Skip to main content
SpringerLink
Log in

Schmerztherapie beim Reizdarmsyndrom

Pain therapy in irritable bowel syndrome

  • Schwerpunkt
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Das Reizdarmsyndrom (RDS) zählt zu den häufigsten Erkrankungen des Gastrointestinaltrakts. Charakteristisch sind chronische abdominale Schmerzen, die in der Regel mit Stuhlgangveränderungen einhergehen, ohne dass sich in der Routinediagnostik eine Ursache nachweisen ließe. Nach führendem Leitsymptom ist eine Unterteilung in einen obstipations-/diarrhö-/blähungs- oder schmerzdominanten Typ sinnvoll. Das Verständnis der komplexen und multifaktoriellen Pathogenese und Pathophysiologie des RDS hat sich in den letzten Jahren erheblich erweitert. Grundlegend gestört sind u. a. die gastrointestinale Motilität, viszerale Sensorik sowie das mukosale Immunsystem. Wichtig für Arzt und Patient ist einerseits die rasche, sorgfältige Diagnosefindung durch Ausschluss relevanter Differenzialdiagnosen, andererseits aber auch eine klare Vermittlung der Diagnose als eigenständige, nicht bedrohliche Erkrankung. Beide Komponenten bilden die unabdingbare Basis für ein erfolgreiches Management dieser chronischen, die Lebensqualität oft schwerwiegend beeinträchtigenden Erkrankung. Die Schmerztherapie stützt sich auf allgemeine Behandlungsprinzipien sowie eine symptomorientierte medikamentöse Behandlung, wobei auch die anderen Symptome des Beschwerdekomplexes Berücksichtigung finden. Hierfür stehen mehrere Substanzen zur Verfügung, die als Bedarfs- oder Dauermedikation angewendet werden können. Auch eine Kombinationstherapie ist möglich. Adjuvante bzw. supportive Effekte lassen sich mitunter mit nichtmedikamentösen (Allgemein-)Maßnahmen erzielen, die allein aber meist nicht zu einer befriedigenden Gesamtlinderung führen. Zu den medikamentösen Therapieoptionen zählen Spasmolytika, Stuhlregulierung, Phytotherapeutika und Probiotika. Insbesondere bei psychischen Komorbiditäten können Antidepressiva eingesetzt werden. Zu den modernen, effektiveren und besser evidenzbasierten Therapieansätzen gehören der Guanylatcyclase-C-Agonist Linaclotid beim Obstipations-RDS, das lokal wirksame Antibiotikum Rifaximin beim Blähungs-RDS und 5-HT3-Antagonisten beim Diarrhö-RDS. In therapierefraktären Fällen oder bei psychischen Komorbiditäten sollten psychotherapeutische Aspekte in eine interdisziplinäre Betreuung eingeschlossen werden.

Abstract

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases. It is characterized by chronic abdominal pain, typically associated with altered bowel habits that cannot be explained by structural abnormalities in routine diagnostic workup. Based on the predominant symptom, IBS can be divided into different subtypes: IBS with predominant constipation, diarrhea, bloating, or pain. Knowledge about the complex and multifactorial IBS pathophysiology has increased tremendously in recent years, e.g., IBS may be related to alterations in gastrointestinal motility, visceral sensitivity, and the mucosal immune system. It is important, both for the patient and the physician, that IBS diagnosis is made quickly and thoroughly based on the typical symptom complex and exclusion of relevant differential diagnoses and to reassure the patient that IBS is a chronic, but benign disease. These components are the fundamental basis for a good patient–physician relationship and for a successful long-term management of this potentially very compromising disorder. IBS therapy is based on general measures as well as symptom-oriented medical therapy, where improvement of abdominal pain is one of the main goals in treating IBS patients. Several pain treatment options are available, which may be used long-term or on demand and which may be combined with other therapies. General medical approaches include antispasmodics, improvement of bowel function, phytotherapy, and probiotics. Especially in patients with psychological comorbidities, antidepressants may be used. Modern drug treatments include the GC-C agonist linaclotide in IBS with predominant constipation, the locally acting antibiotic rifaximin in IBS with bloating, and 5-HT3 antagonists in IBS with predominant diarrhea. Psychotherapy should be included in an interdisciplinary approach in refractory cases or in psychological comorbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Guilarte M, Santos J, Torres I de et al (2007) Diarrhoea-predominant IBS patients show mast cell activation and hyperplasia in the jejunum. Gut 56:203–209

    Article  PubMed Central  PubMed  Google Scholar 

  2. Barbara G, Stanghellini V, De Giorgio R et al (2004) Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 126:693–702

    Article  PubMed  Google Scholar 

  3. Kassinen A, Krogius-Kurikka L, Makivuokko H et al (2007) The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology 133:24–33

    Article  CAS  PubMed  Google Scholar 

  4. Krogius-Kurikka L, Lyra A, Malinen E et al (2009) Microbial community analysis reveals high level phylogenetic alterations in the overall gastrointestinal microbiota of diarrhoea-predominant irritable bowel syndrome sufferers. BMC Gastroenterol 9:95

    Article  PubMed Central  PubMed  Google Scholar 

  5. Lyra A, Rinttila T, Nikkila J et al (2009) Diarrhoea-predominant irritable bowel syndrome distinguishable by 16S rRNA gene phylotype quantification. World J Gastroenterol 15:5936–5945

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Mertz H, Morgan V, Tanner G et al (2000) Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. Gastroenterology 118:842–848

    Article  CAS  PubMed  Google Scholar 

  7. Lawal A, Kern M, Sidhu H et al (2006) Novel evidence for hypersensitivity of visceral sensory neural circuitry in irritable bowel syndrome patients. Gastroenterology 130:26–33

    Article  PubMed  Google Scholar 

  8. Camilleri M, McKinzie S, Busciglio I et al (2008) Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 6:772–781

    Article  PubMed Central  PubMed  Google Scholar 

  9. Layer P, Andresen V, Pehl C et al (2011) Irritable bowel syndrome: German consensus guidelines on definition, pathophysiology and management. Z Gastroenterol 49:237–293

  10. Costanza CD, Longstreth GF, Liu AL (2004) Chronic abdominal wall pain: clinical features, health care costs, and long-term outcome. Clin Gastroenterol Hepatol 2:395–399

    Article  PubMed  Google Scholar 

  11. Webb AN, Kukuruzovic RH, Catto-Smith AG et al (2007) Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database Syst Rev:CD005110

    Google Scholar 

  12. Johannesson E, Simren M, Strid H et al (2011) Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 106:915–922

    Article  PubMed  Google Scholar 

  13. Grundmann O, Yoon SL (2014) Complementary and alternative medicines in irritable bowel syndrome: an integrative view. World J Gastroenterol 20:346–362

    Article  PubMed Central  PubMed  Google Scholar 

  14. Ford AC, Talley NJ, Spiegel BM et al (2008) Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 337:a2313

    Article  PubMed Central  PubMed  Google Scholar 

  15. Moayyedi P, Ford AC, Talley NJ et al (2010) The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut 59:325–332

    Article  CAS  PubMed  Google Scholar 

  16. McFarland LV, Dublin S (2008) Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol 14:2650–2661

    Article  PubMed Central  PubMed  Google Scholar 

  17. Hungin AP, Mulligan C, Pot B et al (2013) Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice – an evidence-based international guide. Aliment Pharmacol Ther 38:864–886

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Liu JP, Yang M, Liu YX et al (2006) Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database Syst Rev:CD004116

    Google Scholar 

  19. Francis CY, Whorwell PJ (1994) Bran and irritable bowel syndrome: time for reappraisal. Lancet 344:39–40

    Article  CAS  PubMed  Google Scholar 

  20. Castro J, Harrington AM, Hughes PA et al (2013) Linaclotide inhibits colonic nociceptors and relieves abdominal pain via guanylate cyclase-C and extracellular cyclic guanosine 3’,5’-monophosphate. Gastroenterology 145:1334–1346.e1–11

    Article  CAS  PubMed  Google Scholar 

  21. Chey WD, Lembo AJ, Lavins BJ et al (2012) Linaclotide for irritable bowel syndrome with constipation: a 26-week, randomized, double-blind, placebo-controlled trial to evaluate efficacy and safety. Am J Gastroenterol 107:1702–1712

    Article  CAS  PubMed  Google Scholar 

  22. Rao S, Lembo AJ, Shiff SJ et al (2012) A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation. Am J Gastroenterol 107:1714–1724

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Quigley EM, Tack J, Chey WD et al (2013) Randomised clinical trials: linaclotide phase 3 studies in IBS-C – a prespecified further analysis based on European Medicines Agency-specified endpoints. Aliment Pharmacol Ther 37:49–61

    Article  CAS  PubMed  Google Scholar 

  24. Videlock EJ, Cheng V, Cremonini F (2013) Effects of linaclotide in patients with irritable bowel syndrome with constipation or chronic constipation: a meta-analysis. Clin Gastroenterol Hepatol 11:1084–1092.e3

    Article  CAS  PubMed  Google Scholar 

  25. Layer P, Stanghellini V (2014) Review article: linaclotide for the management of irritable bowel syndrome with constipation. Aliment Pharmacol Ther 39:371–384

    Article  CAS  PubMed  Google Scholar 

  26. Quartero AO, Meineche-Schmidt V, Muris J et al (2005) Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev:CD003460

    Google Scholar 

  27. Ford AC, Talley NJ, Schoenfeld PS et al (2009) Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 58:367–378

    Article  CAS  PubMed  Google Scholar 

  28. Andresen V, Montori VM, Keller J et al (2008) Effects of 5-hydroxytryptamine (serotonin) type 3 antagonists on symptom relief and constipation in nonconstipated irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol 6:545–555

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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

  30. Schafer E, Ewe K (1990) The treatment of irritable colon. Efficacy and tolerance of buscopan plus, buscopan, paracetamol and placebo in ambulatory patients with irritable colon. Fortschr Med 108:488–492

    CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. de Greck: keine; V. Andresen: Beratung und Vorträge für die Firmen: Aptalis, AbbVie, Almirall, Mundipharma, Shire, Falk, NPS, Norgine; P. Layer: Beratung und Vorträge für die Firmen: Aptalis, AbbVie, Almirall, Mundipharma, Shire, Norgine, Falk, NPS. Der Beitrag enthält keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Medizinische Klinik, Israelitisches Krankenhaus, Lehrkrankenhaus der Universität Hamburg, Orchideenstieg 14, 22297, Hamburg, Deutschland

    M. de Greck, P. Layer &  V. Andresen M. Sc.

Authors
  1. M. de Greck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Layer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Andresen M. Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Andresen M. Sc..

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Greck, M., Layer, P. & Andresen, V. Schmerztherapie beim Reizdarmsyndrom. Schmerz 28, 289–293 (2014). https://doi.org/10.1007/s00482-014-1406-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-014-1406-6

Schlüsselwörter

Keywords

Search

Navigation