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Der Gastroenterologe

, Volume 12, Issue 2, pp 135–140 | Cite as

Medikamentöse Therapien bei Reizmagen und Reizdarm

  • V. Schindler
  • D. Pohl
Schwerpunkt
  • 442 Downloads

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.

Schlüsselwörter

Spasmolytika Diarrhö Probiotika Lifestyle Helicobacter pylori Reizdarmsyndrom (RDS) 

Drug therapy for functional dyspepsia and irritable bowel syndrome

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.

Keywords

Spasmolytics Diarrhea Probiotics  Life style Helicobacter pylori Irritable bowel syndrome (IBS) 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

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.

Literatur

  1. 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 19:245–251CrossRefPubMedGoogle Scholar
  2. 2.
    Bryson HM, Wilde MI (1996) Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states. Drugs Aging 8:459–476CrossRefPubMedGoogle Scholar
  3. 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 355:1035–1040CrossRefPubMedGoogle Scholar
  4. 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 108:1508–1515CrossRefPubMedGoogle Scholar
  5. 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 107:1702–1712CrossRefPubMedGoogle Scholar
  6. 6.
    Efskind PS, Bernklev T, Vatn MH (1996) A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol 31:463–468CrossRefPubMedGoogle Scholar
  7. 7.
    Everhart JE, Renault PF (1991) Irritable bowel syndrome in office-based practice in the United States. Gastroenterology 100:998–1005CrossRefPubMedGoogle Scholar
  8. 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. 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 102:957–965CrossRefPubMedGoogle Scholar
  10. 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)CrossRefPubMedGoogle Scholar
  11. 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)CrossRefPubMedGoogle Scholar
  12. 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:a2313CrossRefPubMedPubMedCentralGoogle Scholar
  13. 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) 45:143–147CrossRefGoogle Scholar
  14. 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 63:1617–1625CrossRefPubMedGoogle Scholar
  15. 15.
    Hojo M, Miwa H, Yokoyama T et al (2005) Treatment of functional dyspepsia with antianxiety or antidepressive agents: systematic review. J Gastroenterol 40:1036–1042CrossRefPubMedGoogle Scholar
  16. 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 48:505–512PubMedGoogle Scholar
  17. 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 CrossRefPubMedGoogle Scholar
  18. 18.
    Lembo AJ, Lacy BE, Zuckerman MJ et al (2016) Eluxadoline for irritable bowel syndrome with diarrhea. N Engl J Med 374:242–253CrossRefPubMedGoogle Scholar
  19. 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 91:456–468CrossRefPubMedGoogle Scholar
  20. 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 20:1279–1287CrossRefPubMedGoogle Scholar
  21. 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)CrossRefPubMedGoogle Scholar
  22. 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.e1CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Sugano K, Tack J, Kuipers EJ et al (2015) Kyoto global consensus report on Helicobacter pylori gastritis. Gut 64:1353–1367CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Talley NJ, Vakil NB, Moayyedi P (2005) American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology 129:1756–1780CrossRefPubMedGoogle Scholar
  25. 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)CrossRefPubMedGoogle Scholar
  26. 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 102:1268–1275CrossRefGoogle Scholar
  27. 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)CrossRefPubMedGoogle Scholar
  28. 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 30:707–717CrossRefPubMedGoogle Scholar
  29. 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 57:1222–1226CrossRefPubMedGoogle Scholar
  30. 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.e9CrossRefPubMedGoogle Scholar
  31. 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 2014:541950PubMedPubMedCentralGoogle Scholar
  32. 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 48:241–247CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag Berlin 2017

Authors and Affiliations

  1. 1.Klinik für Gastroenterologie und HepatologieUniversitätsspital ZürichZürichSchweiz

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