Management der gastroösophagealen Refluxkrankheit (GERD) in der Schwangerschaft

Zusammenfassung

Die gastroösophageale Refluxkrankheit (engl. gastroesophageal reflux disease, GERD) tritt in der Schwangerschaft bei mehr als 50 % der Frauen auf. Oftmals wird GERD als schwangerschaftsimmanente Erscheinung interpretiert. Inadäquat oder nicht behandelt kann GERD die Lebensqualität der Schwangeren erheblich beeinträchtigen. Hauptursache für GERD in der Schwangerschaft ist ein Abfall des unteren Ösophagussphinktertonus, hervorgerufen durch schwangerschaftsbedingte Veränderungen der Sexualhormone, insbesondere Progesteron. Das häufigste Symptom der GERD ist Sodbrennen. Schwere Komplikationen von GERD (z. B. erosive Ösophagitis) während der Schwangerschaft sind selten beschrieben. Symptomatische GERD in der Schwangerschaft sollte entsprechend einem „Step-up”-Algorithmus behandelt werden, beginnend mit spezifischen Verhaltensregeln und Veränderungen des Essverhaltens. Medikamente der ersten Wahl sind Antazida. Wenn die Symptome persistieren, stehen Histamin2-Rezeptorantagonisten zur Verfügung. Protonenpumpen-Inhibitoren (PPI) sind laut einem europäischen Konsensusmeeting 2003 in der Schwangerschaft nicht empfohlen. PPIs sollten daher nur Frauen mit persistierenden Symptomen und komplizierter GERD vorbehalten bleiben. Die GERD-Symptomatik bessert sich nach der Entbindung, über die Spätfolgen bzw. den Einfluss auf nachfolgende Schwangerschaften ist wenig bekannt. Daher wird zurzeit eine prospektive Studie (longitudinale Kohortenanalyse) durchgeführt.

Abstract

Gastroesophageal reflux disease (GERD) is common during pregnancy. The pathogenesis is a decrease in lower oesophageal sphincter pressure caused by female sex hormones, especially progesterone. The most common symptom of GERD is heartburn. Nevertheless, serious reflux complications during pregnancy are rare. In contrast to non-pregnant patients, GERD during pregnancy should be managed with a step-up algorithm beginning with lifestyle modifications and dietary changes. Antacids or sucralfate are considered the first-line on-demand drug therapy. If symptoms persist, any of the histamine-2-receptor antagonists can be used. Proton pump inhibitors are reserved for women with intractable symptoms or complicated reflux disease. Usually, heartburn during pregnancy resolves soon after delivery but little is known about the late sequelae or, respectively, an influence on subsequent pregnancies. Accordingly a prospective study (longitudinal cohort analysis) is currently underway.

gastroösophageale Refluxkrankheit - GERD - Sodbrennen - Schwangerschaft - GERD-Therapie - GERD-Therapie in der Schwangerschaft

gastroesophageal reflux disease - GERD - heartburn - pregnancy - GERD treatment - GERD treatment during pregnancy

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