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Medikamentöse Therapien bei Reizmagen und Reizdarm

Drug therapy for functional dyspepsia and irritable bowel syndrome

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Zusammenfassung

Die funktionelle Dyspepsie (FD) und das Reizdarmsyndrom (RDS) stellen einen Großteil der funktionellen gastrointestinalen Erkrankungen in der Bevölkerung dar. Neben psychologischen und ernährungsmedizinischen Therapieansätzen wurden über die letzten Jahre diverse medikamentöse Behandlungen diskutiert und erforscht. Zur Therapie der FD zählt nach Aufklärung und Versicherung bezüglich Benignität des Leidens und Allgemeinmaßnahmen (diätetisch, verhaltenstechnisch) die medikamentöse Intervention. First-line-Therapieverfahren umfassen die gastrale Säuresuppression, natürliche Pflanzenextrakte, Prokinetika sowie zweitrangig Modulatoren der viszeralen Hypersensitivität und Antidepressiva verschiedener Klassen. Des Weiteren wird beim Nachweis von Helicobacter pylori dessen Eradikation angestrebt. Beim RDS wird subtypenspezifischer (RDS-C und RDS-D) und nach Stufenschema behandelt. Eine sinnvolle Basistherapie beider Subtypen stellen Stuhlregulanzien dar. Die weiteren Therapieoptionen richten sich nach den prädominanten Symptomen der Patienten. Neben hauptsächlich peripher wirkenden Substanzklassen, wie die Sekretagoga oder die μ‑Opioid-Agonisten, gibt es systemisch wirkende Substanzklassen wie die Antidepressiva, die 5‑HT3-Antagonisten, die Prokinetika oder auch die Spasmolytika. Zusätzlich können sich Antibiotika (wie beispielsweise Rifaximin) oder Probiotika positiv auf die RDS-Symptome und/oder das Stuhlverhalten auswirken. Erfreulicherweise steht ein wachsendes Armamentarium von Therapieoptionen in der medikamentösen Therapie funktioneller Magen-Darm-Erkrankungen zur Verfügung. In den letzten Jahren wurden neue Therapieklassen dem Markt zugänglich gemacht; zahlreiche weitere sind in der klinischen Erforschung oder kurz vor der Zulassung.

Abstract

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) represent the majority of functional gastrointestinal disorders (FGID) in the general population. Apart from psychological and dietary modifications, several pharmaceutical therapies have been discussed and studied. After reassurance and lifestyle adaptions, pharmaceutical agents may be used in FD therapy. Gastric acid-suppressive drugs, natural plant extracts, and prokinetics represent first-line therapies, while modulators of visceral hypersensitivity and antidepressants are considered second-line therapies. Furthermore, in case of Helicobacter pylori positivity eradication is recommended. In IBS, treatment depends more stringently on subtypes (constipation or diarrhea dominant) and is usually done in a step-up approach. A reasonable basic therapy in IBS consists of stool regulation. The type and severity of symptoms determine further IBS treatment. Besides peripherally acting drugs such as secrectogogues or μ‑opioid agonists, there are centrally acting drugs such as antidepressants, 5‑HT3 antagonists, prokinetics, or antispasmodics. In addition, IBS symptoms and/or bowel habits may improve after antibiotic (e. g., rifaximin) or probiotic therapies. Fortunately, a growing armamentarium of pharmaceutical treatment options for FGIDs is available. Recently, new drugs have been approved and several more are under development or shortly before approval.

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Literatur

  1. Bijkerk CJ, Muris JW, Knottnerus JA et al (2004) Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 19:245–251

    Article  CAS  PubMed  Google Scholar 

  2. Bryson HM, Wilde MI (1996) Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states. Drugs Aging 8:459–476

    Article  CAS  PubMed  Google Scholar 

  3. Camilleri M, Northcutt AR, Kong S et al (2000) Efficacy and safety of alosetron in women with irritable bowel syndrome: a randomised, placebo-controlled trial. Lancet 355:1035–1040

    Article  CAS  PubMed  Google Scholar 

  4. Chapman RW, Stanghellini V, Geraint M et al (2013) Randomized clinical trial: macrogol/PEG 3350 plus electrolytes for treatment of patients with constipation associated with irritable bowel syndrome. Am J Gastroenterol 108:1508–1515

    Article  CAS  PubMed  Google Scholar 

  5. Chey WD, Lembo AJ, Lavins BJ et al (2012) Linaclotide for irritable bowel syndrome with constipation: a 26-week, randomized, double-blind, placebo-controlled trial to evaluate efficacy and safety. Am J Gastroenterol 107:1702–1712

    Article  CAS  PubMed  Google Scholar 

  6. Efskind PS, Bernklev T, Vatn MH (1996) A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol 31:463–468

    Article  CAS  PubMed  Google Scholar 

  7. Everhart JE, Renault PF (1991) Irritable bowel syndrome in office-based practice in the United States. Gastroenterology 100:998–1005

    Article  CAS  PubMed  Google Scholar 

  8. Ford AC, Delaney BC, Forman D et al (2006) Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients. Cochrane Database Syst Rev. doi:10.1002/14651858.cd003840.pub2

    Google Scholar 

  9. Ford AC, Forman D, Bailey AG et al (2007) Who consults with dyspepsia? Results from a longitudinal 10-yr follow-up study. Am J Gastroenterol 102:957–965

    Article  PubMed  Google Scholar 

  10. Ford AC, Moayyedi P, Lacy BE et al (2014) American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol 109(Suppl 1):S2–S26 (quiz S27)

    Article  PubMed  Google Scholar 

  11. Ford AC, Quigley EM, Lacy BE et al (2014) Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol 109:1547–1561 (quiz 1546, 1562)

    Article  PubMed  Google Scholar 

  12. Ford AC, Talley NJ, Spiegel BM et al (2008) Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 337:a2313

    Article  PubMed  PubMed Central  Google Scholar 

  13. Friesen CA, Sandridge L, Andre L et al (2006) Mucosal eosinophilia and response to H1/H2 antagonist and cromolyn therapy in pediatric dyspepsia. Clin Pediatr (Phila) 45:143–147

    Article  Google Scholar 

  14. Garsed K, Chernova J, Hastings M et al (2014) A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut 63:1617–1625

    Article  CAS  PubMed  Google Scholar 

  15. Hojo M, Miwa H, Yokoyama T et al (2005) Treatment of functional dyspepsia with antianxiety or antidepressive agents: systematic review. J Gastroenterol 40:1036–1042

    Article  CAS  PubMed  Google Scholar 

  16. Khanna R, Macdonald JK, Levesque BG (2014) Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol 48:505–512

    PubMed  Google Scholar 

  17. Lembo A, Pimentel M, Rao SS et al (2016) Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome. Gastroenterology 151(6):1113–1121. doi:10.1053/j.gastro.2016.08.003

    Article  CAS  PubMed  Google Scholar 

  18. Lembo AJ, Lacy BE, Zuckerman MJ et al (2016) Eluxadoline for irritable bowel syndrome with diarrhea. N Engl J Med 374:242–253

    Article  CAS  PubMed  Google Scholar 

  19. Li F, Fu T, Tong WD et al (2016) Lubiprostone is effective in the treatment of chronic idiopathic constipation and irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc 91:456–468

    Article  PubMed  Google Scholar 

  20. Melzer J, Rosch W, Reichling J et al (2004) Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 20:1279–1287

    Article  CAS  PubMed  Google Scholar 

  21. Menees SB, Maneerattannaporn M, Kim HM et al (2012) The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 107:28–35 (quiz 36)

    Article  CAS  PubMed  Google Scholar 

  22. Rao AS, Wong BS, Camilleri M et al (2010) Chenodeoxycholate in females with irritable bowel syndrome-constipation: a pharmacodynamic and pharmacogenetic analysis. Gastroenterology 139:1549–1558.e1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Sugano K, Tack J, Kuipers EJ et al (2015) Kyoto global consensus report on Helicobacter pylori gastritis. Gut 64:1353–1367

    Article  PubMed  PubMed Central  Google Scholar 

  24. Talley NJ, Vakil NB, Moayyedi P (2005) American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology 129:1756–1780

    Article  PubMed  Google Scholar 

  25. Van Kerkhoven LA, Laheij RJ, Aparicio N et al (2008) Effect of the antidepressant venlafaxine in functional dyspepsia: a randomized, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol 6:746–752 (quiz 718)

    Article  PubMed  Google Scholar 

  26. Von Arnim U, Peitz U, Vinson B et al (2007) STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol 102:1268–1275

    Article  Google Scholar 

  27. Wang WH, Huang JQ, Zheng GF et al (2007) Effects of proton-pump inhibitors on functional dyspepsia: a meta-analysis of randomized placebo-controlled trials. Clin Gastroenterol Hepatol 5:178–185 (quiz 140)

    Article  CAS  PubMed  Google Scholar 

  28. Wedlake L, A’hern R, Russell D et al (2009) 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 30:707–717

    Article  CAS  PubMed  Google Scholar 

  29. Wong BS, Camilleri M, Carlson PJ et al (2012) Pharmacogenetics of the effects of colesevelam on colonic transit in irritable bowel syndrome with diarrhea. Dig Dis Sci 57:1222–1226

    Article  CAS  PubMed  Google Scholar 

  30. Wouters MM, Balemans D, Van Wanrooy S et al (2016) Histamine receptor H1-mediated sensitization of TRPV1 mediates visceral hypersensitivity and symptoms in patients with irritable bowel syndrome. Gastroenterology 150:875–887.e9

    Article  CAS  PubMed  Google Scholar 

  31. Xiao G, Xie X, Fan J et al (2014) Efficacy and safety of acotiamide for the treatment of functional dyspepsia: systematic review and meta-analysis. ScientificWorldJournal 2014:541950

    PubMed  PubMed Central  Google Scholar 

  32. Zhao B, Zhao J, Cheng WF et al (2014) Efficacy of Helicobacter pylori eradication therapy on functional dyspepsia: a meta-analysis of randomized controlled studies with 12-month follow-up. J Clin Gastroenterol 48:241–247

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz

    V. Schindler &  D. Pohl

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  1. V. Schindler
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  2. D. Pohl
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Correspondence to D. Pohl.

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V. Schindler wird von Allergan plc unterstützt. D. Pohl hält Vorträge und ist Berater bei den Firmen Allergan und Vifor.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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T. Frieling, Krefeld

M. Fried, Zürich

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Schindler, V., Pohl, D. Medikamentöse Therapien bei Reizmagen und Reizdarm. Gastroenterologe 12, 135–140 (2017). https://doi.org/10.1007/s11377-017-0145-5

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