Empfehlungen zur Therapie der chronischen Obstipation der Arbeitsgruppe für Funktionsdiagnostik und Psychosomatik der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie

Zusammenfassung

Obstipation ist eines der häufigsten gastroenterologischen Probleme, insbesondere im höheren Alter. Die chronische Obstipation wird nun über die Rom-III-Kriterien definiert. Lebensstilmaßnahmen helfen meist nur im frühen Stadium bzw. bei eher leichten Ausprägungen. Bei Obstipation ist auf eine mögliche ursächliche Arzneimittelnebenwirkung zu achten, bei Opioiden stehen neuerdings wirksame Antagonisten bei Obstipation zur Verfügung. Bei Versagen dieser Maßnahmen sind medikamentös Polyethylenglykol oder Laktulose langfristig zu bevorzugen. Psychodiagnostische Fragen zur Angst sollten zur Diagnostik herangezogen werden. Biofeedback ist dann eine effektive Therapie in dieser Situation und insbesondere bei Beckenbodendyssynergie. Chirurgische Interventionen sind selten indiziert bzw. erfolgreich, außer bei Beckenbodenauslassstörungen mit schweren anatomischen Veränderungen.

Abstract

Constipation is one of the most frequent gastroenterological problems, especially among elderly people. Chronic constipation is now defined by the new Rome III criteria. Life style counselling is usually only effective in early stages of disease and for mild types. In patients with constipation one should actively screen for possible causative, medically adverse events. Recently new effective opioid antagonists were introduced to act against constipation in patients on long-term opioid therapy. If these actions fail, medical therapy with polyethylene glycol or lactulose should be favoured in the long-term treatment. Psychodiagnostic queries concerning fear should be included in the diagnostic procedures. Biofeedback is an effective therapy in these cases and especially with pelvic floor dyssynergia. Surgical interventions are rarely indicated or successful with the exception of chronic outlet obstruction with severe anatomic changes.

Schlüsselwörter

Obstipation - opoidinduziert - PEG - Psychologie - Chirurgie

Key words

constipation - opoid-induced - PEG - psychology - surgery

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1 Arbeitsgruppe Funktionsdiagnostik und Psychosomatik der ÖGGH: Heinz Hammer, Johann Hammer, Antje Holzäpfel, Andreas Mayer, Gabriele Moser, Gabriele Novi, Reingard Platzer, Johann Pfeifer, Harald Vogelsang, Peter Weiss, Max Wunderlich.