Z Gastroenterol 2018; 56(11): 1378-1408
DOI: 10.1055/a-0713-0944
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Interpretation und Durchführung der hochauflösenden Ösophagusmanometrie: Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) sowie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS)

Interpretation und performance of high-resolution esophageal manometry: Recommendations of the German Association of Neurogastroenterology and Motility (DGNM) and the German Association of Gastroenterology, Digestive and Metabolic Diseases (DGVS)
Jutta Keller
1   Medizinische Klinik, Israelitisches Krankenhaus, Hamburg
,
Mark Robert Fox
2   Abteilung für Gastroenterologie, Bauchzentrum, Claraspital Basel
3   Klinik für Gastroenterologie und Hepatologie, UniversitätsSpital Zürich
,
Hans-Dieter Allescher
4   Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen
,
Thomas Frieling
5   Medizinische Klinik II, HELIOS Klinikum Krefeld
,
Karl Hermann Fuchs
6   Chirurgie, Markus-Krankenhaus, Frankfurt am Main
,
Miriam Goebel-Stengel
7   Helios Klinikum Rottweil
,
Christian Pehl
8   Medizinische Klinik, Krankenhaus Vilsbiburg
,
Jörg Schirra
9   Medizinische Klinik und Poliklinik II, LMU, Campus Großhadern, München
,
Ivo van der Voort
10   Jüdisches Krankenhaus, Berlin
,
Martin Storr
9   Medizinische Klinik und Poliklinik II, LMU, Campus Großhadern, München
11   Gesundheitszentrum Starnberger See, Gauting
› Author Affiliations
Further Information

Publication History

25 July 2018

16 August 2018

Publication Date:
12 November 2018 (online)

Zusammenfassung

Die Ösophagusmanometrie erlaubt eine genaue Beurteilung der Kontraktilität der Speiseröhre und ist deshalb das Referenzverfahren für die Diagnostik ösophagealer Motilitätsstörungen. Aussagekraft und Bedeutung der Methode haben durch die Einführung der hochauflösenden Ösophagusmanometrie (HRM) noch weiter gewonnen, welche die funktionelle Anatomie der Speiseröhre in einer visuell intuitiv zu erfassenden Weise darstellt. Die aktuelle 3. Version der international gebräuchlichen Chicago-Klassifikation gibt standardisierte Empfehlungen zur Durchführung und Auswertung der HRM. Sie dient in vielen Bereichen auch als konkrete Basis für den vorliegenden Expertenkonsensus. Allerdings geht die Chicago-Klassifikation bislang nicht oder nur kursorisch auf die funktionelle Beurteilung des unteren und oberen Ösophagussphinkters sowie auf die Bedeutung zusätzlicher Untersuchungen wie Provokationsmahlzeiten und/oder Langzeituntersuchungen ein. Der aktuelle Expertenkonsensus berücksichtigt deshalb zusätzliche, kürzlich publizierte, hochqualitative klinische Studien und gibt Empfehlungen, die eine aussagekräftige Untersuchung der Motilität des gesamten Ösophagus mittels HRM zur Klärung klinisch relevanter Fragestellungen ermöglichen.

Abstract

Esophageal manometry provides a detailed evaluation of esophageal contractility and, therefore, represents the reference method for diagnosis of esophageal motility disorders. Significance and clinical relevance have been further increased by implementation of high-resolution esophageal manometry (HRM), which reveals the functional anatomy of the esophagus in a visually-intuitive manner. The current 3 rd version of the international Chicago Classification (CC v3.0) gives standardized recommendations on performance and interpretation of HRM and serves as the basis for much of this expert consensus document. However, CC v3.0 gives only limited information with regards to the function of the lower and upper esophageal sphincters, the use of adjunctive tests including solid test meals and long-term ambulatory HRM measurements. In this expert consensus, we describe how to perform and interpret HRM on the basis of the CC v3.0 with additional recommendations based on the results of recent, high-quality clinical studies concerning the use of this technology to assess the causes of esophageal symptoms in a variety of clinical scenarios.

 
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