Erkrankungen des Dünndarms (außer Morbus Crohn)

  • F. S. Lehmann
  • A. Leutenegger
  • U. Keller

Zusammenfassung

Maldigestion, die Störung der Verdauungsfunktion und Malabsorption, die verminderte Aufnahme in der Dünndarmschleimhaut, führen zur verminderten Resorption von Fetten, Kohlehydraten, Proteinen, Vitaminen, Mineralien und Spurenelementen und den entsprechenden Mangelerscheinungen. Störungen der Fettresorption sind oft durch einen Mangel an Pankreaslipase bedingt, wie er bei der chronischen Pankreatitis beobachtet wird. Dies führt nicht nur zur Ausscheidung von Fettstühlen (Steatorrhö), sondern langfristig auch zum Mangel an fettlöslichen Vitaminen (A, D, E, K). Laktoseintoleranz und Zöliakie (Sprue) sind die klinisch wichtigsten Störungen der Kohlehydratresorption. Bei der Laktoseintoleranz liegt ein Mangel an Laktase vor, sodass die Laktose nicht in Glukose und Galaktose gespalten und aufgenommen werden kann. Die Sprue ist eine gliadininduzierte Erkrankung der Dünndarmmukosa, die zu Zottenatrophie und damit zur mangelnden Resorption von Vitaminen (B12, K, D), Eisen, Folsäure und Kalzium führt.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Chlebowski RT, Grosvenor MB, Bernhard NH, Morales LS, Bulcavage LM (1989) Nutritional status, gastrointestinal dysfunction, and survival in patients with AIDS. Am J Gastroenterol 84:1288–1293PubMedGoogle Scholar
  2. Dobbins WO III (1995) The diagnosis of Whipple’s disease. N Engl J Med 332:390–391PubMedCrossRefGoogle Scholar
  3. Durand DV, Lecomte C, Cathebras P, Rousset H, Godeau P (1997) Whipple’s disease. Clinical review of 52 cases. Medicine Baltimore 76:170–184PubMedCrossRefGoogle Scholar
  4. Eeftinck-Schattenkerk JK, van Gool T, van Ketel RJ, Bartelsman JF, Kuiken CL, Terpstra WJ, Reiss P (1991) Clinical significance of small intestinal microsporidiosis in HIV-1-infected individuals. Lancet 337:895-BPubMedCrossRefGoogle Scholar
  5. Ferreira M, Davies SL, Butler M, Scott D, Clark M, Kumar P (1992) Endomysial antibody: is it the best screening test for coeliac disease? Gut 33:1633–1637PubMedCrossRefGoogle Scholar
  6. Guerrant RL, Bobak DA (1991) Bacterial and protozoal gastroenteritis. N Eng J Med 325:327–340CrossRefGoogle Scholar
  7. Holmes GK, Prior P, Lane MR, Pope D, Allan RN (1989) Malignancy in coeliac disease: effect of a gluten free diet. Gut 30:333-BPubMedCrossRefGoogle Scholar
  8. Kotier DP, Francisco A, Clayton F, Scholes JV, Orenstein JM (1990) Small intestinal injury and parasitic diseases in AIDS. Ann Intern Med 113:444–449CrossRefGoogle Scholar
  9. Lanciano RM, Martz K, Montana GS, Hanks GE (1992) Influence of age, prior abdominal surgery, fraction size, and dose on complications after radiation therapy for squamous cell cancer of the uterine cervix. A pattern of care study. Cancer 69:2124–2130Google Scholar
  10. Letschert JG, Lebesque JV, de Boer RW, Hart AA, Bartelink H (1990) Dose-volume correlation in radiation-related late small bowel complications: a clinical study. Radiother Oncol 18:307–320PubMedCrossRefGoogle Scholar
  11. Letschert JG, Lebesque JV, Aleman BM et al. (1994) The volume effect in radiation-related late small bowel complications: results of a clinical study of the EORTC Radiotherapy Cooperative Group in patients treated for rectal carcinoma. Radiother Oncol 32:116–123PubMedCrossRefGoogle Scholar
  12. Lowsky R, Archer GL, Fyles G et al. (1994) Brief report: Diagnosis of Whipple’s disease by molecular analysis of peripheral blood. N Engl J Med 331:1343–1346PubMedCrossRefGoogle Scholar
  13. Menke DM, Kyle RA, Fleming CR, Wolfe JT, Kurtin PJ, Oldenburg WA (1993) Symptomatic gastric amyloidosis in patients with primary systemic amyloidosis. Mayo Clin Proc 68:763–767PubMedCrossRefGoogle Scholar
  14. Müller C, Stain C, Burghuber O (1993) Tropheryma whippelii in peripheral blood mononuclear cells and cells of pleural effusion (letter). Lancet 341:701PubMedCrossRefGoogle Scholar
  15. Orenstein JM, Chiang J, Steinberg W, Smith PD, Rotterdam H, Kotler DP (1990) Intestinal microsporidiosis as a cause of diarrhea in human immunodeficiency virus-infected patients: a report of 20 cases. Hum Pathol 21:475–481PubMedCrossRefGoogle Scholar
  16. Porras JA, Reig R, Vidal F, Richart C (1994) Massive rectorrha-gia and hypovolemic shock in primary amyloidosis (letter). Am J Gastroenterol 89:643–644PubMedGoogle Scholar
  17. Relman DA, Schmidt TM, MacDermott RP, Flakow S (1992) Identification of the uncultured bacillus of Whipple’s disease. N Engl J Med 327:293–301PubMedCrossRefGoogle Scholar
  18. Sterchi EE, Mills PR, Fransen JAM, Hauri HP, Lentze MJ, Nairn HY, Ginsel L, Bond J (1990) Biogenesis of intestinal lactase-phlorizin hydrolase in adults with lactose intolerance: evidence for reduced biosynthesis and slowed-down maturation in enterocytes. J Clin Invest 86:1329–1337PubMedCrossRefGoogle Scholar
  19. Strocchi A, Levitt MD (1992) Factors affecting hydrogen production and consumption by human fecal flora; the critical roles of hydrogen tension and methanogenesis. J Clin Invest 89:1304–1311PubMedCrossRefGoogle Scholar
  20. Suarez FL, Savaiano DA, Levitt MD (1995) A comparison of symptoms after the consumption of milk or lactose-hydro-lyzed milk by people with self-reported severe lactose intolerance. New Engl J Med 333:1–4PubMedCrossRefGoogle Scholar
  21. Tada S, Lida M, Iwashita A, Matsui T, Fuchigami T, Yamamoto T, Yao T, Fuiishima M (1990) Endoscopic and biopsy findings of the upper digestive tract in patients with amyloidosis. Gastrointest Endosc 36:10–14PubMedCrossRefGoogle Scholar
  22. Unsworth DJ, Brown DL (1994) Serological screening suggests that adult coeliac disease is underdiagnosed in the UK and increases the incidence by up to 12%. Gut 35:61–64PubMedCrossRefGoogle Scholar
  23. Adachi Y, Matsushima T, Mori M, Sugimachi K, Oiwa T (1993) Blind loop syndrome: multiple ileal ulcers following side-to-side anastomosis. Pathology 25:402–404PubMedCrossRefGoogle Scholar
  24. Berry SM, Fischer JE (1994) Enterocutaneous fistulas. Curr Probi Surg 31:471–566Google Scholar
  25. Lewis SJ, Young G, Mann M, Franco S, O’Keefe S (1997) Improvement in specificity of 14C-d-xylose breath test for bacterial overgrowth. Dig Dis Sci 42:1587–1592PubMedCrossRefGoogle Scholar
  26. Longo WE, Vernava AM (1992) Clinical implications of jejunoileal diverticular diseases. Dis Colon Rectum 35:381–388PubMedCrossRefGoogle Scholar
  27. Nubiola P et al. (1989) Treatment of 27 post-operative enterocutaneous fistulas with the long half-life somatostatin analogue SMS 201–995. Ann Surg 210:56–58PubMedCrossRefGoogle Scholar
  28. Psathakis D, Utschakowski A, Muller G et al. (1994) Clinical significance of duodenal diverticula. J Am Coll Surg 178:257–260PubMedGoogle Scholar
  29. Saltzman JR, Kowdley KV, Pedrosa MC, Sepe T, Golner B, Perrone G, Russell RM (1994) Bacterial overgrowth without clinical malabsorption in elderly hypochlorhydric subjects. Gastroenterology 106:615–623PubMedGoogle Scholar
  30. Tsiotos GG, Farnell MB, Ilstrup D (1994) Non-meckelian jejunal or ileal diverticulosis: an analysis of 112 cases. Surgery 116:726–732PubMedGoogle Scholar
  31. Bianchi A (1997) Longitudinal intestinal lengthening and tailoring: results in 20 children. J R Soc Med 90(8):429–432PubMedGoogle Scholar
  32. Bühler L, Charbonnet P, Majno P, Kadry Z, Pichard C, Giostra E, Mentha G, Morel P (1997) Small intestine graft in Switzerland: indications and potential recipients. Schweiz Med Wo-chenschr Suppl 89:46S-50SGoogle Scholar
  33. Byrne TA, Persinger RL, Young LS, Ziegler TR, Wilmore DW (1995) A new treatment for patients with short-bowel syndrome. Growth hormone, glutamine, and a modified diet. Ann Surg 222:243–254PubMedCrossRefGoogle Scholar
  34. Deitel M, Wong KH (1985) The short-bowel syndrome. In: Deitel M (ed) Nutrition in clinical surgery, 2nd edn. Williams & Wilkins, Baltimore London Los Angeles SydneyGoogle Scholar
  35. Heeckt PF, Bauer AJ, Beger HG, Schraut WH (1995) Chirurgische Therapie des Kurzdarmsyndroms. Z Gastroenterol 33(1):15–19PubMedGoogle Scholar
  36. Kasper H, Scheppach W (1995) Kurzdarmsyndrom. In: Biesalski HK, Fürst P, Kasper H, Kluthe R, Pölert W, Puchstein C, Stähelin HB (Hrgs) Ernährungsmedizin. Thieme, Stuttgart New YorkGoogle Scholar
  37. King DR, Anvari M, Jamieson GG, King JM (1996) Does the colon adopt small bowel features in a small bowel environment? Aust N Z J Surg 66(8):543–546PubMedCrossRefGoogle Scholar
  38. Krähenbühl L, Büchler MW (1997) Pathophysiologie, Klinik und Therapie des Kurzdarmsyndroms. Chirurg 68(6):559–567PubMedCrossRefGoogle Scholar
  39. Nordgaard I, Hansen BS, Mortensen PB (1994) Colon as a digestive organ in patients with short bowel [see comments]. Lancet 343:373–376PubMedCrossRefGoogle Scholar
  40. Nour B, Van Thiel DH, Kocoshis S (1995) Intestinal failure and intestinal transplantation: new therapy for individuals sustaining large losses of bowel: a review. J Okla State Med Assoc 88(5):191–197PubMedGoogle Scholar
  41. Panis Y, Messing B, Rivet P, Coffin B, Hautefeuille P, Matuchansky C, Rambaud JC, Valleur P (1997) Segmental reversal of the small bowel as an alternative to intestinal transplantation in patients with short bowel syndrome. Ann Surg 225(4):401–407PubMedCrossRefGoogle Scholar
  42. Scolapio JS, Camilleri M, Fleming CR, Oenning LV, Burton DD, Sebo TJ, Batts KP, Kelly DG (1997) Effect of growth hormone, glutamine, and diet on adaptation in short-bowel syndrome: a randomized, controlled study [see comments]. Gastroenterology 113:1074–1081PubMedCrossRefGoogle Scholar
  43. Thompson JS, Langnas AN, Pinch LW, Kaufman S, Quigley EM, Vanderhoof JA (1995) Surgical approach to short-bowel syndrome. Experience in a population of 160 patients. Ann Surg 222(4):600–607PubMedGoogle Scholar
  44. Thompson JS (1996) The role of prophylactic cholecystectomy in the short-bowel syndrome. Arch Surg 131(5):556–560PubMedCrossRefGoogle Scholar
  45. Vanderhoof JA, Langnas AN (1997) Short-bowel syndrome in children and adults. Gastroenterology 113(5): 1767–1778PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2002

Authors and Affiliations

  • F. S. Lehmann
  • A. Leutenegger
  • U. Keller

There are no affiliations available

Personalised recommendations