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Zentralbl Chir 2021; 146(02): 176-187
DOI: 10.1055/a-1309-2368
Übersicht

Die konservative Therapie der Refluxkrankheit und ihre Grenzen

Conservative Therapy of Reflux Disease and its Limits
Joachim Labenz
Innere Medizin, Diakonie Klinikum, Jung-Stilling-Krankenhaus Siegen, Deutschland
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Zusammenfassung

Die gastroösophageale Refluxkrankheit (GERD) ist häufig. Protonenpumpeninhibitoren (PPI) gelten als Mittel der ersten Wahl für alle klinischen Manifestationen. Sie wirken allerdings bei mindestens 30% der Patienten unzureichend, zudem werden sie gelegentlich auch nicht vertragen. Einige Patienten wünschen sich auch eine therapeutische Alternative. Alginate bewirken eine mechanische Refluxhemmung durch Bildung einer gelartigen Schicht in der sog. Acid Pocket, einem Säurereservoir, das unmittelbar nach der Nahrungsaufnahme auf dem Speisebrei im Magenkorpus entsteht. Sie kommen zur Symptombehandlung einer unkomplizierten GERD als Alternative und bei unzureichendem PPI-Effekt auf die Symptome auch als Ergänzung zu einem PPI (add-on) in Betracht. Bei persistierenden Refluxbeschwerden sowie einer nicht heilenden Refluxösophagitis ist eine differenzierte endoskopische und funktionsanalytische Diagnostik zur Ursachenklärung erforderlich. Extraösophageale Manifestationen der GERD, wie z. B. Husten, Räusperzwang, Stimmprobleme und Globusgefühl, sprechen häufig nicht auf eine Antirefluxtherapie an. Neue Daten sprechen dafür, dass es sich um komplexe Hypersensitivitätssyndrome handelt, bei denen Reflux nur einer von mehreren möglichen Auslösern ist.

Abstract

Gastrooesophageal reflux disease (GORD) is common. Proton pump inhibitors (PPI) are regarded as first line therapy for all clinical manifestations. However, their efficacy is inadequate for at least 30% of patients and they are occasionally poorly tolerated. Moreover, some patients would prefer an alternative therapy. Alginate cause mechanical reflux inhibition by forming a gelatinous layer in the so-called acid pocket, an acid reservoir that forms on the surface of the chyme in the gastric corpus immediately after food intake. They may be used an alternative to treat the symptoms of uncomplicated GORD and as an add-on to PPIs if these do not improve symptoms adequately. If the reflux symptoms persist or if reflux oesophagitis does not heal, differentiated diagnostic testing must be performed, using endoscopy and functional analysis. Extraoesophageal manifestations of GORD include cough, compulsive clearing of the throat, problems with the voice and globus sensation. These often do not respond to antireflux therapy. Recent data indicate that these are complex hypersensitivity syndromes and that reflux is only one of several possible triggers.

Schlüsselwörter

Alginat - extraösophageale Symptome - GERD - Protonenpumpeninhibitor

Key words

alginate - extraesophageal symptoms - GORD - proton pump inhibitor


Publication History

Article published online:
17 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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