Download PDF
Aktuelle Ernährungsmedizin 2022; 47(03): 200-215
DOI: 10.1055/a-1555-5612
CME-Weiterbildung

Diagnostik und Therapie des Reizdarmsyndroms vom Diarrhö- und Mischtyp

Diagnosis and Therapy of Irritable Bowel Syndrome of the Diarrhea and Mixed Type
Bettina Mirgeler
,
Toktam Pour
,
Christian Sina
› Further Information
Also available at
    Permissions and Reprints

Symptome wie Diarrhö, Meteorismus und abdominale Schmerzen sind im klinischen Alltag häufig. Die Ursache ist oft das Reizdarmsyndrom (RDS). Während die Pathogenese noch unklar ist, wird die Pathophysiologie zunehmend besser verstanden. Im klinischen Alltag stellt die Diagnostik und Therapie des RDS eine große Herausforderung dar. Die heterogene Symptomatik und der Mangel an validierten Biomarkern erfordert eine umfassende Differenzialdiagnostik [1].

Abstract

Symptoms such as diarrhea, meteorism, and abdominal pain are common in everyday clinical practice. The cause is often irritable bowel syndrome (IBS). While the pathogenesis is still unclear, the pathophysiology of the disease is increasingly better understood. Irritable bowel syndrome can be divided into different subgroups. Particularly relevant for clinical practice are IBS with predominant constipation (IBS-C), IBS with predominant diarrhea (IBS-D), and IBS with mixed bowel habits (IBS-M). The diagnosis and therapy of IBS represent a major challenge. The heterogeneous symptoms and the lack of validated biomarkers require comprehensive differential diagnostics. This includes laboratory diagnostic, checking for food allergies, endoscopy, abdominal sonography, H2 breath tests, homocholic acid taurine tests, and psychosomatic diagnostic. There are different therapeutic approaches like nutrition therapy, administration of probiotics and symptom-oriented drug therapies. This article aims to give an overview of the diagnosis and therapy of IBSD and IBS-M in Germany with insights and experiences from clinical practice.

Schlüsselwörter

Reizdarmsyndrom - S3-RDS-Leitlinie - Diagnostik - Therapie
irritable bowl syndrom - S3-guidline - Therapy - Diagnosis


Publication History

Article published online:
14 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Enck P, Aziz Q, Barbara G. et al. Irritable bowel syndrome. Nat Rev Dis Primers 2016; 2: 16014
    CrossrefPubMedSearch in Google Scholar
  • 2 Rom IV Komitee. Rom IV Kriterien, Anhang A: Rom-IV-Diagnosekriterien für FGIDs. 4. Aufl. Rom: ROME FOUNDATION; 2016
    PubMed
  • 3 Oka P, Parr H, Barberio B. et al. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5: 908-917 Epub 2020. Erratum in: Lancet Gastroenterol Hepatol 2020; 5 (12): e8. PMID: 32702295
    CrossrefPubMedSearch in Google Scholar
  • 4 Hauser W, Marschall U, Layer P. et al. The Prevalence, Comorbidity, Management and Costs of Irritable Bowel Syndrome. Dtsch Arztebl Int 2019; 116: 463-470
    PubMedSearch in Google Scholar
  • 5 Layer P, Andresen V, Pehl C. et al. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie des Reizdarmsyndroms der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoff wechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM).. Z Gastroenterol: 2021. 59. 1323-1415
    Thieme ConnectSearch in Google Scholar
  • 6 Raskov H, Burcharth J, Pommergaard HC. et al. Irritable bowel syndrome, the microbiota and the gut-brain axis. Gut Microbes 2016; 7: 365-383
    CrossrefPubMedSearch in Google Scholar
  • 7 Schemann M.. Reizdarm und Reizmagen – Pathophysiologie und Biomarker. Der Gastroenterologe 2017; 12: 114-129
    CrossrefPubMedSearch in Google Scholar
  • 8 Saffouri GB, Shields-Cutler RR, Chen J. et al. Small intestinal microbial dysbiosis underlies symptoms associated with functional gastrointestinal disorders. Nat Commun 2019; 10: 2012
    CrossrefPubMedSearch in Google Scholar
  • 9 Zhan K, Zheng H, Li J. et al. Gut Microbiota-Bile Acid Crosstalk in Diarrhea-Irritable Bowel Syndrome. Biomed Res Int 2020; 2020: 3828249
    CrossrefPubMedSearch in Google Scholar
  • 10 Jabbar KS, Dolan B, Eklund L. et al. Association between Brachyspira and irritable bowel syndrome with diarrhoea. Gut 2021; 70: 1117-1129
    CrossrefPubMedSearch in Google Scholar
  • 11 Tiffany CR, Bäumler AJ.. Dysbiosis: from fiction to function. Am J Physiol Gastrointest Liver Physiol 2019; 317: G602-G608
    CrossrefPubMedSearch in Google Scholar
  • 12 Saffouri GB, Shields-Cutler RR, Chen J. et al. Small intestinal microbial dysbiosis underlies symptoms associated with functional gastrointestinal disorders. Nat Commun 2019; 10: 2012
    CrossrefPubMedSearch in Google Scholar
  • 13 Fritscher-Ravens A, Pflaum T, Mösinger M. et al. Many Patients With Irritable Bowel Syndrome Have Atypical Food Allergies Not Associated With Immunoglobulin E. Gastroenterology 2019; 157: 109-118.e5
    CrossrefPubMedSearch in Google Scholar
  • 14 Arango Sancho P.. Complications of Phosphate and Vitamin D Treatment in X-Linked Hypophosphataemia. Adv Ther 2020; 37: 105-112
    CrossrefPubMedSearch in Google Scholar
  • 15 Thomson AB, Sauve MD, Kassam N. et al. Safety of the long-term use of proton pump inhibitors. World J Gastroenterol 2010; 16: 2323-2330
    CrossrefPubMedSearch in Google Scholar
  • 16 Husby S, Murray JA, Katzka DA.. AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease-Changing Utility of Serology and Histologic Measures: Expert Review. Gastroenterology 2019; 156: 885-889
    CrossrefPubMedSearch in Google Scholar
  • 17 Raithel M, Hagel A, Albrecht H. et al. Excretion of urinary histamine and N-tele methylhistamine in patients with gastrointestinal food allergy compared to non-allergic controls during an unrestricted diet and a hypoallergenic diet. BMC Gastroenterol 2015; 15: 41
    CrossrefPubMedSearch in Google Scholar
  • 18 Reese I, Ballmer-Weber B, Beyer K. et al. German guideline for the management of adverse reactions to ingested histamine: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Association of Allergologists (AeDA), and the Swiss Society for Allergology and Immunology (SGAI). Allergo J Int 2017; 26: 72-79
    CrossrefPubMedSearch in Google Scholar
  • 19 Manzotti G, Breda D, Di Gioacchino M. et al. Serum diamine oxidase activity in patients with histamine intolerance. Int J Immunopathol Pharmacol 2016; 29: 105-111
    CrossrefPubMedSearch in Google Scholar
  • 20 Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT. et al. Histamine Intolerance: The Current State of the Art. Biomolecules 2020; 10: 1181
    CrossrefPubMedSearch in Google Scholar
  • 21 Valent P, Akin C, Arock M. et al. Definitions, criteria and global classification of mast cell disorders with special reference to mast cell activation syndromes: a consensus proposal. Int Arch Allergy Immunol 2012; 157: 215-225
    Search in Google Scholar
  • 22 Bojarski C, Tangermann P, Barmeyer C. et al. Prospective, double-blind diagnostic multicentre study of confocal laser endomicroscopy for wheat sensitivity in patients with irritable bowel syndrome. Gut 2021; gutjnl-2021-325181
    CrossrefPubMedSearch in Google Scholar
  • 23 Oronsky B, Ma PC, Morgensztern D. et al. Nothing But NET: A Review of Neuroendocrine Tumors and Carcinomas. Neoplasia 2017; 19: 991-1002
    CrossrefPubMedSearch in Google Scholar
  • 24 Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS); Netzwerk Neuroendokrine Tumoren (NeT) e.V. (Patientenvertretung); Bundesorganisation Selbsthilfe NeuroEndokrine Tumoren e.V. (NET-sgh) (Patientenvertretung) et al. S2k-Leitlinie Neuroendokrine Tumore [Practice guideline neuroendocrine tumors - AWMF-Reg. 021-27]. Z Gastroenterol 2018; 56 : 583–5681. 10.1055/a-0604-2924
    PubMed
  • 25 Cicero G, Ascenti G, Bottari A. et al. MR enterography: what is next after Crohn’s disease?. Jpn J Radiol 2019; 37: 511-517
    CrossrefPubMedSearch in Google Scholar
  • 26 Rana SV, Malik A.. Breath tests and irritable bowel syndrome. World J Gastroenterol 2014; 20: 7587-7601
    CrossrefPubMedSearch in Google Scholar
  • 27 Simrén M, Stotzer PO.. Use and abuse of hydrogen breath tests. Gut 2006; 55: 297-303
    CrossrefPubMedSearch in Google Scholar
  • 28 Fani B, Bertani L, Paglianiti I. et al. Pros and Cons of the SeHCAT Test in Bile Acid Diarrhea: A More Appropriate Use of an Old Nuclear Medicine Technique. Gastroenterol Res Pract 2018; 2018: 2097359
    CrossrefPubMedSearch in Google Scholar
  • 29 Barkun AN, Love J, Gould M. et al. Bile acid malabsorption in chronic diarrhea: pathophysiology and treatment. Can J Gastroenterol 2013; 27: 653-659
    CrossrefPubMedSearch in Google Scholar
  • 30 Surdea-Blaga T, Baban A, Nedelcu L. et al. Psychological Interventions for Irritable Bowel Syndrome. J Gastrointestin Liver Dis 2016; 25: 359-366
    CrossrefPubMedSearch in Google Scholar
  • 31 Grad S, Dumitrascu DL.. Irritable Bowel Syndrome Subtypes: New Names for Old Medical Conditions. Dig Dis 2020; 38: 122-127
    CrossrefPubMedSearch in Google Scholar
  • 32 Bellini M, Tonarelli S, Nagy AG. et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients 2020; 12: 148
    CrossrefPubMedSearch in Google Scholar
  • 33 Shepherd SJ, Gibson PR.. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc 2006; 106: 1631-1639
    CrossrefPubMedSearch in Google Scholar
  • 34 Altobelli E, Del Negro V, Angeletti PM. et al. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients 2017; 9: 940
    CrossrefPubMedSearch in Google Scholar
  • 35 Rastgoo S, Ebrahimi-Daryani N. Agah Shahram et al. Glutamine Supplementation Enhances the Effects of a Low FODMAP Diet in Irritable Bowel Syndrome Management. Frontiers in Nutrition 2021; 8: 1079
    CrossrefPubMedSearch in Google Scholar
  • 36 Camilleri M.. Management Options for Irritable Bowel Syndrome. Mayo Clin Proc 2018; 93: 1858-1872
    CrossrefPubMedSearch in Google Scholar
  • 37 Zong G, Lebwohl B, Hu FB.. Gluten intake and risk of type 2 diabetes in three large prospective cohort studies of US men and women. Diabetologia 2018; 61: 2164-2173
    CrossrefPubMedSearch in Google Scholar
  • 38 Canakis A, Haroon M, Weber HC.. Irritable bowel syndrome and gut microbiota. Curr Opin Endocrinol Diabetes Obes 2020; 27: 28-35
    CrossrefPubMedSearch in Google Scholar