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Dtsch Med Wochenschr 2016; 141(19): 1395-1402
DOI: 10.1055/s-0042-108700
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© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie der chronischen nicht-infektiösen Diarrhö

Chronic, non-infectious diarrhea: diagnostics and therapy
Korinna Ulbricht
1   Medizinische Klinik, Israelitisches Krankenhaus in Hamburg
,
Peter Layer
1   Medizinische Klinik, Israelitisches Krankenhaus in Hamburg
,
Viola Andresen
1   Medizinische Klinik, Israelitisches Krankenhaus in Hamburg
› Author Affiliations
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Publication History

Publication Date:
19 September 2016 (online)

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Zusammenfassung

Die chronische, nicht-infektiöse Diarrhö kann durch eine Vielzahl gastrointestinaler Erkrankungen ausgelöst werden. Bereits bei der Anamnese ist auf begleitende Warnsymptome und spezifische Auslöser zu achten. Der fäkale Entzündungsmarker Calprotecin kann zwar bei der Differenzierung zwischen organischen und funktionellen Magen-Darmerkrankungen helfen, ist jedoch nicht spezifisch.

Zur symptomatischen Therapie der chronischen Diarrhö stehen u. a. gelbildende Ballaststoffe, Loperamid und Colestyramin zur Verfügung und auch die Gabe von Probiotika kann symptomlindernd wirken. Der zur Therapie einer akuten Diarrhö zugelassene Enkephalinase-Inhibitors Racecadotril kann für eine Langzeitanwendung bei chronischer Diarrhö bisher nur wenige Daten vorweisen. Mit dem Wirkstoff Eluxadolin, der durch Modulierung von Opioid-Rezeptoren im Darmnervensystem Bauchschmerzen und Durchfälle lindern kann, steht voraussichtlich demnächst eine neue therapeutische Option zur Verfügung. Weitere medikamentöse Ansätze beim Therapie-refraktären Reizdarmsyndrom mit Diarrhö umfassen 5-HT3-Rezeptor-Antagonisten, das Antibiotikum Rifaximin sowie niedrig dosierte trizyklische Antidepressiva. Spezifische Diäten wie die low-FODMAP-Diät können ebenfalls Beschwerden des RDS lindern.

Abstract

Chronic, non-infectious diarrhea can be caused by a variety of gastrointestinal diseases. In anamnesis, it is important to take accompanying warning symptoms and specific triggers into account. The fecal inflammatory marker calprotectin may help differentiating between organic and functional gastrointestinal disorders, but it is not specific. Among other options, gelling fibres, Loperamide and Cholestyramine as well as probiotics are available for the symptomatic treatment of chronic diarrhea. For long-term treatment of chronic diarrhea with the enkephalinase inhibitor racecadotril, which is approved for acute diarrhea, only limited data are available. Eluxadolin presents a new therapeutic option. It can alleviate abdominal pain and diarrhea by modulation of opioid receptors in the enteric nervous system. Additional approaches in intractable irritable bowel syndrome with diarrhea (IBS-D) include 5-HT3 receptor antagonists, the antibiotic Rifaximin as well as low-dose tricyclic antidepressants. Specific diets such as the low-FODMAP diet can also relieve symptoms in IBS.

Schlüsselwörter

chronische nichtinfektiöse Diarrhö - Calprotectin - Diarrhö-dominantes Reizdarmsyndrom - Low-FODMAP-Diät

Keywords

chronic non-infectious diarrhea - calprotectin - IBS with diarrhea - low-FODMAP diet
 

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