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Alte und neue Erkenntnisse zu den Durchfallerkrankungen im Kindesalter

Past and present aspects of diarrheal disease in childhood. I: Etiology and pathophysiology

I. Ätiologie und Pathophysiologie

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Zusammenfassung

Die vorliegende Arbeit ist eine Bestandsaufnahme und Zusammenfassung der jüngsten Forschungsergebnisse auf dem Gebiete der akuten Durchfallerkrankungen. Der entscheidende Fortschritt besteht darin, daß wir nun die Hauptursache aller Durchfallerkrankungen in einer Störung der bakteriellen intestinalen Homöostase sehen. Die Überwucherung des Dünndarmes mit apathogenen und pathogenen Keimen hat Veränderungen im intestinalen Metabolismus zur Folge, die zu gesteigerter intestinaler Wasser-und Elektrolytsekretion führen. Anaerobe Keime führen durch enzymatische Dekonjugation und Dehydroxylation von Gallensäuren zu Flüssigkeitssekretion im Dünndarm und Hemmung der Flüssigkeitsabsorption im Dickdarm. 10-OH-Fettsäuren, die von enzymbildenden anaeroben Keimen aus langkettigen Fettsäuren der Nahrung intraluminal gebildet werden, bewirken eine profuse Flüssigkeitssekretion im Dünndarm. Die Fähigkeit zahlreicher Stämme von E. coli zur Bildung eines Enterotoxins, das qualitativ ähnliche Wirkung wie das Choleratoxin hat, wurde als eine weitere Ursache für den akuten kindlichen Durchfall entdeckt. Die Trennung zweier völlig verschiedener pathogener Mechanismen der Colibakterien, nämlich der enterotoxischen und der enteroinvasiven Wirkung, die von extranukleärem chromosomalem Material bestimmt werden, ist ebenso ein Ergebnis jüngster Forschung. Überwucherung des Dünndarmes mit Bakterien führt aus noch ungeklärten Gründen zum Verlust der Laktaseaktivität und später der Aktivität aller Disaccharidasen in der Darmschleimhaut.

Summary

The present article is a comprehensive review of recent research results in the field of acute diarrhea. The most important new idea in contrast to older views is that almost all acute diarrheas are associated with a disturbance of intestinal bacterial homeostasis: overgrowth of the small intestine with apathogenic or pathogenic organisms is followed by changes in intestinal metabolism with increase in intestinal water and electrolyte secretion. Anaerobic organisms cause by enzymatic deconjugation and dydroxylation of bile acids secretion of fluid into the small intestine and inhibition of fluid absorption from the large intestine. 10-OH-fatty acids, which are formed intraluminally by enzymatic hydroxylation of long-chain unsaturated fatty acids from the diety by similar anaerobic organisms, produce profuse secretion of fluid into the small intestine. The ability of numerous strains of E. Coli to produce enterotoxin, which has a qualitatively similar action to cholera toxin, is now considered to be a major cause of infantile diarrhea. The separation of two completely different pathophysiologic mechanisms of E. Coli, the enterotoxic and the enteroinvasive action which are determined by extranuclear chromosomal material, is an important result of recent research. Overgrowth of the small intestine with different bacteria is followed by loss of activity of lactase, and later of all disaccharidases in the intestinal mucosa.

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  1. Universitäts-Kinderklinik, Anichstr. 35, A-6020, Innsbruck, Österreich

    J. Peter Guggenbichler

  2. Department of Pediatrics, Mayo Clinic, Rochester, Minn., USA

    G. B. Stickler (Chairman)

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  1. J. Peter Guggenbichler
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Guggenbichler, J.P., Stickler, G.B. Alte und neue Erkenntnisse zu den Durchfallerkrankungen im Kindesalter. Infection 3, 127–142 (1975). https://doi.org/10.1007/BF01641335

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