Zusammenfassung
In der Praxis des niedergelassenen Allgemeinmediziners und des Spezialisten ist das Reizdarmsyndrom (RDS) eines der häufigsten Krankheitsbilder überhaupt. Auch ohne eine krankheitsbezogene Mortalität hat das RDS für die betroffenen Patienten und die Gesellschaft erhebliche Konsequenzen. Insofern sind rational begründete und effektive Behandlungsmodalitäten erforderlich. In den letzten Jahren wurden neue richtungsweisende Erkenntnisse zur Pathophysiologie und Behandlung gewonnen. Der üblichen Verzögerung zwischen dem Erkenntnisgewinn und der Umsetzung dieser Erkenntnisse in eine verbesserte Behandlungsqualität gilt es zu begegnen. Für die Diagnosestellung werden standardisierte Kriterien wie die Rom II- oder die DGVS-Kriterien zugrunde gelegt. Während Allgemeinmaßnahmen wie Ernährungsberatung und die so genannte „kleine Psychotherapie” unverzichtbarer Bestandteil des Managements dieser Patienten sind, sind die Wirkungen meist nicht hinreichend. Evidenzbasierte medikamentöse Behandlungen umfassen bestimmte Phytopharmaka, Spasmolytika, niedrig dosierte trizyklische Antidepressiva sowie - soweit die arzneimittelrechtlichen Zulassungsverfahren bereits abgeschlossen sind - 5-HT-3-Rezeptorantagonisten und 5-HT-4-Rezeptoragonisten.
Eine kurative Behandlung steht derzeit noch nicht zur Verfügung, so dass alle heute verfügbaren Interventionen lediglich einen palliativen Charakter haben und darauf abzielen, Symptome zu mildern. Dies mag sich in der Zukunft ändern.
Summary
Patients with irritable bowel syndrome (IBS) are highly prevalent among subjects seeking medical attention at the general practitioner or specialist level. While IBS lacks any disease associated excess mortality, this disorders is relevant to the affected subjects due to the considerable burden with regard to the symptoms and an impaired quality of life. Furthermore, this disease has a substantial impact on society due to the economical consequences. In recent years substantial progress has been achieved regarding our pathophysiological understanding. However, as usual, there has been a substantial delay between the discovery of disease mechanisms and its translation into improved patient care. For diagnosing IBS standardized criteria have been established (i. e. Rome II- or the DGVS-criteria).
Regarding treatment, life style advice such as avoidance of specific nutrients that precipitate or aggravate or the „little psychotherapy“ (addressing patients concerns and anxiety regarding the symptoms) are considered essential. However, the overall response rate is disappointing. Evidence-based pharmacological interventions include herbal preparations, spasmolytics, low dose tricyclic antidepressants and 5-HT-3-receptor antagonists and 5-HT-4-receptor agonists.
At present no cure for patients with IBS exists. Thus, all currently available treatments target palliation of symptoms. This, however, may change in the future.
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(Suppl 2)
II43-II47
Prof. Dr. Gerald Holtmann
Royal Adelaide Hospital, Department of Gastroenterology, Hepatology and General Medicine, University of Adelaide
North Tce
Adelaide, SA 5000
Australia
Phone: +61 8 8222 2412
Fax: +61 8 8222 2414
Email: gerald.holtmann@adelaide.edu.au
