Gastrointestinale Motilitätsstörungen bei Intensivpatienten

Was ist neu?

Diagnostik von gastrointestinalen Motilitätsstörungen Die Klärung der Ätiologie einer gastrointestinalen Motilitätsstörung auf der Intensivstation umfasst bis heute vor allem die Anamnese und die klinische Diagnostik. Die Erhebung des gastralen Residualvolumens wird nicht mehr generell empfohlen.

Therapie Vor allem die Behandlung der Hypomotilität steht im Fokus neuer medikamentöser Behandlungsansätze. Für die Funktionsstörung des oberen Gastrointestinaltrakts werden Metoclopramid und Erythromycin verwendet. Ein rein peripher wirksamer Dopamin-Rezeptor-Antagonist Trazpiroben befindet sich in klinischer Testung. Ein möglicher Einsatz von Neurokinin-1-Rezeptor-Antagonisten wie Aprepitant erfolgt off-label. Die Behandlung der Parese des unteren Gastrointestinaltrakts erfolgt mittels osmotischer und stimulierender Laxanzien und bei höhergradiger Paralyse auch mit indirekten Parasympatholytika. Peripher wirkende μ-Opioid-Rezeptor-Antagonisten (z. B. Methylnaltrexon) zeigen keinen Zusatznutzen. Hochselektive Serotonin-Rezeptor-Agonisten wie Prucaloprid bieten hier mögliche neue Therapieansätze.

Abstract

The gastrointestinal tract is one of the most complex organ systems of the human body. On the one hand, it forms the absorption surface for nutrients, but on the other hand it is also a barrier for toxins, food components and against up to 10¹⁴ commensal microorganisms. The complexity of the interplay between absorption, motility and immune functions of the gastrointestinal tract is particularly evident in critically ill patients. In this article, we review the latest updates on pathogenic relationships of motility disorders and diagnostic algorithms in intensive care patients. In addition to established therapies, new developments in the treatment of hypomotility are outlined.

Schlüsselwörter

Intensivmedizin - Motilitätsstörung - Behandlung

Key words

intensive care - hypomotility - treatment

Publication History

Article published online:
30 May 2022

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