Das geheime Leiden

Zusammenfassung

Der Reizdarm ist eine häufig auftretende funktionelle Erkrankung, deren Pathogenese nicht im Detail geklärt ist. Es zeichnet sich jedoch ab, dass neben anderen Faktoren auch die intestinalen Bakterien involviert sind. Die Zusammensetzung weist bei Reizdarmpatienten deutliche Verschiebungen im Vergleich zu Gesunden auf. Bei einem Teil der Patienten kann eine geringgradige Entzündung in der Darmwand nachgewiesen werden, die vermutlich auf der veränderten Zusammensetzung der Bakterien basiert. Lokal im Darm wirksame Antibiotika sowie Probiotika tragen zur Korrektur der gestörten Balance der Bakterien bei und reduzieren wahrscheinlich neben anderen Mechanismen die entzündliche Aktivität. Metaanalysen zufolge können einige ausgewählte Probiotika zu einer Verbesserung der Reizdarmsymptome führen. Allerdings ist die Wirkung der Probiotika stammspezifisch. In verschiedenen Studien erwiesen sich nur bestimmte Keime als wirksam, andere zeigten keine Effekte. Probiotika bieten interessante Ansätze zur Verbesserung von Reizdarmsymptomen und werden in der Praxis zunehmend eingesetzt.

Abstract

Irritable bowel syndrome is a common functional disorder whose pathogenesis is not exactly known. However, it is becoming obvious that in addition to other factors, the intestinal bacteria are involved. The bacterial composition is notably different in patients with irritable bowel syndrome compared with healthy subjects. In a proportion of patients, low-grade inflammation of the intestinal wall is found, which is suspected to be caused by the changed bacterial composition. Antibiotics that are locally effective in the gut, as well as probiotics, contribute to correcting the bacterial dysbalance and, in addition to other mechanisms, probably reduce the inflammatory activity. Meta-analyses have shown that selected probiotics may improve the symptoms of irritable bowel syndrome. However, the effect of the probiotics depends on the specific bacterial strain. Various studies have shown that certain strains were effective, whereas others did not show any effect. Probiotics offer interesting approaches to improving the symptoms of irritable bowel syndrome and are increasingly used in practice.

Schlüsselwörter

intestinale Bakterien - Dysbalance - Entzündung - Antibiotika - Probiotika - abdomineller Bauchumfang - Reizdarmbeschwerden

Keywords

intestinal bacteria - dysbalance - inflammation - antibiotics - probiotics - abdominal circumference - irritable bowel syndrome

• Literatur

• 1 Drossman DA, Camilleri M, Mayer EA et al. AGA technical review on irritable bowel syndrome. Gastroenterology 2002; 123: 2108-2831
• 2 Cremonini F, Talley NJ. Irritable bowel syndrome: epidemiology, natural history, health care seeking and emerging risk factors. Gastroenterol Clin North Am 2005; 34: 189-204
• 3 Longstreth GF, Thompson WG, Chey WD et al. Functional bowel disorders. In: Drossman DA, Corazziari E, Delvaux M, et al., eds. Rome III: the functional gastrointestinal disorders. 3rd. ed. McLean, VA: Degnon; 2006: 487-555
• 4 Saito YA, Cremonini F, Talley NJ. Association of the 1438G/A and 102T/C polymorphism of the 5-HT2A receptor gene with irritable bowel syndrome 5-HT2A gene polymorphism in irritable bowel syndrome. J Clin Gastroenterol 2005; 39: 835 author reply 835–836
• 5 Mertz H, Naliboff B, Munakata J et al. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology 1995; 109: 40-52
• 6 Ringel Y, Carroll IM. Alterations in the intestinal microbiota and functional bowel symptoms. Gastrointest Endosc Clin N Am 2009; 19: 141-150, vii
• 7 Posserud I, Stotzer PO, Bjornsson ES et al. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut 2007; 56: 802-808
• 8 Kassinen A, Krogius-Kurikka L, Makivuokko H et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology 2007; 133: 24-33
• 9 Quigley EM, Flourie B. Probiotics and irritable bowel syndrome: a rationale for their use and an assessment of the evidence to date. Neurogastroenterol Motil 2007; 19: 166-172
• 10 Spiller RC. Role of infection in irritable bowel syndrome. J Gastroenterol 2007; 42 (Suppl. 17) 41-47
• 11 Lin HC. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA 2004; 292: 852-858
• 12 Malinen E, Rinttila T, Kajander K et al. Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR. Am J Gastroenterol 2005; 100: 373-382
• 13 Brint EK, MacSharry J, Fanning A et al. Differential expression of toll-like receptors in patients with irritable bowel syndrome. Am J Gastroenterol 2011; 106: 329-336
• 14 Chadwick VS, Chen W, Shu D et al. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology 2002; 122: 1778-1783
• 15 Liebregts T, Adam B, Bredack C et al. Immune activation in patients with irritable bowel syndrome. Gastroenterology 2007; 132: 913-920
• 16 O'Mahony L, McCarthy J, Kelly P et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology 2005; 128: 541-551
• 17 Pimentel M, Lembo A, Chey WD et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 2011; 6; 364: 22-32
• 18 Pimentel M, Park S, Mirocha J et al. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med 2006; 145: 557-563
• 19 Gribar SC, Richardson WM, Sodhi CP et al. No longer an innocent bystander: epithelial toll-like receptor signaling in the development of mucosal inflammation. Mol Med 2008; 14: 645-659
• 20 Cario E. Bacterial interactions with cells of the intestinal mucosa: Toll-like receptors and NOD2. Gut 2005; 54: 1182-1193 Epub 2005 Apr 19
• 21 Sherman PM, Ossa JC, Johnson-Henry K. Unraveling mechanisms of action of probiotics. Nutr Clin Pract 2009; 24: 10-14
• 22 Eckmann L. Innate immunity and mucosal bacterial interactions in the intestine. Curr Opin Gastroenterol 2004; 20: 82-88
• 23 Yan F, Polk DB. Probiotic bacterium prevents cytokine-induced apoptosis in intestinal epithelial cells. J Biol Chem 2002; 277: 50959-50965
• 24 Madsen K, Jijon H, Yeung H et al. DNA from probiotic bacteria exerts antiinflammatory actions on intestinal epithelial cells by inhibition of NF-kappa B. Gastroenterology 2002; 122: A64
• 25 Kelly D, Campbell JI, King TP et al. Commensal anaerobic gut bacteria attenuate inflammation by regulating nuclear-cytoplasmic shuttling of PPAR-gamma and RelA. Nat Immunol 2004; 5: 104-112 Epub 2003 Dec 21
• 26 Peña JA, Versalovic J. Lactobacillus rhamnosus GG decreases TNF-alpha production in lipopolysaccharide-activated murine macrophages by a contact-independent mechanism. Cell Microbiol 2003; 5: 277-285
• 27 Haller D, Serrant P, Peruisseau G et al. IL-10 producing CD14 low monocytes inhibit lymphocyte-dependent activation of intestinal epithelial cells by commensal bacteria. Microbiol Immunol 2002; 46: 195-205
• 28 Petrof E, Kojima K, Ropeleski MJ et al. Probiotics inhibit nuclear factor-kappaB and induce heat shock proteins in colonic epithelial cells through proteasome inhibition. Gastroenterology 2004; 127: 1474-1487
• 29 Moayyedi P, Ford AC, Talley NJ et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut 2008; 59: 325-332
• 30 McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol 2008; 14: 2650-2661
• 31 Agrawal A, Houghton LA, Morris J et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173-010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2008; 29: 104-114
• 32 Marteau P, Cuillerier E, Meance S et al. Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study. Aliment Pharmacol Ther 2002; 16: 587-593
• 33 Bouvier M, Méance S, Bouley C et al. Effects of consumption of a milk fermented by a probiotic Bifidobacterium animalis (strain DN-173-010) on colonic transit times in healthy humans. Biosci Microflora 2001; 20: 43-48
• 34 Guyonnet D, Chassany O, Ducrotte P et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther 2007; 26: 475-486
• 35 Guyonnet D, Woodcock A, Stefani B et al. Fermented milk containing Bifidobacterium lactis DN-173 010 improved self-reported digestive comfort amongst a general population of adults. A randomized, open-label, controlled, pilot study. J Dig Dis 2009; 10: 61-70
• 36 Guyonnet D, Schlumberger A, Mhamdi L et al. Fermented milk containing Bifidobacterium lactis DN-173 010 improves gastrointestinal well-being and digestive symptoms in women reporting minor digestive symptoms: a randomised, double-blind, parallel, controlled study. Br J Nutr 2009; 102: 1654-1662
• 37 Layer P, Andersen V, Pehl C et al. DGVS-Leitlinie Reizdarm. Z Gastroenterol 2011; 49: 237-293
• 38 Shanahan F. Probiotics in perspectives. Gastroenterology 2010; 139: 1808-1812