Gastroenterologie up2date 2018; 14(01): 67-84
DOI: 10.1055/s-0043-121453
Ösophagus/Magen/Duodenum
Georg Thieme Verlag KG Stuttgart · New York

Gastroösophageale Refluxkrankheit – Update 2018

Herbert Koop
,
Joachim Labenz
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
12. März 2018 (online)

Vor einer Dekade erschien der Beitrag über die gastroösophageale Refluxkrankheit in diesem Journal [1] – somit ist es Zeit für eine kritische Bestandsaufnahme und Überprüfung der Empfehlungen. Mittlerweile erschienen zudem die überarbeitete Leitlinie der DGVS [2] und eine Übersicht zu aktuellen Kontroversen der Refluxtherapie [3]. Nachfolgend wird daher der aktuelle Wissensstand zu Diagnostik, Therapie und aufkommenden Entwicklungen dargestellt.

Kernaussagen
  • Im Rahmen der subtilen Anamnese müssen neben den möglichen Refluxsymptomen auch weitere Beschwerden sorgfältig erfasst werden.

  • Eine subkardiale Akkumulation von ungepufferter Säure frühzeitig nach Nahrungsaufnahme (Acid Pocket) gilt als wesentlicher Faktor für postprandiales Sodbrennen.

  • Funktionsdiagnostische Untersuchungen haben ihren Platz vor allem bei Therapieversagern und in der präoperativen Diagnostik.

  • Refluxsymptome, die vorrangig auf einer Perzeptionsstörung beruhen, sprechen schlecht auf PPI an.

  • Mit der elektrischen Stimulation des unteren Ösophagussphinkters und dem Linx-Verfahren deuten sich neue chirurgische Alternativen der Refluxtherapie an.

  • Extraösophageale Manifestationen ohne ösophageale Refluxsymptome scheinen primär auf einem Hypersensitivitätssyndrom zu beruhen, dessen Therapie noch nicht gesichert ist.

  • Einer korrekten bioptischen Diagnostik eines Barrett-Ösophagus im Rahmen der Indexendoskopie kommt eine zentrale Rolle zu.

  • Kleine Barrett-Zungen (< 1 cm) bedürfen in der Regel keiner endoskopischen Überwachung.

 
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