Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and preceding gastrointestinal infections. Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases, and therapy includes drug treatment of the predominant symptoms, nutrition and psychotherapy. Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain–gut interactions. IBS considerably affects quality of life and imposes a profound burden on patients, physicians and the health-care system. The past decade has seen remarkable progress in our understanding of functional bowel disorders such as IBS that will be summarized in this Primer.
The gut microbiota not only influences host metabolism but can also affect brain function and behaviour through the microbiota-gut-brain axis. To explore the potential role of the intestinal microbiota in anorexia nervosa (AN), we comprehensively investigated the faecal microbiota and short-chain fatty acids in these patients before (n = 55) and after weight gain (n = 44) in comparison to normal-weight participants (NW, n = 55) along with dietary intake and gastrointestinal complaints. We show profound microbial perturbations in AN patients as compared to NW participants, with higher levels of mucin-degraders and members of Clostridium clusters I, XI and XVIII and reduced levels of the butyrate-producing Roseburia spp. Branched-chain fatty acid concentrations, being markers for protein fermentation, were elevated. Distinct perturbations in microbial community compositions were observed for individual restrictive and binge/purging AN-subtypes. Upon weight gain, microbial richness increased, however perturbations in intestinal microbiota and short chain fatty acid profiles in addition to several gastrointestinal symptoms did not recover. These insights provide new leads to modulate the intestinal microbiota in order to improve the outcomes of the standard therapy.
Zusammenfassung. Ziel dieser Studie ist die Validierung der deutschen Version des “Patient Health Questionnaire (PHQ-D)“. Der PHQ wurde zum praktikablen Screening psychischer Störungen für die Primärmedizin entwickelt und erfasst direkt die diagnostischen Kriterien des DSM-IV. N = 357 allgemeinmedizinische/internistische Patienten und N = 171 psychosomatische Patienten wurden mit dem PHQ-D und dem Strukturierten Klinischen Interview für DSM-IV (SKID-I) untersucht, wobei das SKID-I als diagnostischer Goldstandard diente. Ärzte und Patienten wurden zur Akzeptanz des PHQ-D befragt. Eine ausgezeichnete Kriteriumsvalidität des PHQ-D zeigte sich insbesondere bei der Diagnose der Major Depression, wo die Sensitivität für die medizinische Stichprobe bei 95% und die Spezifität bei 86% lag. Gute teststatistische Werte ergaben sich u.a. auch für die Panikstörung. Die Anwendung des PHQ-D wurde von jeweils mehr als 90% der Patienten und Ärzte gut akzeptiert. Mit dem PHQ-D liegt ein praktikables, valides und gut akzeptiertes Instrument zur Anwendung in Forschung und klinischer Praxis vor. Sein Einsatz kann zur verbesserten Versorgung psychischer Störungen beitragen.
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