Mikrobiota und Reizdarmsyndrom – eine kritische Bestandsaufnahme

Zusammenfassung

Dieses narrative Review beleuchtet kritisch die Rolle der Darmmikrobiota bei funktionellen Störungen vom Typ Reizdarmsyndrom. Ausgehend von Veränderungen der Zusammensetzung und Vielfalt der Mikrobiota, wie sie oft in korrelativen Studien gefunden wurden, stellt es kritische Fragen nach Ursache/Wirkung, nach Spezifität und Sensitivität der Befunde im Vergleich zu anderen Erkrankungen und nach den klinisch-wissenschaftlichen Möglichkeiten, die Mikrobiota zu verändern. Dabei werden Prä-, Pro- und Antibiotika ebenso diskutiert wie der Einfluss von Ernährung und der Austausch durch fäkalen Mikrobiom-Transfer (FMT). Für das Reizdarmsyndrom haben sich bislang die wenigsten Strategien als erfolgreiche Therapieansätze erwiesen. Dies kann zum einen an der Heterogenität des Krankheitsbildes selbst liegen, zum anderen an nach wie vor unklaren Konzepten der mikrobiellen Forschung, z. B. dem Begriff der Dysbiose, oder an methodischen Differenzen der molekulargenetischen Forschung, die in den publizierten Arbeiten nicht sichtbar werden. Künftige Studien sollten sich auf die Identifizierung der Faktoren konzentrieren, die das Ansprechen auf solche Behandlungsarten erklären und vorhersagen können.

Abstract

This narrative review critically explores the role of the gut microbiota in functional bowel disorders of IBS-type. Starting with changes in the microbiota composition and diversity, as they have been often found in correlative IBS studies, it raises the question of cause and consequence, of sensitivity and specificity of findings in comparison to other diseases, and of the scientific and clinical options to manipulate the microbiota. This includes a discussion of pre- and probiotics and antibiotics as well as the role of nutrition and the microbiota exchange with fecal microbiota transfer (FMT). For IBS, most of these strategies have not been found to be successful therapies. This may be due to the heterogeneity of the disease itself, but eventually also due to the concepts of microbiological research, e. g., the term dysbiosis, or in methodological differences of the molecular-genetic research that are not visible in the published papers. Future studies should aim to identify those factors that may explain and predict the response to such therapies.

Schlüsselwörter

Mikrobiota - Mikrobiom - Dysbiose - Reizdarmsyndrom - Probiotika - Antibiotika - FODMAP - Stuhltransfer

Key words

microbiota - microbiome - dysbiosis - irritable bowel syndrome - probiotics - antibiotics - FODMAP - fecal microbiota transfer

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