton C, Dinan TG, Cryan JF. The neuropharmacology of butyrate: The bread and butter of the microbiota-gut-brain axis? Neurochem Int 2016; 99: 110–132.

    Article  CAS  PubMed  Google Scholar 

  13. Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain-gut-enteric microbiota axis. Nat Rev Gastroenterol Hepatol 2009; 6(5): 306–314.

    Article  CAS  PubMed  Google Scholar 

  14. Logan AC, Jacka FN, Prescott SL. Immune-microbiota interactions: dysbiosis as a global health issue. Curr Allergy Asthma Rep 2016; 16(2): 13.

    Article  PubMed  Google Scholar 

  15. Ringel Y, Ringel-Kulka T. The intestinal microbiota and irritable bowel syndrome. J Clin Gastroenterol 2015; 49 Suppl 1: S56–S59.

    Article  CAS  PubMed  Google Scholar 

  16. Chung CS, Chang PF, Liao CH, et al. Differences of microbiota in small bowel and faeces between irritable bowel syndrome patients and healthy subjects. Scand J Gastroenterol 2016; 51(4): 410–419.

    Article  CAS  PubMed  Google Scholar 

  17. Tap J, Derrien M, Törnblom H, et al. Identification of an intestinal microbiota signature associated with severity of irritable bowel syndrome. Gastroenterology 2017; 152(1): 111–123.

    Article  PubMed  Google Scholar 

  18. Crouzet L, Gaultier E, Del'Homme C, et al. The hypersensitivity to colonic distension of IBS patients can be transferred to rats through their fecal microbiota. Neurogastroenterol Motil 2013; 25(4): e272–e282.

    Article  CAS  PubMed  Google Scholar 

  19. Ahmad OF, Akbar A. Microbiome, antibiotics and irritable bowel syndrome. Br Med Bull 2016; 120(1): 91–99.

    Article  CAS  PubMed  Google Scholar 

  20. Reid G. Probiotics: definition, scope and mechanisms of action. Best Pract Res Clin Gastroenterol 2016; 30(1): 17–25.

    Article  CAS  PubMed  Google Scholar 

  21. Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M. Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate. World J Gastroenterol 2016; 22(32): 7186–7202.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Meier R. Probiotics in irritable bowel syndrome. Ann Nutr Metab 2010; 57 Suppl: 12–13.

    Article  Google Scholar 

  23. Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol 2014; 109(10): 1547–1561.

    Article  PubMed  Google Scholar 

  24. Zhang Y, Li L, Guo C, et al. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis. BMC Gastroenterol 2016; 16(1): 62.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sánchez B, Delgado S, Blanco-Míguez A, Lourenço A, Gueimonde M, Margolles A. Probiotics, gut microbiota, and their influence on host health and disease. Mol Nutr Food Res 2017; 61(1).

    Google Scholar 

  26. Shokryazdan P, Faseleh Jahromi M, Navidshad B, Liang JB. Effects of prebiotics on immune system and cytokine expression. Med Microbiol Immunol 2017; 206(1): 1–9.

    Article  CAS  PubMed  Google Scholar 

  27. Charalampopoulos D, Rastall RA. Prebiotics in foods. Curr Opin Biotechnol 2012; 23(2): 187–191.

    Article  CAS  PubMed  Google Scholar 

  28. Krumbeck JA, Maldonado-Gomez MX, Ramer-Tait AE, Hutkins RW. Prebiotics and synbiotics: dietary strategies for improving gut health. Curr Opin Gastroenterol 2016; 32(2): 110–119.

    Article  CAS  PubMed  Google Scholar 

  29. Ponziani FR, Pecere S, Lopetuso L, Scaldaferri F, Cammarota G, Gasbarrini A. Rifaximin for the treatment of irritable bowel syndrome - a drug safety evaluation. Expert Opin Drug Saf 2016; 15(7): 983–991.

    Article  CAS  PubMed  Google Scholar 

  30. Pimentel M, Lembo A, Chey WD, et al; TARGET Study Group. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 2011; 364(1): 22–32.

    Article  CAS  PubMed  Google Scholar 

  31. Lembo A, Pimentel M, Rao SS, et al. Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome. Gastroenterology 2016; 151(6): 1113–1121.

    Article  CAS  PubMed  Google Scholar 

  32. Staudacher HM, Whelan K. Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet. Proc Nutr Soc 2016; 75(3): 306–318.

    Article  CAS  PubMed  Google Scholar 

  33. Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nat Rev Gastroenterol Hepatol 2014; 11(4): 256–266.

    Article  CAS  PubMed  Google Scholar 

  34. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146(1): 67–75.

    Article  CAS  PubMed  Google Scholar 

  35. Konturek PC, Haziri D, Brzozowski T, et al. Emerging role of fecal microbiota therapy in the treatment of gastrointestinal and extra-gastrointestinal diseases. J Physiol Pharmacol 2015; 66(4): 483–491.

    CAS  PubMed  Google Scholar 

  36. Weingarden AR, Chen C, Bobr A, et al. Microbiota transplantation restores normal fecal bile acid composition in recurrent Clostridium difficile infection. Am J Physiol Gastrointest Liver Physiol 2014; 306(4): G310–G319.

    Article  CAS  PubMed  Google Scholar 

  37. Jackson MA, Goodrich JK, Maxan ME, et al. Proton pump inhibitors alter the composition of the gut microbiota. Gut 2016; 65(5): 749–756.

    Article  PubMed  Google Scholar 

  38. van Nood E, Speelman P, Nieuwdorp M, Keller J. Fecal microbiota transplantation: facts and controversies. Curr Opin Gastroenterol 2014; 30(1): 34–39.

    Article  PubMed  Google Scholar 

  39. Wang S, Xu M, Wang W, et al. Systematic review: adverse events of fecal microbiota transplantation. PLoS One 2016; 11(8): e0161174.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Petrof EO, Khoruts A. From stool transplants to next-generation microbiota therapeutics. Gastroenterology 2014; 146(6): 1573–1582.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Borody TJ, George L, Andrews P, et al. Bowel-flora alteration: a potential cure for inflammatory bowel disease and irritable bowel syndrome? Med J Aust 1989; 150(10): 604.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Innere Medizin II, Thüringen-Kliniken GmbH Saalfeld, Rainweg 68, 07318, Saalfeld, Deutschland

    P. C. Konturek (Chefarz)

  2. Medizinische Klinik 1, Universitätsklinikum Erlangen, Erlangen, Deutschland

    Yurdagül Zopf

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Correspondence to P. C. Konturek.

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This article is part of a supplement not sponsored by the industry.

Interessenkonflikt

Prof. Dr. med. Peter Konturek und Prof. Dr. med. Yurdagül Zopf erklären, dass keine finanziellen Interessenkonflikte in Bezug auf dieses Manuskript bestehen.

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Konturek, P.C., Zopf, Y. Therapeutische Modulation der Darmmikrobiota beim Reizdarmsyndrom. MMW - Fortschritte der Medizin 159 (Suppl 7), 1–5 (2017). https://doi.org/10.1007/s15006-017-0338-3

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