Zusammenfassung
Hintergrund
Obwohl die Divertikelkrankheit zu den häufigsten gastrointestinalen Erkrankungen zählt, ist die Pathogenese nur unzureichend geklärt.
Fragestellung
Ziel der Arbeit ist Beschreibung der Anatomie und Pathogenese der Divertikelkrankheit unter Berücksichtigung der Risikofaktoren und die Darstellung struktureller und funktioneller Veränderungen der Darmwand.
Material und Methode
Anhand einer Literaturauswertung werden tradierte ätiologische Faktoren der Divertikelkrankheit dargestellt und bewertet sowie neue pathogenetische Konzepte analysiert und diskutiert.
Ergebnisse
Als Kolondivertikulose wird die erworbene Ausstülpung von multiplen, zunächst reizlosen Pseudodivertikeln durch Muskellücken der Kolonwand bezeichnet. Die Divertikelkrankheit ist gekennzeichnet durch Divertikelblutungen und/oder entzündliche Veränderungen (Divertikulitis) mit entsprechenden Komplikationen (Abszess- und Fistelbildung, gedeckte und offene Perforation, Peritonitis, Stenosierung). Risikofaktoren für die Divertikelkrankheit sind zunehmendes Alter, genetische Prädisposition, erbliche Bindegewebserkrankungen, ballaststoffarme Ernährung, hoher Fleischkonsum und ausgeprägtes Übergewicht. Veränderungen des Bindegewebes führen zur Schwächung der präfomierten Austrittsstellen der Divertikel und zur Versteifung der Darmwand mit verminderter Rückstellfähigkeit. Es wird vermutet, dass intestinale Innervationsstörungen und strukturelle Veränderungen der Muskulatur zu abnormen Kontraktilitätsmustern mit erhöhtem intraluminalem Druck führen, die der Divertikelausbildung Vorschub leisten. Eine vermehrte Ausschüttung schmerzvermittelnder Neurotransmitter wird für die persistierende Schmerzsymptomatik bei chronischen Verläufen verantwortlich gemacht.
Schlussfolgerungen
Aufgrund der aktuellen Datenlage lässt sich die Pathogenese der Divertikelkrankheit nicht auf einen singulären Faktor zurückführen, sondern muss als ein multifaktorielles Geschehen angesehen werden.
Abstract
Background
Although diverticular disease is one of the most frequent gastrointestinal disorders the pathogenesis is not yet sufficiently clarified.
Objectives
The aim is to define the anatomy and pathogenesis of diverticular disease considering the risk factors and description of structural and functional alterations of the bowel wall.
Methods
This article gives an appraisal of the literature, presentation and evaluation of classical etiological factors, analysis and discussion of novel pathogenetic concepts.
Results
Colonic diverticulosis is defined as an acquired out-pouching of multiple and initially asymptomatic pseudodiverticula through muscular gaps in the colon wall. Diverticular disease is characterized by diverticular bleeding and/or inflammatory processes (diverticulitis) with corresponding complications (e.g. abscess formation, fistula, covered and open perforation, peritonitis and stenosis). Risk factors for diverticular disease include increasing age, genetic predisposition, congenital connective tissue diseases, low fiber diet, high meat consumption and pronounced overweight. Alterations of connective tissue cause a weakening of preformed exit sites of diverticula and rigidity of the bowel wall with reduced flexibility. It is assumed that intestinal innervation disorders and structural alterations of the musculature induce abnormal contractile patterns with increased intraluminal pressure, thereby promoting the development of diverticula. Moreover, an increased release of pain-mediating neurotransmitters is considered to be responsible for persistent pain in chronic diverticular disease.
Conclusions
According to the present data the pathogenesis of diverticular disease cannot be attributed to a single factor but should be considered as a multifactorial event.
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Danksagung
Die Autoren danken Frau Bettina Facompré, Frau Inka Geurink, Frau Miriam Lemmer, Frau Karin Stengel sowie Herrn Clemens Franke für die Hilfe bei den Labor- und Fotoarbeiten.
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Interessenkonflikt: T. Wedel und M. Böttner geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Wedel, T., Böttner, M. Anatomie und Pathogenese der Divertikelkrankheit. Chirurg 85, 281–288 (2014). https://doi.org/10.1007/s00104-013-2617-6
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DOI: https://doi.org/10.1007/s00104-013-2617-6