Rolle der metabolischen Chirurgie bei Diabetes mellitus Typ 2 und NASH

Zusammenfassung

Diabetes mellitus Typ 2 stellt bereits heute in ökonomischer, medizinischer und sozialer Hinsicht ein globales Problem dar, dessen Bedeutung in den nächsten zwei Jahrzehnten noch massiv zunehmen wird. Bariatrische Chirurgie ist zweifelsohne die wirkungsvollste Behandlung von morbider Adipositas, führt zu substantiellem, anhaltendem Gewichtsverlust, Verbesserung von Begleiterkrankungen und Reduktion von Mortalität. Metabolische Chirurgie führt bei 56 bis 95 % der morbid adipösen Typ-2-Diabetiker zur Diabetesremission. Jüngste Ergebnisse zeigen für Patienten mit einem Body-Mass-Index zwischen 30 und 40 kg/m² ebenfalls exzellente Ergebnisse. Die Verbesserung der diabetischen Stoffwechsellage ist auch auf eine kalorische Restriktion und Änderung der gastrointestinalen Hormonsekretion zurückzuführen. Die Etablierung von Diabeteschirurgie verlangt ein besseres pathophysiologisches Verständnis der Erkrankung und der Operationsmethoden – diese Arbeit beschreibt den Einfluss etablierter Operationsmethoden auf die diabetische Stoffwechsellage und die Hormonsekretion des Gastrointestinaltrakts.

NASH (nichtalkoholische Steatohepatitis) betrifft rund ein Drittel der morbid adipösen Patienten. Es werden Prävalenz, Diagnosestellung und Beeinflussung der Erkrankung durch metabolische Chirurgie diskutiert. Der Goldstandard zur Diagnosestellung ist nach wie vor die Leberbiopsie. In mehreren Publikationen konnte die positive Beeinflussung der NASH durch metabolische Chirurgie gezeigt werden – für morbid adipöse Patienten stellt metabolische Chirurgie die effektivste Therapie der NASH dar.

Summary

In economic, medical and social terms, type 2 diabetes is currently already a global problem, whose importance is expected to show a further massive increase in the next twenty years. Bariatic surgery is undoubtedly the most effective treatment for morbid obesity, leads to substantial, long-lasting weight loss, an improvement in concurrent diseases and a reduction in mortality. Metabolic surgery produces a remission of diabetes in 56 to 95 % of morbidly obese type 2 diabetics. The latest results also show excellent results for patients with a BMI of between 30 and 40 kg/m2. The improvement in diabetic metabolic control is also due to a caloric restriction and change in gastrointestinal hormone secretion. For diabetes surgery to become established, a better pathophysiological understanding of the disease and the surgical methods is required. This paper therefore describes the influence of established surgical methods on diabetic metabolic control and hormone secretion of the gastrointestinal tract.

NASH (non-alcoholic steatohepatitis) affects about a third of morbidly obese patients. The prevalence, diagnosis and effect on the disease of metabolic surgery is discussed. The gold standard for diagnosis remains a liver biopsy. Several publications have reported the positive influence of metabolic surgery on NASH, and for morbidly obese patients this form of surgery is the most effective treatment for that disease.

Schlüsselwörter

Diabetes mellitus Typ 2 - NASH - metabolische Chirurgie

Keywords

Type 2 diabetes - nonalcoholic steatohepatitis - metabolic surgery

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