Zusammenfassung
Die Therapie der gastro-ösophagealen Refluxkrankheit ist in der Mehrzahl der Fälle
unkompliziert. Etwa 20% aller Patienten klagen jedoch auch unter Standardtherapie
mit Protonenpumpeninhibitoren über Symptome und gelten demnach als therapieresistent.
Die Ursache hierfür mag zum einem in einem gestörten Metabolismus dieser Substanzen
liegen, weit häufiger liegt jedoch ein auch unter Säureinhibition bestehender nicht-
bzw. schwach-saurer Reflux vor. Verlässlich objektivierbar diagnostiziert werden kann
der nicht-/schwach-saure Reflux derzeit nur mit Hilfe einer kombinierten Langzeit-pH-Metrie/Impedanzmessung.
Das therapeutische Spektrum nach Diagnosestellung ist derzeit noch begrenzt, etablierte
Verfahren existieren nicht. Prinzipiell in Frage kommen jedoch medikamentöse, endoskopische
als auch chirurgische Maßnahmen
Summary
The therapy of gastroesophageael reflux disease (GERD) is uncomplicated in most cases.
However, 20 % of GERD patients suffer from reflux-associated symptoms under therapy
with protone pump inhibitors (PPI). The cause of this resistance to PPI-therapy remains
unclear. Today, the most discussed theory is the presence of the non- or weakly acidic
reflux.
Objective measurements of the weakly/non-acidic reflux are available since the development
of intraluminal impedance monitoring in combination with pH-monitoring.
The therapy of weakly/non-acidic GERD is not well established, so far. In the course
of clinical studies the therapeutic spectrum (i. e. modification of the medical therapy,
endoscopic anti-reflux procedures or surgical therapy) has to be tested.
Literatur
- 1
Guillemot F, Ducrotte P, Bueno L.
Prevalence of functional gastrointestinal disorders in a population of subjects consulting
for gastroesophageal reflux disease in general practice.
Gastroenterol Clin Biol.
2005;
29
243-246
- 2
Kawano S, Murata H, Tsuji S. et al .
Randomized comparative study of omeprazole and famotidine in reflux esophagitis.
J Gastroenterol Hepatol.
2002;
17
955-959
- 3
Koek G H, Sifrim D, Lerut T, Janssens J, Tack J.
Effect of the GABA(B) agonist baclofen in patients with symptoms and duodeno-gastro-oesophageal
reflux refractory to proton pump inhibitors.
Gut.
2003;
52
1397-1402
- 4
Locke G R, Talley N J, Fett S L. et al .
Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study
in Olmsted County, Minnesota.
Gastroenterology.
1997;
112
1448-1456
- 5
Mainie I, Tutuian R, Agrawal A, Hila A, Freeman J, Castell D.
Reflux (acid or non-acid) detected by multichannel intraluminal impedance-pH testing
predicts good symptom response from fundoplication.
Gastroenterol.
2005;
128
A1-826
(Suppl 2)
- 6
Meining A, Fackler A, Tzavella K. et al .
Lower esophageal sphincter pressure in patients with gastroesophageal reflux diseases
and posture and time patterns.
Dis Esophagus.
2004;
17
155-158
- 7
Menges M, Muller M, Zeitz M.
Increased acid and bile reflux in Barrett’s esophagus compared to reflux esophagitis,
and effect of proton pump inhibitor therapy.
Am J Gastroenterol.
2001;
96
331-337
- 8
Milkes D, Gerson L B, Triadafilopoulos G.
Complete elimination of reflux symptoms does not guarantee normalization of intraesophageal
and intragastric pH in patients with gastroesophageal reflux disease (GERD).
Am J Gastroenterol.
2004;
99
991-996
- 9
Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J.
Prevalence of gastro-oesophageal reflux symptoms and the influence of age and sex.
Scand J Gastroenterol.
2004;
39
1040-1045
- 10
Quigley E M.
Non-erosive reflux disease: part of the spectrum of gastro-oesophageal reflux disease,
a component of functional dyspepsia, or both?.
Eur J Gastroenterol Hepatol.
2001;
13
S13-18
(Suppl 1)
- 11
van Rensburg C J, Bardhan K D.
No clinical benefit of adding cisapride to pantoprazole for treatment of gastro-oesophageal
reflux disease.
Eur J Gastroenterol Hepatol.
2001;
13
909-914
- 12
Sifrim D, Castell D, Dent J, Kahrilas P J.
Gastro-oesophageal reflux monitoring: review and consensus report on detection and
definitions of acid, non-acid, and gas reflux.
Gut.
2004;
53
1024-1031
- 13
Soga T, Matsuura M, Kodama Y. et al .
Is a proton pump inhibitor necessary for the treatment of lower-grade reflux esophagitis?.
J Gastroenterol.
1999;
34
435-440
- 14
Stein H J, Feussner H, Siewert J R.
Indikation zur Antirefluxchirurgie des Oesophagus.
Chirurg.
1998;
69
132-140
- 15
Vaezi M F, Richter J E.
Importance of duodeno-gastro-esophageal reflux in the medical outpatient practice.
Hepatogastroenterology.
1999;
46
40-47
- 16
Vakil N B, Traxler B, Levine D.
Dysphagia in patients with erosive esophagitis: prevalence, severity, and response
to proton pump inhibitor treatment.
Clin Gastroenterol Hepatol.
2004;
2
665-668
Priv.-Doz. Dr. med. A. Meining
II. Medizinische Klinik des Klinikum r. d. Isar, TU München
Ismaningerstraße 22
81675 München
Phone: 089/41400
Fax: 089/41404905
Email: alexander.meining@lrz.tum.de
