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Wirksamkeit von darmlöslichem Lecithin (Phosphatidylcholin) zur Behandlung der Colitis ulcerosa

Eine Metaanalyse

Efficacy of enteric lecithin (phosphatidylcholine) in the treatment of ulcerative colitis: a meta-analysis

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MMW - Fortschritte der Medizin Aims and scope

Abstract:

Background: Phosphatidylcholine is an essential component of the intestinal mucus and serves as a protective shield against the ingress of bacteria from the stool. In the intestinal mucus of patients with ulcerative colitis, phosphatidylcholine is reduced by 70%, which makes the intestine susceptible to bacterial inflammation. Local application by administering enteric phosphatidylcholine could compensate for this deficiency.

Method: A summary analysis of three clinical studies published until now with 160 included patients with ulcerative colitis was performed.

Results and Conclusion: The meta-analysis showed that lecithin enriched with phosphatidylcholine and microencapsulated with Eudragit S-100 significantly improved the remission rate as well as the clinical and endoscopic picture. There was also an improvement in histology and quality of life. All parameters were significantly superior to placebo. The remission achieved was maintained significantly longer with enteric lecithin than with placebo. The side effect profile was identical to the placebo group, which is particularly important for the patients. In complementary medicine, phosphatidylcholine can be seen as protection for the intestines.

Zusammenfassung

Hintergrund: Phosphatidylcholin ist ein essenzieller Bestandteil des Darmschleims und dient als Schutzschild gegen das Eindringen von Bakterien aus dem Stuhl. Im Darmschleim von Patienten mit Colitis ulcerosa ist Phosphatidylcholin um 70% vermindert, welches den Darm anfällig gegenüber bakteriell ausgelösten Entzündungen macht. Lokale Applikation durch Gabe von darmlöslichem Phosphatidylcholin könnte diesen Mangel ausgleichen.

Methode: Es wurde eine zusammenfassende Analyse der drei bisher veröffentlichten klinischen Studien mit 160 eingeschlossenen Colitis-ulcerosa-Patienten durchgeführt.

Ergebnisse und Schlussfolgerung: Die Metaanalyse zeigte, dass mit Phosphatidylcholin angereichertes und mit Eudragit S-100 mikroverkapseltes Lecithin die Remissionsrate sowie das klinische und endoskopische Bild deutlich verbessert. Auch in Bezug auf Histologie und Lebensqualität war eine Besserung festzustellen. Gegenüber Placebo waren alle Parameter signifikant überlegen. Die erreichte Remission blieb unter darmlöslichem Lecithin deutlich länger erhalten als unter Placebo. Das Nebenwirkungsprofil war identisch zur Placebogruppe, was für die Patienten besonders wichtig ist. Phosphatidylcholin ist damit komplementärmedizinisch als Schutz für den Darm anzusehen.

Eingereicht am 22.10.2021 - Revision akzeptiert am 16.12.2021

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Abb. 1:

Mod. nach Stremmel W et al. 2021 [28]

Abb. 2:

Nach Stremmel W et al. 2021 [28]

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Authors and Affiliations

  1. Medical Center Baden-Baden, Beethovenstraße 2, 76530, Baden-Baden, Deutschland

    Wolfgang Stremmel

  2. Institut für Molekulare Pathobio­chemie, Experimentelle Gentherapie und Klinische Chemie, RWTH Universitätsklinikum Aachen, Aachen, Deutschland

    Hüseyin Vural,  Osman Evliyaoglu &  Ralf Weiskirchen

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  1. Wolfgang Stremmel
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  2. Hüseyin Vural
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  3. Osman Evliyaoglu
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Correspondence to Wolfgang Stremmel.

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Prof. Wolfgang Stremmel ist Autor der drei randomisierten kontrollierten Studien, die in dieser Metaanalyse untersucht wurden, sowie der Beobachtungsstudie zur Remissionserhaltung. Prof. Hüseyin Vural, Prof. Osman Evliyaoglu und Prof. Ralf Weiskirchen erklären, dass kein Interessenkonflikt vorliegt. Die hier veröffentliche Metaanalyse erhielt keine finanzielle Unterstützung.

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Stremmel, W., Vural, H., Evliyaoglu, O. et al. Wirksamkeit von darmlöslichem Lecithin (Phosphatidylcholin) zur Behandlung der Colitis ulcerosa. MMW - Fortschritte der Medizin 164 (Suppl 7), 3–11 (2022). https://doi.org/10.1007/s15006-022-0832-0

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