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Reizdarm und Reizmagen – Pathophysiologie und Biomarker

Irritable bowel syndrome and functional dyspepsia—pathophysiology and biomarkers

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Der Gastroenterologe Aims and scope

Zusammenfassung

Funktionelle Magendarmerkrankungen, wie Reizdarm oder Reizmagen, gehören zu den häufigsten Gründen, warum Patienten den Arzt aufsuchen. Diagnose und gezielte Therapie bleiben bis heute eine große Herausforderung. Beide Syndrome werden bisher rein symptomenbasiert nach Ausschlussdiagnose diagnostiziert. Inzwischen ist aber klar, dass Reizdarm und Reizmagen mit definierten strukturellen, molekularen, genetischen, immunologischen, nervalen und psychosozialen Veränderungen assoziiert sind. Symptome werden durch Stress, Motilitätsstörungen, gastrointestinale Infektionen, Immunaktivierung sowie erhöhte mechanische und chemische Sensibilität ausgelöst bzw. verschlimmert. Die vielen heute bekannten Pathomechanismen spiegeln zum einen den multifaktoriellen Charakter wider, sind zum anderen aber auch Hinweise auf pathophysiologisch unterschiedliche Erkrankungssubtypen. Es ist zu erwarten, dass die weitere Aufklärung pathophysiologisch relevanter Faktoren und deren Clusteranalyse und Korrelation mit den klinischen Symptomen die Diagnostik und Therapie funktioneller Magen-Darm-Erkrankungen verbessert. In Zukunft könnten Biomarker helfen, Patienten besser zu klassifizieren und damit eine spezifische Therapieentscheidung zu ermöglichen.

Abstract

Functional gastrointestinal diseases such as irritable bowel syndrome (IBS) or functional dyspepsia (FD) are the most frequent causes why patients seek medical care. Diagnosis and therapy is a challenge. Both IBS and FD are a primarily symptom-based exclusion diagnosis. Recent findings indicate that IBS and FD are associated with well-defined structural, molecular, genetic, immunological, neural and psychosocial abnormalities. Symptoms are caused or worsen after particular diet, stress, gastroenteritis as well as mechanical and chemical hypersensitivity. The numerous pathophysiological mechanisms of IBS and FD reflect the multifactorial character of these diseases and strongly suggest the existence of distinct disease entities. It is expected that further insights into pathophysiological mechanisms, their clustering and association with clinical symptoms will improve diagnosis and therapy. The major challenge will be the development of biomarkers to better characterize IBS and FD subgroups and to treat the specific pathomechanisms.

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Danksagung

Der Autor bedankt sich bei der Deutschen Forschungsgemeinschaft für die kontinuierliche Förderung seiner Forschung seit dem Jahr 1988 und bei allen ehemaligen und aktuellen Mitarbeitern und Mitarbeiterinnen sowie den vielen nationalen und internationalen Kollaborationspartnern.

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  1. Lehrstuhl für Humanbiologie, Technische Universität München, Liesel Beckmann Strasse 4, 85354, Freising, Deutschland

    M. Schemann

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Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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M. Fried, Zürich

T. Frieling, Krefeld

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Schemann, M. Reizdarm und Reizmagen – Pathophysiologie und Biomarker. Gastroenterologe 12, 114–129 (2017). https://doi.org/10.1007/s11377-017-0143-7

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