Chronische Obstipation

Kernaussagen

Epidemiologie

• Obstipation begleitet die Menschheit seit alters her. Mit der aufkommenden Zivilisation hat sich die erschwerte Defäkation jedoch quasi zur Volkskrankheit entwickelt. Ihr Verständnis und ihre Definition unterlagen dabei stetem Wandel.

• Wenngleich die Obstipation in Deutschland quantitativ nicht die Bedeutung erlangt hat wie in den USA oder Frankreich, so ist der individuelle Leidensdruck bei einem Teil der Patienten erheblich.

Diagnostik und Therapie

• Wesentlicher Garant erfolgreicher Behandlung ist die Anamnese, ergänzt durch die digital-rektale Untersuchung und die funktionelle Proktoskopie.

• Bei primärer Obstipation ohne Anhalt für Alarmsymptome ist eine Therapie ohne darüber hinausgehende vertiefende Diagnostik gerechtfertigt und meist erfolgreich.

• Bei fehlendem Ansprechen oder Hinweisen auf eine komplizierte Ätiologie stehen neurophysiologische und bildgebende diagnostische Verfahren zur Verfügung, die eine subtile Differenzierung ermöglichen.

• Die Wertigkeit dieser diagnostischen Instrumente setzt jedoch Detailkenntnisse voraus und ist nicht einheitlich.

• Basistherapeutische/medikamentöse Maßnahmen sind teilweise seit dem Altertum etabliert, für ihre Verfügbarkeit im medikamentösen Armamentarium bedurfte es jedoch des Wirksamkeitsnachweises in Studien.

• Neue wirksame Medikamente haben dem etablierten therapeutischen Spektrum sinnvolle Facetten hinzugefügt, sind aber nicht als Ersatz der etablierten Substanzen in der Primärtherapie zu verstehen.

• Literatur

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