S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM)[1]

Inhaltsverzeichnis Seite Abkürzungsverzeichnis 238 Teil I Einführung und Methodik 238 Hintergrund und Ziele 238 Methodik 238 Teil II Grundlagen 242 Kapitel 1 Definition und Epidemiologie 242 1 – 1 Definition und Epidemiologie des RDS bei Erwachsenen (AG 1) 242 1 – 2 Definition und Epidemiologie des RDS bei Kindern (AG 9) 245 Kapitel 2 Pathophysiologie 247 2 – 1 Pathophysiologie des RDS bei Erwachsenen (AGs 2, 11, 12) 247 2 – 1 Pathophysiologie des RDS bei Kindern (AG 9) 251 Teil III Diagnosesicherung 252 Kapitel 3 Diagnostisches Vorgehen bei V. a. RDS 252 3 – 1 Diagnostisches Vorgehen bei V. a. RDS bei Erwachsenen (AG 3) 252 3 – 2 Diagnostisches Vorgehen bei V. a. RDS bei Kindern (AG 9) 256 3 – 3 Abgrenzung des RDS von spezifischen Motilitätsstörungen des Dünn- und Dickdarms (AG 10) 257 Teil IV Allgemeine (symptomunabhängige) Therapieverfahren 259 Kapitel 4 Allgemeine, komplementäre und alternative Verfahren 259 4 – 1 Allgemeine Grundsätze in der Therapie des RDS (AG 6) 259 4 – 2 Allgemeine, komplementäre und alternative Verfahren beim RDS bei Erwachsenen (AG 6) 260 4 – 3 Allgemeine, komplementäre und alternative Verfahren beim RDS bei Kindern (AG 9) 262 Kapitel 5 Ernährung 262 5 – 1 Diagnostische und therapeutische Rolle der Ernährung beim RDS bei Erwachsenen (AG 5) 262 5 – 2 Diagnostische und therapeutische Rolle der Ernährung beim RDS bei Kindern (AG 5, AG 9) 266 Kapitel 6 Psyche 266 6 – 1 Diagnostische und therapeutische Rolle der Psyche beim RDS bei Erwachsenen (AG 4) 266 6 – 2 Diagnostische und therapeutische Rolle der Psyche beim RDS bei Kindern (AG 9) 268 Teil V Gezielte (symptomorientierte) Therapie 268 Kapitel 7 Therapie der RDS-Symptome Diarrhö und Schmerz 268 7 – 1 Therapie von Diarrhö und Schmerz beim RDS von Erwachsenen (AG 7) 268 A) Symptom Schmerz 268 B) Symptom Diarrhö 271 7 – 2 Therapie von Schmerzen und Diarrhö bei Kindern mit RDS (AG 9) 272 Kapitel 8 Therapie der RDS-Symptome Obstipation und Blähungen 273 8 – 1 Therapie von Obstipation und Blähungen beim RDS von Erwachsenen (AG 8) 273 A) Symptom Obstipation 273 B) Symptomkomplex „Blähungen/abdominelle Distension/Meteorismus/Flatulenz” 276 8 – 2 Therapie von Obstipation und Blähungen bei Kindern mit RDS (AG 9) 278 Appendix I Beispiele für gebräuchliche Therapieschemata von pharmakologischen Behandlungen des Reizdarmsyndroms bei Erwachsenen 279 Appendix II Beispiele von Substanzen in der Entwicklung oder von Substanzen aus anderen Indikationen zum potenziellen Einsatz beim RDS 279 Appendix III Ältere Diagnose-Kriterien des RDS 281 Literatur 282

1 In Zusammenarbeit mit Deutsche Gesellschaft für Innere Medizin (DGIM), Berufsverband Niedergelassener Gastroenterologen Deutschlands (bng), Gesellschaft für Pädiatrische Gastroenterologie und Ernährung (GPGE), Deutsche Gesellschaft für Ernährungsmedizin (DGEM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Deutsche Gesellschaft für Allgemein- und Familienmedizin (DEGAM), Deutsche Gesellschaft zum Studium des Schmerzes (DGSS), Deutsche Gesellschaft für Verhaltensmedizin und Verhaltensmodifikation (DGVM), Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM), Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit (DTG), Deutsche Gesellschaft für Naturheilkunde, Deutsche Reizdarmselbsthilfe e. V. (Patientenorganisation).

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1 In Zusammenarbeit mit Deutsche Gesellschaft für Innere Medizin (DGIM), Berufsverband Niedergelassener Gastroenterologen Deutschlands (bng), Gesellschaft für Pädiatrische Gastroenterologie und Ernährung (GPGE), Deutsche Gesellschaft für Ernährungsmedizin (DGEM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Deutsche Gesellschaft für Allgemein- und Familienmedizin (DEGAM), Deutsche Gesellschaft zum Studium des Schmerzes (DGSS), Deutsche Gesellschaft für Verhaltensmedizin und Verhaltensmodifikation (DGVM), Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM), Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit (DTG), Deutsche Gesellschaft für Naturheilkunde, Deutsche Reizdarmselbsthilfe e. V. (Patientenorganisation).

6 ² Eine Symptomdauer > 2 – 3 Wochen, aber < 3 Monate rechtfertigt noch nicht die Diagnose eines Reizdarmsyndroms [9]. Dennoch gelten die Empfehlungen zum Management (Diagnostik, Therapie) des Reizdarmsyndroms auch für diese Patienten, denn auch diese Patienten bedürfen einer diagnostischen Abklärung und können therapeutisch nicht vertröstet werden. Eine Symptomdauer < 2 – 3 Wochen ist hingegen nicht Gegenstand der aktuellen Leitlinien.

13 ³ Da sich eine Diabetes-Erkrankung bei Kindern in der Regel als akutes Krankheitsbild äußert, hat die Blutzuckerbestimmung bei chronischen Beschwerden eher einen geringen Stellenwert.

14 ⁴ Anmerkung: Der Evidenzgrad A gründet sich auf positive Metaanalysen zum Einsatz von Probiotika beim RDS. Allerdings wurden in den Studien, die in den Metaanalysen getestet wurden, z. T. unterschiedliche Probiotikastämme untersucht, was erklärt, dass die Studienlage für einzelne Probiotikastämme weniger eindeutig ist, wie die Tab. 5-1 zeigt.

16 ⁵ Erläuterung zur Definition: Probiotika sind lebende Mikroorganismen (in der Regel Bakterien oder Pilze), die, in ausreichenden Mengen oral aufgenommen, einen gesundheitsfördernden Einfluss auf den Wirtsorganismus haben können. Präbiotika sind hingegen nicht verdaubare Lebensmittelbestandteile, die ihren Wirt günstig beeinflussen, indem sie das Wachstum und/oder die Aktivität einer oder mehrerer Bakterienarten im Dickdarm gezielt anregen und somit die Gesundheit des Wirtes verbessern.

17 Unwohlsein meint ein unangenehmes Empfinden, welches nicht als Schmerz beschrieben wird. Bei pathophysiologischer Forschung und in klinischen Studien sollte eine aktuell bestehende Schmerz/Unwohlseins-Frequenz von mindestens 2 Tagen pro Woche als Einschlusskriterium gewählt werden.

18 ⁷ Die Kriterien müssen erfüllt sein für die vergangenen 3 Monate, und die Symptome müssen mindestens 6 Monate vor Diagnosestellung begonnen haben.