Pathophysiologie der Pankreasinsuffizienz

Zusammenfassung

Die chronische Pankreatitis ist überwiegend ethyltoxischer Genese und tritt mit einer Inzidenz von 3 - 10 Fällen pro 100 000 Einwohnern und Jahr auf, wobei überwiegend Männer betroffen sind. Die Erkrankung wird zunächst meist durch intermittierend auftretende Oberbauchschmerzen symptomatisch, während trotz irreversibler Organdestruktionen aufgrund der großen funktionellen Reservekapazität der Bauchspeicheldrüse Beschwerden der exokrinen und endokrinen Pankreasinsuffizienz oft erst Jahre bis Jahrzehnte später auftreten. Dabei steht dann die Steatorrhö im Vordergrund, da einerseits die Pankreaslipaseaktivität stark eingeschränkt ist und andererseits keine effektiven extrapankreatischen Ersatzsysteme für die Fettverdauung existieren. Die exokrine Pankreasinsuffizienz hat jedoch nicht nur eine verminderte Enzymsekretion, sondern auch eine gestörte Interaktion zwischen gastrointestinaler Motilität, Sekretion und endokriner Funktion zur Folge. Daher sollten neuere Therapieentwicklungen nicht nur die intraluminale Enzymsubstitution, sondern auch die Wiederherstellung einer intakten und koordinierten Verdauungsfunktion zum Ziel haben.

Abstract

Long-term alcohol consumption is the most common cause of chronic pancreatitis. The incidence of the disease is 3 to 10 per 100 000 inhabitants and year, and the majority of patients are men. The disease is primarily characterized by intermittent abdominal pain. Symptoms of exocrine and endocrine pancreatic insufficiency develop years or even decades later, because of the high reserve capacity of the pancreas. During the course of pancreatic exocrine insufficiency, synthesis and intraluminal activity of the pancreatic lipase is impaired rapidly and its luminal digestive action is hardly compensated by nonpancreatic mechanisms. As a consequence, steatorrhea dominates the clinical picture. Pancreatic exocrine insufficiency induces not only decreased enzyme secretion resulting in nutrient malabsorption but also alterations of upper gastrointestinal motor, secretory and endocrine functions. Therefore, not only delivery of enzymes into the intestinal lumen but also restoration of disturbed integration of digestive functions should be a goal of future therapeutic concepts.

Schlüsselwörter

Chronische Pankreatitis - exokrine Pankreasinsuffizienz - Pankreasenzymsekretion - Alkoholkonsum - Zigarettenrauchen - Steatorrhö - Pankreaslipase - Therapie

Key words

Chronic pancreatitis - exocrine pancreatic insufficiency - pancreatic enzyme secretion - alcohol consumption - cigarette smoking - steatorrhea - pancreatic lipase - therapy

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