Refluxsymptomatik – kein Unterschied in Ausprägung und Schweregrad bei Patienten mit und ohne funktionell bewiesene gastroösophageale Refluxerkrankung

Zusammenfassung

Hintergrund Patienten mit gastroösophagealem Reflux (GERD) leiden oft sehr unter der Symptomatik. Im Rahmen unserer Studie galt es deshalb herauszufinden, ob sich die Lebensqualität und die Symptome bei Patienten mit objektiv nachgewiesener GERD von Patienten ohne funktionell bewiesenes Korrelat unterscheidet.

Material und Methoden Eingeschlossen wurden alle Patienten mit typischer Refluxsymptomatik, die 2017 an unserer Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie hinsichtlich des Vorliegens einer GERD abgeklärt wurden. Alle Patienten erhielten eine hochauflösende Manometrie, 24-h-Impedanz-pH-Metrie und eine Gastroskopie. Die Lebensqualität wurde mittels Quality of Life Index (GIQLI) und die gastrointestinale Symptomatik mittels einer Symptomcheckliste (SCL) evaluiert. Mittels SCL wurde die Schwere und Intensität von 14 verschiedenen Symptomen eruiert. Basierend auf den Resultaten der 24-h-pH-Impedanzmessung wurden die Patienten in 2 Gruppen eingeteilt – Patienten mit gastroösophagealer Refluxerkrankung und Patienten mit rein funktioneller Symptomatik ohne organisches Korrelat. Diese Gruppen wurden miteinander verglichen.

Ergebnisse Ein vollständiger Datensatz war bei 162 Patienten verfügbar, wovon 86 Patienten (52,2%) objektiv an Reflux erkrankt waren (DeMeester-Mittelwert: 37,85; SD ± 29,11) und 76 Patienten (46,1%) einen unauffälligen DeMeester-Score (Mittelwert: 7,01; SD ± 4,09) aufwiesen. Zwischen diesen beiden Gruppen konnte kein signifikanter Unterschied in der Lebensqualität gefunden werden (Mittelwert GIQLI von GERD-Patienten: 94,81; SD ± 22,40; Mittelwert GIQLI von Patienten mit rein funktionellen Symptomen: 95,26; SD ± 20,33; p = 0,988). Außerdem konnte kein signifikanter Unterschied in der Symptomwahrnehmung der Patienten gefunden werden (Mittelwert SCL-Score von Refluxpatienten: 46,97; SD ± 29,23; Mittelwert SCL-Score bei Patienten mit rein funktioneller Symptomatik 48,03; SD ± 29,17; p = 0,827).

Schlussfolgerung Patienten mit funktionellen Refluxbeschwerden unterscheiden sich hinsichtlich des Leidensdrucks nicht von Patienten mit objektiv bewiesener Refluxerkrankung. Eine Differenzierung zwischen gastroösophagealer Refluxerkrankung und funktionellen Refluxsymptomen ist nur mittels Funktionsdiagnostik möglich.

Abstract

Background Patients with gastroesophageal reflux disease (GERD) often suffer greatly from their symptoms. The aim of this study was to determine if there is a difference in quality of life and gastrointestinal symptom complexes between patients with purely functional complaints and patients with objective GERD.

Material and Methods We included all patients with typical reflux symptoms, who had a GERD examination in 2017 at our department. All patients underwent high resolution manometry, 24-h-pH-metry impedance measurement and gastroscopy. Quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI) and gastrointestinal symptoms were rated by a symptom checklist (SCL), assessing the severity and intensity of 14 different symptoms. Based on the results of the 24-h-pH-metry impedance measurement, patients were divided into 2 groups: patients with functional reflux symptoms and patients with true GERD. These two groups were compared.

Results Complete data were available in 162 patients, of whom 86 (52.2%) were objectively suffering from reflux (DeMeester score mean: 37.85; SD ± 29.11) and 76 (46.1%) had a normal DeMeester score (Mean: 7.01; SD ± 4.09). No significant difference in quality of life was found between the two groups (mean GIQLI of GERD patients: 94.81, SD ± 22.40, and mean GIQLI of patients with functional reflux symptoms: 95.26, SD ± 20.33, p = 0.988). Furthermore, no significant difference could be found in the evaluated symptoms (mean general SCL score of GERD patients: 46.97; SD ± 29.23; patients with functional reflux symptoms: 48.03; SD ± 29.17, p = 0.827).

Conclusion Patients with functional complaints suffer just as much from their symptoms as patients with objectively diagnosed GERD. Differentiation between gastroesophageal reflux disease and functional reflux symptoms is only possible by means of functional diagnostic testing.

Schlüsselwörter

gastroösophageale Refluxerkrankung - Lebensqualität - Funktionsdiagnostik - funktionelle Refluxsymptome

Key words

gastroeosophageal reflux disease (GERD) - diagnostics - quality of life - functional reflux symptoms

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