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Z Gastroenterol 2018; 56(10): 1276-1282
DOI: 10.1055/a-0645-7169
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Die Acid Pocket: ein neues Ziel für die Behandlung der gastroösophagealen Refluxkrankheit

The acid pocket – a novel target for the treatment of gastro-esophageal reflux disease
Matthias Sauter
1   Bauchzentrum, Abteilung für Gastroenterologie, St. Claraspital, Basel, Schweiz
2   Klinik für Gastroenterologie und Hepatologie, UniversitätsSpital Zürich, Switzerland
,
Mark Robert Fox
1   Bauchzentrum, Abteilung für Gastroenterologie, St. Claraspital, Basel, Schweiz
2   Klinik für Gastroenterologie und Hepatologie, UniversitätsSpital Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

22 January 2018

14 June 2018

Publication Date:
10 October 2018 (online)

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Zusammenfassung

Die gastroösophageale Refluxkrankheit stellt die häufigste Ursache für Symptome des oberen Gastrointestinaltrakts dar.

Der Säure-Reflux in der postprandialen Phase ist der prädominante Faktor der gastroösophagealen Refluxkrankheit (gastro-esophageal Reflux disease, GERD) und führt zu Beschwerden wie Sodbrennen und saurem Aufstoßen. Die chronische Säureexposition des Ösophagus führt zudem zu Komplikationen wie der Refluxösophagitis, peptischen Stenosen, dem Barrett-Ösophagus oder dem Adenokarzinom.

Das Ausmaß an mukosalen Schäden und Symptomen hängt von zwei Hauptfaktoren ab: (1.) dem Säuregehalt des Refluxats, welches primär von der gastralen Säureproduktion und der Verteilung der Säure im Magen abhängt sowie (2.) der Häufigkeit / Dauer an Refluxepisoden und der Stärke der Refluxbarriere am gastroösophagealen Übergang. Das Konzept der Acid Pocket ist ein Versuch, diese Faktoren in einem gemeinsamen Pathomechanismus zu vereinen.

Die Acid Pocket beschreibt eine Ansammlung von Magensäure am gastroösophagealen Übergang in der postprandialen Phase und stellt ein wichtiges Reservoir für gastroösophageale Refluxepisoden dar. Die Acid Pocket ist sowohl bei Gesunden wie auch bei Refluxpatienten vorhanden. Insbesondere bei Patienten mit einer Hiatushernie und / oder einem hypotensiven unteren Ösophagus-Sphinkter kann sich die Acid Pocket aber über den gastroösophagealen Übergang hinaus in den distalen Ösophagus ausbreiten, was zu einer erhöhten Säureexposition insbesondere des distalsten Ösophagus-Abschnitts und somit Refluxbeschwerden führt.

In den letzten Jahren wurde die Acid Pocket als mögliches Ziel von pharmakologischen und chirurgischen GERD-Therapien postuliert. Säurehemmende Medikamente wie z. B. Protonen-Pumpen-Inhibitoren reduzieren den Säuregehalt der Acid Pocket, wogegen Alginat-Substanzen, Prokinetika und die Fundoplikatio-Operation die Acid Pocket nach distal weg vom gastroösophagealen Übergang dislozieren.

Abstract

Increased acid reflux after meals is a key feature of gastro-esophageal reflux disease (GERD) and is the most important cause for patient symptoms, particularly heartburn and acid regurgitation. Chronic acid exposure also predisposes to associated pathologies including reflux esophagitis, esophageal stricture, Barrett’s esophagus, and Barrett’s carcinoma (esophageal adenocarcinoma). The severity of esophageal symptoms and mucosal damage is related to two key factors, (i) the acidity of the refluxate, which depends primarily on the gastric secretory output and its distribution within the stomach, and (ii) the frequency and duration of reflux events which depends on the efficacy of the reflux barrier at the gastro-esophageal junction and the esophageal clearance function. The concept of the acid pocket is an attempt to bring these two factors into a unified patho-mechanism.

The acid pocket describes an area of unbuffered, highly acidic, gastric secretion in the proximal stomach adjacent to the esophago-gastric junction (GEJ) which forms in the postprandial period and is the source of acid refluxate into the esophagus. It is observed both in healthy individuals as well as in reflux patients. However, the presence of a hiatus hernia and/or a weak lower esophageal sphincter in patients allows the acid pocket to encroach on the gastro-esophageal junction. This results in very high acid exposure of the squamous epithelium of the distal esophagus, leading to mucosal damage and symptoms. Recently, the acid pocket has been proposed as a target for pharmacological and surgical therapies of GERD. Proton pump inhibitors and related medications reduce its acidity; whereas, alginate preparations, prokinetics, and fundoplication displace it away from the gastro-esophageal junction.

Schlüsselwörter

Acid Pocket - Reflux-Ösophagitis - gastrointestinale Motilität

Keywords

acid pocket - gastroösophageale Refluxkrankheit - acid layer - Protonen-Pumpen-Inhibitoren
 

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