Chronische intestinale Pseudoobstruktion – Übersicht und Update 2008

 

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Zusammenfassung

Bei der chronischen intestinalen Pseudoobstruktion handelt es sich um eine gravierende Störung der gastrointestinalen Motilität, die klinisch schwer vom Bild der mechanischen intestinalen Obstruktion zu differenzieren ist. Zugrunde liegen können Neuropathien des extrinsischen oder intrinsischen Nervensystems oder intestinale Myopathien. Fast ein Drittel der Patienten benötigt langfristig eine parenterale Heimernährung. Chirurgische Eingriffe bis hin zur Dünndarmtransplantation müssen erforderlichenfalls angewendet werden, um vital bedrohliche Verläufe abzuwenden. Wenngleich sich das Verständnis von Pathogenese und therapeutischen Ansätzen der seltenen Entität noch stark im Fluss befinden, erlaubt der aktuelle Wissenstand eine differenzierte Diagnostik, eine Klassifikation der primären und sekundären Ursachen und eine gezielte Therapie.

Abstract

The term chronic intestinal pseudo-obstruction describes a syndrome of severly altered gastrointestinal motility that clinically resembles mechanical intestinal obstruction. The syndrome comprises numerous underlying primary or secondary neuropathies of the intrinsic or entrinsic nervous system as well myopathies. Almost a third of the patients requires long-term total parenteral nutrition (TPN). However, emergency surgery and even small bowel transplantation as an ultimate option after failure of TPN may become necessary to evade a vital threat. Although our understanding of pathogenesis and therapeutical options is still evolving, current knowledge allows a differentiated diagnostic approach, classification of the primary and secondary causes and differentiated therapy.

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Dr. Holger Seidl

Abteilung für Gastroenterologie, Hepatologie und Gastroenterologische Onkologie, Klinikum München-Bogenhausen

Englschalkinger Str. 77

81925 München

Email: H.Seidl@lrz.tum.de