Antidiarrhoika bei chronischer Diarrhoe

Zusammenfassung

Chronischer Diarrhoe können zahlreiche Ursachen zugrunde liegen, so dass eine geeignete Basisdiagnostik erforderlich ist. Wann immer möglich sollte entsprechend eine spezifische Therapie durchgeführt werden. Ist keine spezielle Therapie möglich, kann eine symptomatische Therapie eingeleitet werden, um dem massiven Elektrolyt- und Wasserverlust entgegenzuwirken und eine Besserung der Lebensqualität des Patienten zu erreichen. Zum Einsatz kommen insbesondere Loperamid, Colestyramin, Quellstoffe/Ballaststoffe, Probiotika, Anticholinerika und bei schweren Verläufen Opioide. Bei sachgemäßem Einsatz der o. g. Medikamente ist selbst eine Dauertherapie mit einem niedrigen Nebenwirkungspotential verbunden.

Abstract

Chronic diarrhea can be caused by multiple disease entities. Basic diagnostic tests are required in order to administer specific therapies whenever possible. If no specific treatment can be used, a symptomatic management should be initiated in order to prevent massive electrolyte- and water losses. Substances that can be used are loperamide, cholestyramine, bulking agents, probiotics, anticholinergic agents and in severe cases opioids. If used properly these agents can be prescribed longterm with an acceptable side effect profile.

Schlüsselwörter

Differenzialdiagnose - Gallensäureverlustsyndrom - Opioide - Megacolon

Keywords

differential diagnosis - bile acid malabsorption - opioids - megacolon

• Literatur

• 1 Abraham BP, Sellin JH. Drug-induced, factitious, & idiopathic diarrhoea. Best Pract Res Clin Gastroenterol 2012; 26: 633-648
• 2 Benson 3rd AB, Ajani JA, Catalano RB et al. Recommended guidelines for the treatment of cancer treatment-induced diarrhea. J Clin Oncol 2004; 22: 2918-2926
• 3 Corbould A, Campbell J. Efficacy of octreotide but not long-acting somatostatin analogue for severe refractory diabetic diarrhoea. Diabet Med 2009; 26: 828-829
• 4 DiStefano PS, Brown OM. Biochemical correlates of morphine withdrawal. 2. Effects of clonidine. J Pharmacol Exp Ther 1985; 233: 339-344
• 5 Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol 1996; 31: 463-468
• 6 Fedorak RN, Field M, Chang EB. Treatment of diabetic diarrhea with clonidine. Ann Intern Med 1985; 102: 197-199
• 7 Fine KD, Schiller LR. AGA technical review on the evaluation and management of chronic diarrhea. Gastroenterology 1999; 116: 1464-1486
• 8 Hoffmann JC, Zeitz M. Small bowel disease in the elderly: diarrhoea and malabsorption. Best Pract Res Clin Gastroenterol 2002; 16: 17-36
• 9 Kaiser L, Surawicz CM. Infectious causes of chronic diarrhoea. Best Pract Res Clin Gastroenterol 2012; 26: 563-571
• 10 Li Z, Vaziri H. Treatment of chronic diarrhoea. Best Pract Res Clin Gastroenterol 2012; 26: 677-687
• 11 McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol 2008; 14: 2650-2661
• 12 Meyer C, O'Neal DN, Connell W et al. Octreotide treatment of severe diabetic diarrhoea. Intern Med J 2003; 33: 617-618
• 13 Murray JA, Rubio-Tapia A. Diarrhoea due to small bowel diseases. Best Pract Res Clin Gastroenterol 2012; 26: 581-600
• 14 Nehra V, Camilleri M, Burton D et al. An open trial of octreotide long-acting release in the management of short bowel syndrome. Am J Gastroenterol 2001; 96: 1494-1498
• 15 Parisi GC, Zilli M, Miani MP et al. High-fiber diet supplementation in patients with irritable bowel syndrome (IBS): a multicenter, randomized, open trial comparison between wheat bran diet and partially hydrolyzed guar gum (PHGG). Dig Dis Sci 2002; 47: 1697-1704
• 16 Roy SL, Scallan E, Beach MJ. The rate of acute gastrointestinal illness in developed countries. J Water Health 2006; 4 (Suppl. 02) 31-69
• 17 Schiller LR. Definitions, pathophysiology, and evaluation of chronic diarrhoea. Best Pract Res Clin Gastroenterol 2012; 26: 551-562
• 18 Wald A. Irritable bowel syndrome – diarrhoea. Best Pract Res Clin Gastroenterol 2012; 26: 573-580
• 19 Walley T, Milson D. Loperamide related toxic megacolon in Clostridium difficile colitis. Postgrad Med J 1990; 66: 582
• 20 Walters JR, Tasleem AM, Omer OS et al. A new mechanism for bile acid diarrhea: defective feedback inhibition of bile acid biosynthesis. Clin Gastroenterol Hepatol 2009; 7: 1189-1194
• 21 Wedlake L, A'Hern R, Russell D et al. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2009; 30: 707-717