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Divertikulitis

Domäne der konservativen bzw. medikamentösen Therapie?

Diverticulitis

Domain of conservative or drug therapy?

  • Arzneimitteltherapie
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Zusammenfassung

Ein verstärktes Interesse der Wissenschaftsgemeinschaft an der Divertikelkrankheit in den letzten 10–15 Jahren hat zu vermehrten Publikationen geführt. Unter anderem wurden nicht evidenzbasierte therapeutische Paradigmen in randomisierten, kontrollierten Therapiestudien überprüft. Die Bedeutung der Chirurgie in der Therapie der Divertikulitis hat in den vergangenen Jahren abgenommen, insbesondere hat sie keine Bedeutung bei der erfolgreich konservativ behandelten Divertikulitis von Typ 1a, 1b und auch 2a nach Classification of diverticular disease (CDD). Weiterhin hat die Chirurgie nur noch einen untergeordneten Stellenwert bei der rezidivierenden Divertikulitis von Typ 3b nach CDD. Die Divertikulitis ist also tatsächlich zunehmend eine Domäne der konservativen bzw. der medikamentösen Therapie. Als wirksame Medikamente für die Behandlung der Divertikelkrankheit stehen uns allerdings derzeit nur die klassischen, etablierten Antibiotika zur Verfügung. Auch diese werden allerdings in ihrer Bedeutung zurückgedrängt. Über 90 % der Patienten mit Typ 1a/1b können gemäß aktuellen Daten sicher ohne den Einsatz von Antibiotika behandelt werden. Möglicherweise wird in Zukunft auch Typ 2a erfolgreich ohne Antibiotika zu behandeln sein. Substanzen wie Rifaximin, Mesalazin oder Probiotika, die vor allen Dingen bei den chronisch rezidivierenden Formen (CDD Typ 3a/3b) geprüft wurden, konnten sich bislang nicht etablieren.

Abstract

Increasing interest in diverticular disease by the scientific community in the last 10–15 years has resulted in an increased number of publications. Among other things, nonevidence-based therapeutic paradigms were tested in randomized, controlled therapy studies. The importance of surgery in the therapy of diverticulitis has diminished in recent years; in particular, it has no role in the treatment of diverticulitis types 1a, 1b, and 2a according to the Classification of Diverticular Disease (CDD) treated successfully by conservative means. Surgery has only a subordinate role in recurrent type 3b diverticulitis according to the CDD. Diverticulitis is therefore increasingly treated using conservative or drug therapy. However, only the classic, established antibiotics are currently available as effective drugs for the treatment of diverticular disease. However, these are also decreasing in significance. Over 90% of patients with type 1a/1b diverticulitis can be safely treated according to current data without the use of antibiotics. It is possible that type 2a diverticulitis will also be successfully treated without antibiotics in the future. Substances such as rifaximin, mesalazine, or probiotics, which were tested above all in patients with chronic recurrent forms (CDD type 3a/3b), have not yet been established.

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Authors and Affiliations

  1. Spital Bülach, Spitalstr. 24, 8180, Bülach, Schweiz

    S. Böhm

  2. Evangelisches Krankenhaus Köln-Kalk, Köln, Deutschland

    W. Kruis

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  1. S. Böhm
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Correspondence to S. Böhm.

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Interessenkonflikt

S. Böhm gibt an, dass kein Interessenkonflikt besteht. W. Kruis: Vortragshonorare und Beratung von der Falk Foundation und Dr. Falk Pharma GmbH, Freiburg/Breisgau.

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

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M. Wehling, Mannheim

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Böhm, S., Kruis, W. Divertikulitis. Internist 58, 745–752 (2017). https://doi.org/10.1007/s00108-017-0266-4

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