Zusammenfassung
Kritisch kranke Patienten leiden häufig unter Störungen der Darmmotilität, einerseits als Folge der primären Erkrankung, welche die Aufnahme auf eine Intensivstation notwendig macht, andererseits als Komplikation des Intensivaufenthaltes. Störungen der Darmmotilität können durch Beeinträchtigungen der muskulären Funktion des Gastrointestinaltraktes, der Schrittmacherzellen des Darmes oder der nervalen Aktivität ausgelöst werden. Das enterale Nervensystem als neuronales Kontrollsystem des Darmes, enthält die größte Ansammlung von Nervenzellen (108 Zellen) außerhalb des zentralen Nervensystems. Das enterische Nervensystem funktioniert unabhängig vom zentralen Nervensystem und generiert nach Bedarf verschiedenste Motilitätsmuster: Die postprandiale Motilität beginnt nach der Nahrungsaufnahme, die interdigestive Motilität startet einige Stunden nach dem Essen. Wichtig für eine ungestörte Motilität ist die balancierte Interaktion zwischen hemmenden und stimulierenden Einflüssen. Kommt dieses Gleichgewicht aus dem Lot, sind schwere Darmmotilitätsstörungen, welche sich nach ihrem klinischen Erscheinungsbild und ihrer Ausbreitung unterscheiden, die Folge. Diese Übersichtsarbeit befasst sich mit dem Erscheinungsbild spezieller Motilitätsstörungen (Gastroparese, Postoperativer Ileus und Ogilvie Syndrom) sowie mit allgemeinen und speziellen Therapieoptionen, um die Häufigkeit oder den Schweregrad dieser Motilitätsstörungen zu reduzieren.
Summary
Critical illness affects gastrointestinal motility – not only as a primary problem, which brings the patient to the intensive care unit (ICU), but also as a complication consecutive to the ICU stay. Motility disturbances may result from impaired function of gastrointestinal muscle, pacemaker cell function and nerve activity. The most important neural control system is the enteric nervous system that contains the largest collection of neurons (108 cells) outside the central nervous system. Through its organization it can operate independently of the brain and generate motility patterns according to need: a postprandial motility pattern starting after food intake, and an interdigestive motility pattern starting several hours after a meal. Undisturbed intestinal motility depends critically on a balanced interaction between inhibition and excitation, and a disturbance in this balance leads to severe derangements of intestinal motility. These motility disturbances differ in clinical appearance and location but can affect all parts of the gastrointestinal tract. This review focuses on select motility disturbances such as gastroparesis, postoperative ileus, and Ogilvie's syndrome. Generally effective methods to treat these conditions are given. Finally, we focus on special management options to prevent such motility disturbances or to reduce their severity.
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Fruhwald, S., Holzer, P. & Metzler, H. Gastrointestinal motility in acute illness. Wien Klin Wochenschr 120, 6–17 (2008). https://doi.org/10.1007/s00508-007-0920-2
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DOI: https://doi.org/10.1007/s00508-007-0920-2