Zusammenfassung
Hintergrund
Die funktionelle Dyspepsie (FD) und das Reizdarmsyndrom (RDS) sind die beiden wichtigsten funktionellen gastrointestinalen Erkrankungen. Sie betreffen jeweils etwa 5–15 % der Bevölkerung und stellen darüber hinaus bei etwa einem Drittel bis zur Hälfte der gastroenterologischen Patienten die Ursache für einen Arztbesuch dar. Die Behandlung ist oft nicht zufriedenstellend, was wesentlich dadurch bedingt wird, dass Pathogenese und Pathophysiologie unzureichend geklärt sind.
Pathogenese
Seit einigen Jahren wird die Bedeutung des Darmmikrobioms für Entstehung und Unterhaltung von Symptomen zunehmend deutlich. Die Verteilung der mikrobiellen Besiedlung des Gastrointestinaltrakts mit Zunahme der Keimdichte um viele Zehnerpotenzen von oral nach anal erklärt, weshalb dem Mikrobiom im Zusammenhang mit der FD weniger Bedeutung beigemessen wird. Es gibt hierzu bislang entsprechend wenige und kleine Studien, die keine klare Aussage zulassen. Es wird allerdings zunehmend evident, dass eine FD nach Gastroenteritiden entstehen kann. Für die wesentliche Beteiligung des Darmmikrobioms an der Entstehung von RDS-Symptomen sprechen 3 prinzipielle Beobachtungen: Am besten untersucht ist hierbei vermutlich die Bedeutung bakterieller gastrointestinaler Infekte, die das Risiko für ein RDS etwa 5-fach steigern. Zweitens wurden quantitative und qualitative Veränderungen des Mikrobioms im Dünn- und Dickdarm bei RDS-Patienten beschrieben. Drittens können Therapien, wie die Gabe von Pro- und Antibiotika, die auf eine Beeinflussung des Darmmikrobioms gerichtet sind, günstige Effekte haben.
Ausblick
Auch wenn das weitgehende Verständnis der relevanten Mechanismen noch lange nicht erreicht ist, erweitern Experten aufgrund der vorliegenden Daten jetzt bereits das etablierte Konzept der bei RDS gestörten „gut–brain axis“ um die Dimension des Mikrobioms zur „microbiome–gut–brain axis“.
Abstract
Background
Among the functional gastrointestinal diseases (FGID), functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the clinically most important entities. Both affect about 5–15 % of the population. Furthermore, they are the reason for a consultation in about one third to up to half of the gastroenterological patients. Therapy of FGID is often unsatisfactory. A major reason for this is that the pathogenesis and pathophysiology of both diseases are incompletely understood.
Pathogenesis
More recently, evidence has been accumulating that alterations of the gut microbiome are implicated in the development and persistence of symptoms. Currently, researchers are focusing on the importance of the microbiome for IBS. This is explained by the distribution of microbes in the human gastrointestinal tract with an increase of microbial density by several orders of magnitude between the stomach and the rectum. For FD, there are currently few and usually small studies that do not allow clear conclusions. However, evidence is increasing that FD can develop after gastroenteritis. For IBS, three main lines of evidence indicate that bacteria may be involved in the pathogenesis and pathophysiology of the disease: First, bacterial gastrointestinal infections increase the risk for developing IBS about 5-fold. Second, quantitative and qualitative alterations of the small and large intestinal microbiome have been observed in IBS. Third, studies report positive effects of treatments directed at gut microbiota such as probiotics and antibiotics.
Future
Comprehension of relevant mechanisms is only fragmentary, so far. However, based on current data experts already extend the established concept of the disturbed gut–brain axis in FGID to also include the microbiome (microbiome–gut–brain axis).
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Interessenkonflikt . J. Keller und V. Andresen geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Keller, J., Andresen, V. Darmmikrobiom und funktionelle gastrointestinale Erkrankungen. Gastroenterologe 10, 102–110 (2015). https://doi.org/10.1007/s11377-014-0964-6
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DOI: https://doi.org/10.1007/s11377-014-0964-6