Ärzte sind oft unsicher bei der Diagnose einer funktionellen gastrointestinalen Störung, Patienten lehnen die Diagnose häufig ab. Die Behandlung wird von beiden Seiten häufig frustran erlebt. Dieser Beitrag stellt Grundzüge einer abgestuften biopsychosozialen Diagnostik und Therapie von funktionellen gastrointestinalen Störungen vor. Die Darstellung der therapeutischen Optionen soll Sicherheit geben und zu einer größeren Zufriedenheit in der Arzt-Patienten-Interaktion führen.
Abstract
Approximately 50 % of chronic gastrointestinal symptoms in primary care can be attributed to functional gastrointestinal disorders (FGID). The most frequent gastrointestinal disorders are functional dyspepsia and irritable bowel syndrome. FGID are heterogenous with regards to the amount of symptoms and associated patient’s impairment as well as to the underlying pathophysiological mechanisms. The biopsychosocial model of FGID assumes that biological, psychological and social factors interact in the predisposition to and in the initiation and course of FGID. The Rome Foundation defines FGID as disorders of the brain-gut interaction.
Some physicians are hesitant to diagnose FGID due to the lack of specific biomarkers and/or structural changes in the gastrointestinal tract. In addition, some FGID to not respond well to conventional medications. Some patients are reluctant to accept the diagnosis of a FGID because they are afraid that a serious somatic disease has been missed and/or to be diagnosed as mentally ill.
The use of interdisciplinary evidence-based guidelines for diagnosis and management of FGID can increase the certainty of diagnosis and the therapeutic options for physicians. In addition, these guidelines include recommendations how to explain the disorder and the management to the patient to establish a trustful doctor-patient relationship.
FGID are diagnosed by the history of a typical cluster of symptoms and by guideline – recommended exclusion of somatic gastrointestinal disorders. FGID should be managed according to the main symptoms, the associated impairment and patients’ preferences in a graduated approach by education and by dietary, pharmacological and psychological treatments.
Schlüsselwörter
funktionelle gastrointestinale Störungen - biopsychosoziales Modell - interdisziplinäre Leitlinien - abgestufte Behandlung
Key words
functional gastrointestinal disorders - biopsychosocial model - interdisciplinary guidelines - graduated treatment approach
