Phytotherapeutische Empfehlungen in medizinischen Leitlinien zur Behandlung gastroenterologischer Erkrankungen – ein systematischer Überblick

Zusammenfassung

Phytotherapeutika gewinnen zunehmend an Einfluss bei der Behandlung von gastroenterologischen Erkrankungen. Ihre Beliebtheit und wachsende Wirksamkeitsevidenz führen dazu, dass sie vermehrt in medizinische Leitlinien integriert werden. Ein systematisches Screening identifizierte empfohlene phytotherapeutische Ansätze. Entsprechend der aktuellen wissenschaftlichen Datenlage werden einige Empfehlungen für die Anwendung von Phytotherapeutika ausgesprochen. Bei Reizdarmsyndrom wird vor allem bei Schmerzen und Blähungen der Einsatz von Pfefferminzöl „stark empfohlen“. Weitere Phytotherapeutika wie beispielsweise STW-5, tibetanisches Padma Lax oder warme Kümmelölauflagen haben sich wirksam zur Symptomlinderung erwiesen. Es wird „empfohlen“, sie ins Behandlungskonzept zu integrieren. Bei Chronischer Obstipation werden 30g Ballaststoffe am Tag empfohlen. Die beste Datenlage existiert dabei zu Flohsamenschalen mit moderater Evidenz und für Chicorée-Inulin. Bei Colitis ulcerosa können Flohsamenschalen und die Kombination von Myrrhe, Kamillenblütenextrakt und Kaffeekohle komplementär in der remissionserhaltenden Behandlung eingesetzt werden. Ebenfalls eine „offene Empfehlung“ gibt es für Curcumin (Curcuma longa radix) sowohl für die Remissionsinduktion als auch -erhaltung. Einige Phytotherapeutika (z.B. Wermut [Artemisia absintium herba], Weihrauch [Boswellia serrata resina]) zeigen Wirksamkeitshinweise zur Behandlung von Morbus Crohn, jedoch ist die Datenlage noch nicht ausreichend für Empfehlungen. Cannabisbasierte Arzneimittel können nach nicht ausreichender Wirksamkeit oder Kontraindikation der empfohlenen Standardtherapie bei abdominellen Schmerzen und bei klinisch relevantem Appetitverlust erwogen werden, sollte jedoch nicht zur Therapie der akuten Entzündung bei aktivem Morbus Crohn eingesetzt werden. Weitere Empfehlungen für andere gastroenterologische Erkrankungen werden diskutiert. Die Sicherheit und Verträglichkeit der Phytotherapeutika wurden als überwiegend “sehr gut“ bis „tolerabel“ eingestuft. Einige klare Empfehlungen für den Einsatz von Phytotherapeutika zur Behandlung gastroenterologischer Erkrankungen zeigen das große Wirkpotenzial. Phytotherapeutika können aufgrund ihres großen Wirkspektrums bei komplexen Regulationsstörungen sehr gut komplementär zu herkömmlichen Medikamenten eingesetzt werden. Dennoch sind weitere methodisch gut durchgeführte Wirkungsstudien für weitere Empfehlungen erforderlich.

Abstract

Phytotherapeutics are gaining influence in the treatment of gastroenterological diseases. Their popularity and growing evidence of efficacy contribute to their integration into medical guidelines. A systematic screening identified recommended phytotherapeutic approaches. Based on current scientific data, some recommendations for the use of phytotherapeutic agents are given. For irritable bowel syndrome the use of peppermint oil is “strongly recommended”, especially for pain and flatulence. Other phytotherapeutics such as STW-5, Tibetan Padma Lax or warm caraway oil pads have proven effective in alleviating symptoms. It is “recommended” to integrate them into the treatment concept. For chronic constipation, 30g of fiber per day is recommended. Best data exists for plantago psyllium with moderate evidence and chicory inulin. In case of ulcerative colitis, plantago psyllium as well as the combination of myrrh, chamomile flower extract, and coffee charcoal can be used as a complementary treatment in maintaining remission. There is also an “open recommendation” for curcumin for both, remission induction and maintenance. Some phytotherapeutic treatments (e.g., Artemisia absintium, Boswellia serata) show evidence of effectiveness for the treatment of Crohnʼs disease, but data are not yet sufficient for recommendations. Cannabis-based medicines can be considered for abdominal pain and clinically relevant appetite loss if standard therapy is ineffective or contraindicated, but they should not be used for acute inflammation in active Crohnʼs disease. Further recommendations for other gastroenterological diseases are discussed. The safety and tolerability of the phytotherapeutics were rated as predominantly “very good” to “acceptable”. Some clear recommendations for the use of phytotherapeutics to treat gastroenterological diseases show their great potential. Due to their wide range of effects, phytotherapeutics can be used very well as a complement to conventional medicines in case of complex regulatory disorders. However, further methodologically well-conducted impact studies would be helpful in order to be able to make further recommendations.

Schlüsselwörter

Leitlinien - gastroenterologische Erkrankungen - Phytotherapie - Phytopharmaka - Pflanzliche Arzneimittel - Übersichtsarbeit - AWMF

Keywords

guidelines - gastroenterological disorders - phytotherapy - phytopharmaceuticals - herbal medicine - review - AWMF

Publication History

Received: 21 August 2023

Accepted after revision: 27 February 2024

Article published online:
11 April 2024

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