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Alte und neue Erkenntnisse zu den Durchfallerkrankungen im Kindesalter

Past and present aspects of diarrheal disease in childhood. Clinical study and treatment

II. Klinik und Therapie

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Zusammenfassung

Aus den ätiologischen und patholophysiologischen Vorgängen, die im ersten Teil dieser Arbeit behandelt wurden, ergeben sich Konsequenzen: Das Auffinden der Ursache der Durchfallerkrankungen bedarf neuer Laboruntersuchungen, die aber zum Großteil technisch einfach und ohne großen Laboraufwand durchzuführen sind. Wichtige Konsequenzen liegen aber in einer entsprechend begründeten logisch modifizierten Therapie. Die wichtigste Entdeckung für das therapeutische Handeln liegt darin, daß Glukose und Natrium in einer optimal bilanzierten Glukose-Elektrolytlösung die Absorption steigern und große Mengen Wasser mit sich ziehen. Da die Absorptionsmechanismen für Elektrolyte und Glukose bei akuten Diarrhöen erhalten bleiben, kann man dieses Prinzip anwenden, um eine rasche orale Rehydratation und eine Normalisierung der intestinalen Homöostase zu erzielen. Die sofortige Umstellung der Diät auf eine 24stündige Ernährung mit der vorher erwähnten Glukose-Elektrolytlösung verhindert im allgemeinen schwerere Dehydratationszustände und damit in vielen Fällen eine Krankenhausaufnahme. Die völlige Ausschaltung von Laktose und langkettigen Fettsäuren aus der Nahrung vermeidet die Aufrechterhaltung pathologischer osmotischer und chemischer Zustände im Darm. Antibiotika sind bei den akuten Durchfallerkrankungen und selbst bei der enteroinvasiven Coli- und Shigelladiarrhoe nur selten eindeutig indiziert, im Falle der Salmonella-Gastroenteritis sogar kontraindiziert. Die weitere Forschung konzentriert sich neben der Entwicklung von Medikamenten zur Neutralisation der Enterotoxinwirkung speziell auf die Prävention der Durchfallerkrankungen und die Entwicklung wirksamer Impfstoffe.

Summary

The etiologic and pathophysiologic findings described in the first part of this paper have important consequences: The recognition of the specific etiology of diarrhea requires new laboratory methods: most of these, however, are technically easy to perform and do not require a large laboratory. A long-ranging consequence of this changed concept is a well-founded modification of therapy. The most important discovery was, that in a well balanced glucose electrolyte solution sodium and glucose enhance their absorption mutually and increase the absorption of water by solvent drag. Since in most acute diarrheas the mechanisms of absorption of glucose and electrolytes are retained this mechanism can be utilized for fast oral rehydration and reinstitution of normal intestinal homeostasis. Prompt institution of a diet consisting of the previously mentioned glucose-electrolyte solution usually prevents severe dehydration and the need for stationary treatment. The elimination of lactose and long chain fatty acids from the diet prevents continuation of the pathologic osmotic and chemical conditions in the intestine. Antibiotics are not indicated in acute diarrhea with the exception of diarrhea caused by enteroinvasive E. Coli or Shigella, in the case of Salmonella-gastroenteritis even contraindicated. Further research concentrates on the development of drugs for neutralisation of E. Coli enterotoxin and the prevention of diarrheas by development of effective vaccines.

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

    J. P. Guggenbichler

  2. Chairman Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA

    G. B. Stickler

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Guggenbichler, J.P., Stickler, G.B. Alte und neue Erkenntnisse zu den Durchfallerkrankungen im Kindesalter. Infection 3, 189–201 (1975). https://doi.org/10.1007/BF01642765

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