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Z Gastroenterol 2021; 59(06): 580-591
DOI: 10.1055/a-1378-9627
Übersicht

Chologene Diarrhö, Stiefkind der chronischen Diarrhö – Prävalenz, Diagnostik und Therapie. Update 2021

Bile acid diarrhea, stepchild of chronic diarrhea – prevalence, diagnosis and treatment. Update 2021
Martin Storr
1   Zentrum für Endoskopie, Starnberg
,
Manfred Gross
2   Internistisches Klinikum München Süd, Klinik für Gastroenterologie, München
,
Ahmed Madisch
3   Klinikum Siloah, Gastroenterologie, interventionelle Endoskopie, Diabetologie und Akutgeriatrie, Hannover
,
Ulrike von Arnim
4   Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum, Magdeburg
,
Hubert Mönnikes
5   Klinik für Innere Medizin, Martin Luther Krankenhaus, Berlin
,
Julian Walters
6   Imperial College London, UK
,
Heiner Krammer
7   Praxis für Gastroenterologie und Ernährungsmedizin am Deutschen End- und Dickdarmzentrum Mannheim
,
Jutta Keller
8   Israelitisches Krankenhaus, Hamburg
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Zusammenfassung

Die chologene Diarrhö ist eine der häufigsten nicht diagnostizierten Ursachen der chronischen Diarrhö. Zahlreiche verschiedene Pathophysiologien können einer chronischen Diarrhö zugrunde liegen. Auch nach Ausschlussdiagnostik der häufigeren Ursachen verbleiben bis zu 5 % der Bevölkerung von einer ungeklärten chronischen Diarrhö betroffen. In diesem Kollektiv findet sich in bis zu 50 % als Ursache eine chologene Diarrhö.

Die verschiedenen Pathophysiologien, die zu einer chologenen Diarrhö führen, sind gut charakterisiert. Danach lässt sich die chologene Diarrhö in einen primären, einen sekundären und einen tertiären Subtyp unterteilen. Allen Ursachen gemein sind die erhöhte Menge an Gallensäuren im Kolon und im Fäzes und die dadurch bedingte sekretorisch-osmotische Diarrhö, bei schwereren Formen in Kombination mit einer Steatorrhö. Die Diagnostik der chologenen Diarrhö folgt einem klaren Algorithmus, der neben der Ursachensuche und dem diagnostischen Therapieversuch den 75SeHCAT-Test als Referenzverfahren für den Nachweis eines Gallensäurenverlusts angibt. Aufgrund der Chronizität der Beschwerden und der Notwendigkeit einer dauerhaften, lebenslangen Therapie scheint eine einmalige sichere Diagnosestellung prinzipiell sinnvoll; der Test ist allerdings derzeit nur an wenigen Zentren verfügbar. Die Therapie umfasst neben der Behandlung identifizierbarer Grundkrankheiten den Einsatz von Gallensäuren bindenden Arzneimitteln, Ernährungsempfehlungen und Vitaminsubstitutionen.

Der vorliegende Übersichtsartikel fasst Pathophysiologie und Stellenwert der chologenen Diarrhö zusammen und diskutiert die aktuelle Diagnostik und Therapie.

Abstract

Bile acid diarrhea is one of the most frequently undiagnosed causes of chronic diarrhea. A variety of different pathophysiologic causes can underlie chronic diarrhea. Even after exclusion of the more frequent causes, up to 5 % of the population remains affected by unexplained chronic diarrhea. In up to 50 % within this cohort, bile acid diarrhea is the underlying cause.

The various pathophysiologies leading to bile acid diarrhea are well characterized. In this way, bile acid diarrhea can be divided into primary, secondary and tertiary subtypes. Common to all causes is the increased amount of bile acids in the colon and in the faeces and the resulting secretory-osmotic diarrhea, in more severe forms in combination with steatorrhea. The diagnosis of bile acid diarrhea follows a clear algorithm which, in addition to the search for the cause and possibly a therapeutic trial, recognizes the 75SeHCAT test as the reference method for the detection of an increased loss of bile acids. In view of the chronic nature of the symptoms and the need for permanent, lifelong therapy, the use of a one-time, reliable diagnostic test is justified, though the test is currently only available at a few centers. In addition to the treatment of identifiable underlying diseases, the current treatment includes the use of drugs that bind bile acids, with additional nutritional recommendations and vitamin substitutions.

The present review article summarizes the pathophysiology and importance of bile acid diarrhea and discusses the current approach towards diagnosis and treatment.

Schlüsselwörter

chologene Diarrhö - Diarrhö - Gallensäurenverlust - SeHCAT-Test

Key words

bile acid diarrhea - diarrhea - bile acid loss - SeHCAT test


Publication History

Received: 21 December 2020

Accepted: 26 January 2021

Article published online:
25 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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