Der Einfluß somatischer und psychosozialer Faktoren auf Entstehung und Verlauf chronisch-entzündlicher Darmerkrankungen

Zusammenfassung

Chronisch-entzündliche Darmerkrankungen (Morbus Crohn, Colitis ulcerosa) werden traditionellerweise zu den psychosomatischen Erkrankungen gezählt. In jüngster Zeit wurde diese Zuordnung aber mehrfach in Frage gestellt; zugleich wurden biomedizinische Faktoren beschrieben, die in der Entstehung und im Verlauf der Erkrankungen eine Rolle spielen könnten. Die vorliegende Übersichtsarbeit hat das Ziel, den aktuellen Stand der biomedizinischen und psychosomatischen Forschung zur Ätiologie und Verlaufsgestaltung bei chronisch-entzündlichen Darmerkrankungen darzustellen und unter methodischen Gesichtspunkten kritisch zu bewerten. Forschungsergebnisse zu folgenden Themenbereichen werden referiert: Epidemiologie; soziodemographische Merkmale; Genetik; diätetische Faktoren und Zigarettenrauchen; Medikamente; Permeabilitätsstörung der Darmepithelien; immunologische Faktoren; mikrobiologische Faktoren; psychiatrische Störung; emotionale Symptomatik, Persönlichkeitsmerkmale; kritische Lebensereignisse und psychosozialer Streß; Lebensqualität und Krankheitsbewältigung.

Summary

Inflammatory bowel diseases (Crohn's disease, ulcerative colitis) were thought to be psychosomatic disorders. However, this argument has recently been questioned by many researchers. At the same time, biomedical factors have been described that were claimed to play a role in the aetiology and modulation of the course of inflammatory bowel diseases (IBD). In the present paper, the state of research regarding both biomedical and psychosomatic factors of the aetiology and course of IBD is reviewed and critically evaluated from a methodological perspective. Results covering the following topics are presented: epidemiology; sociodemographic variables; genetic factors; dietary factors and cigarette smoking; drugs; permeability of bowel epithelia; immunological factors; microbiological factors; psychiatric disorders, affective symptoms, personality factors; life events and psychosocial stress; quality of life; and coping with the illness. Among biomedical factors, a genetically based pathological immune reaction is highly probable. However, the findings of immunological disturbances are of a more descriptive nature and seem to explain not the aetiological process of the development of the disease, but rather a kind of disposition. The question of which agents trigger the pathological immune cascade is still under investigation. Interesting findings can possibly be expected of the psycho-neuro-immunological research in this area. Results of research on psychological pathology (psychiatric disorders, personality factors) are inconclusive. In particular, some modern, well-controlled studies have not been able to confirm the findings of the older literature. Part of the high rate of psychiatric morbidity might be due to effects of selective sampling of more disturbed subjects. Research pertaining to the influence of distressing life events has also yielded inconsistent results. Prospective studies about the association of psychosocial stress and somatic symptomatology mostly demonstrated cross-sectional correlations which did not allow for causal interpretations. However, coping research has shown interesting results that point to the mediating influence of coping strategies on the course of the disease. Finally, perspectives for future research are suggested.