Motilitätsstörungen des Ösophagus – was ist neu?

Im Extremfall können sich Patienten mit Ösophagus-Motilitätsstörungen nicht ausreichend ernähren – und auch pulmologische Komplikationen kommen vor. Die Achalasie ist die wichtigste definierte Ösophagus-Motilitätsstörung. In den letzten 10–15 Jahren gewann man neue Erkenntnisse zur Pathophysiologie; und neue diagnostische und therapeutische Verfahren ermöglichen nun eine frühere Erkennung und zielgenauere Therapie dieser und anderer Ösophagus-Motilitätsstörungen.

Abstract

Esophageal motor disorders are an important cause of dysphagia but can also be associated with retrosternal pain and heartburn as well as regurgitation. In extreme cases, patients are not able to eat appropriately and lose weight. Repetitive aspiration can occur and may cause pulmonological complications. Achalasia represents the most important and best-defined esophageal motor disorder and is characterized by insufficient relaxation of the lower esophageal sphincter in combination with typical disturbances of esophageal peristalsis. Additional defined motor disorders are distal esophageal spasm, hypercontractile esophagus, absent contractility and ineffective peristalsis. Patients with appropriate symptoms should primarily undergo esophagogastroduodenoscopy for exclusion of e.g., tumors and esophagitis. Esophageal high-resolution manometry is the reference method for diagnosis and characterization of motor disorders in non-obstructive dysphagia. An esophagogram with barium swallow may deliver complementary information or may be used if manometry is not available. Balloon dilatation and Heller myotomy are long established and more or less equally effective therapeutic options for patients with achalasia. Peroral endoscopic myotomy (POEM) enhances the therapeutic armamentarium for achalasia and hypertensive/spastic motor disorders since 2010. For hypotensive motor disorders, which may occur as a complication of e.g., rheumatological diseases or idiopathically, therapeutic options are still limited.

Kernaussagen

• Ösophagus-Motilitätsstörungen sind eine wichtige Ursache dysphagischer Beschwerden, aber auch von retrosternalen Schmerzen oder Brennen sowie Regurgitationen.

• Die Achalasie ist charakterisiert durch eine unzureichende bzw. fehlende schluckinduzierte Erschlaffung des unteren Ösophagus-Sphinkters (UÖS) sowie typische Störungen der tubulären Motilität.

• Der langfristige Gebrauch potenter Opioidanalgetika kann hypertensiv-spastische und achalasieartige Krankheitsbilder verursachen.

• Die hochauflösende Ösophagus-Manometrie ist das Referenzverfahren für die Diagnostik ösophagealer Motilitätsstörungen.

• Die perorale endoskopische Myotomie (POEM) hat das therapeutische Spektrum bei Achalasie wesentlich erweitert und stellt vor allem bei Typ-III-Achalasie das bevorzugte Therapieverfahren dar.

• Die Therapie dysphagischer Beschwerden bei hypotensiven Motilitätsstörungen basiert vor allem auf Allgemein- sowie diätetischen Maßnahmen, mit gutem Kauen, aufrechter Körperhaltung beim Essen und Trinken sowie ggf. breiiger bzw. flüssiger Kost.

• In Deutschland gibt es aktuell keine zugelassenen Prokinetika zur Therapie von Motilitätsstörungen des oberen Gastrointestinaltrakts.

Schlüsselwörter

Motilitätsstörung - Ösophagus - Achalasie - Ösophagusspasmus - hyperkontraktil

Publikationsverlauf

Artikel online veröffentlicht:
13. September 2023

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