Gastroösophageale Refluxkrankheit – was tun, wenn PPI nicht ausreichend wirksam, verträglich oder erwünscht sind?

Joachim Labenz; Herbert Koop

doi:10.1055/s-0042-121021

DMW - Deutsche Medizinische Wochenschrift, Inhaltsverzeichnis

Dtsch Med Wochenschr 2017; 142(05): 356-366
DOI: 10.1055/s-0042-121021

Übersicht

Gastroösophageale Refluxkrankheit – was tun, wenn PPI nicht ausreichend wirksam, verträglich oder erwünscht sind?

Gastro-Oesophageal Reflux Disease – How to Manage if PPI are not Sufficiently Effective, not Tolerated, or not Wished?

Joachim Labenz

,

Herbert Koop

Abstract

Die Standardtherapie der GERD mit PPI ist weniger wirksam als gedacht: Mindestens 30 % der Patienten haben persistierende Symptome und Läsionen (Therapielücke). Bei persistierender Symptomatik oder Wunsch einer alternativen Behandlung ist eine stratifizierte Diagnostik erforderlich. Alginate und neue Operationsverfahren erweitern die Therapieoptionen.

Als Therapie der ersten Wahl bei gastroösophagealer Refluxkrankheit (GERD) gelten Protonenpumpeninhibitoren (PPI). Schlägt diese Therapie nur unzureichend an oder wird nicht vertragen, stehen Alginate als therapeutische Alternative zur Verfügung. Persistierende Refluxbeschwerden und nicht heilende Refluxösophagitis erfordern eine differenzierte endoskopische und funktionsanalytische Diagnostik. Extraösophageale Manifestationen der GERD sprechen häufig nicht auf eine Antirefluxtherapie an. Neue Daten legen nahe, dass es sich um komplexe Hypersensitivitätssyndrome handelt, bei denen der Reflux nur einer von mehreren möglichen Auslösern ist.

Schlüsselwörter

gastroösophageale Refluxkrankheit - Protonenpumpeninhibitor (PPI) - persistierende Symptome - nicht geheilte Ösophagitis - extraösophageale Manifestationen

Key words

gastrooesophageal reflux disease - proton pump inhibitor (PPI) - persisting symptoms - not healed oesophagitis - extraoesophageal manifestation

Volltext

Referenzen

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