Divertikelkrankheit – Neues zur Pathogenese

Zusammenfassung

Die Divertikelkrankheit ist mit einer hohen Inzidenz, Morbidität und Belastung des Gesundheitssystems verbunden. Dennoch ist die Pathogenese nicht zufriedenstellend geklärt und wird als multifaktoriell angesehen. Nicht beeinflussbare Risikofaktoren sind zunehmendes Alter, genetische Prädisposition und seltene erbliche Bindegewebserkrankungen. Beinflussbare Risikofaktoren sind ballaststoffarme Ernährung, hoher Fleischkonsum und starkes Übergewicht. Veränderungen des Bindegewebes führen zur Schwächung präfomierter Austrittsstellen der Divertikel („loci minoris resistentiae“) und könnten das gehäufte Auftreten der Divertikelkrankheit bei Erkrankungen erklären, die durch eine systemische Bindegewebsschwäche bedingt sind. Das Ausmaß neuromuskulärer Veränderungen und einer gestörten Kolonmotilität wurden bisher unterschätzt, da sie eine Divertikelausbildung triggern können. Darüber hinaus werden Innervationsstörungen der Darmwand verantwortlich gemacht für die persistierende Schmerzsymptomatik bei chronischen Verläufen der Divertikelkrankheit.

Abstract

Diverticular disease is associated with a high incidence, morbidity and burden of the healthcare system. However, the pathogenesis is not yet satisfactorily clarified and thought to be multifactorial. Non-influenceable risk factors include increasing age, genetic predisposition and rare congenital connective tissue diseases. Influenceable risk factors are low-fiber diet, increased meat consumption and obesity. Alterations of connective tissue lead to a weakening of preformed emergence sites of diverticula („loci minoris resistentiae“) and may explain the increased incidence of diverticular disease in diseases caused by a systematic connective tissue disorder. The impact of neuromuscular alterations and disturbed colonic motility on triggering diverticula formation has been previously underestimated. Moreover, intestinal innervation disorders are considered to be responsable for persisting recurrent pain symptoms in chronic diverticular disease.

Schlüsselwörter

Divertikelkrankheit - Pathogenese - Risikofaktoren

Keywords

diverticular disease - pathogenesis - risk factors

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