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Arzneimitteltherapie des Reizdarmsyndroms

Was funktioniert, was nicht – und bei wem?

Drug therapy for irritable bowel syndrome

What works, what doesn’t work and for whom?

  • Arzneimitteltherapie
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Zusammenfassung

Die Therapie von Reizdarmpatienten ist oft eine Herausforderung, insbesondere wenn ein breites Spektrum von Symptomen vorliegt und anamnestische Hinweise auf Triggerfaktoren, wie diätetische Einflüsse oder Stress, fehlen. Aktuelle pathogenetische Konzepte propagieren Alterationen in ZNS oder Peripherie, die unter Einbeziehung psychologischer (Stress, Angst, Depression) und biologischer Faktoren (postinfektiöse Residuen, subklinische Entzündung) in integrative Krankheitsmodelle eingehen und zur Erklärung nachweisbarer symptomgenerierender Störungen gastrointestinaler Funktionen (Motilität, Hypersensitivität) dienen. Bei fehlenden universal wirksamen oder kausalen Ansätzen orientiert sich die medikamentöse Basistherapie an den führenden Symptomen, insbesondere Schmerz, Diarrhö und Obstipation. Neben etablierten Medikamenten wie Spasmolytika, Opioiden oder Laxantien sind neu entwickelte Substanzen und solche mit primär anderer Indikation (z. B. Antidepressiva) zur differenzierten individuellen Therapie einsetzbar. In Evaluation befindliche, konzeptionell neuartige Ansätze lassen weitere Fortschritte in der Therapie des Reizdarmsyndroms erwarten.

Abstract

The therapy of patients with irritable bowel syndrome (IBS) is often challenging, especially if a broad spectrum of symptoms is present and trigger factors, such as the influence of diet or stress, are lacking. Current pathogenetic concepts propose central or peripheral alterations that cause disturbed gastrointestinal function (motility, visceral sensitivity) and subsequent symptoms. These alterations are possibly related to psychological (stress, depression, anxiety) and biological (post-infectious residuals, micro-inflammation) influences. Since no universally effective medical treatment is available to treat the causes of the disease, standard medical therapy is symptom directed (especially for pain, constipation and diarrhoe). In addition to well established drugs (like spasmolytics, opioids and laxatives), newly developed compounds including those with other primarily indications (e.g. antidepressants) are available for highly differentiated individualized therapies. New medical approaches which are currently undergoing evaluation, promise further progress in the treatment of IBS.

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  1. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Interdisziplinäres Stoffwechsel-Centrum/Endokrinologie und Diabetes mellitus, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    H. Mönnikes, M. Schmidtmann & I. R. van der Voort

  2. Medizinische Klinik mit Schwerpunkt Psychosomatik und Psychotherapie, Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    M. Schmidtmann

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  1. H. Mönnikes
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Mönnikes, H., Schmidtmann, M. & van der Voort, I.R. Arzneimitteltherapie des Reizdarmsyndroms. Internist 47, 1073–1083 (2006). https://doi.org/10.1007/s00108-006-1694-8

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