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DOI: 10.1055/s-2000-8050
Diagnostisches und therapeutisches Management refluxassoziierter Erkrankungen des gastroösophagealen Übergangs
Publication History
Publication Date:
31 December 2000 (online)
Zusammenfassung.
Die refluxinduzierten Erkrankungen des gastro-ösophagealen Überganges nehmen immer mehr an Bedeutung zu und erfordern ein interdisziplinär abgestimmtes diagnostisches und therapeutisches Management. Dieser Umstand resultiert insbesondere aus der Tatsache, dass die zumeist refluxbedingten Adenokarzinome des distalen Ösophagus und der Kardia im Gegensatz zu den übrigen Neoplasien des oberen Gastrointestinaltraktes eine dramatische Zunahme der Inzidenz aufweisen. Da das Ausmaß des Refluxgeschehens nicht immer mit dem subjektiven Beschwerdebild korreliert, erhöht sich das Risiko insbesondere für symptomarme Patienten an refluxbedingten Komplikationen zu erkranken. Die Anforderungen an die Diagnostik bestehen daher im frühen Erkennen präkanzeröser Konditionen und Läsionen. Der erste Schritt dazu wird durch die Verifizierung des gastroösophagealen sowie auch des duodenogastroösophagealen Refluxes eingeleitet und setzt sich in der Diagnostik der refluxbedingten Schleimhautmetaplasie, im Sinne eines Barrett-Ösophagus, als Präkanzerose fort. Dazu stehen heute neben den traditionellen diagnostischen bildgebenden Verfahren und der Endoskopie mit Biopsie zusätzliche moderne Methoden zur Objektivierung des Refluxes mit Hilfe der Ösophagus-Manometrie und pH-Metrie zur Verfügung. Das Spektrum in der Behandlung der Refluxerkrankung und der refluxbedingten Komplikationen bezieht die konservative Therapie ebenso wie moderne, invasive Interventionsmöglichkeiten ein. Die Auswahl aus den zur Verfügung stehenden Therapieoptionen ergibt sich sowohl aus der Symptomatik als auch aus dem Ausmaß der diagnostisch gesicherten refluxbedingten Folgeerkrankungen.
Diagnostic and therapeutic management of gastroesophageal reflux disease.
The reflux-induced diseases of the gastroesophageal junction are gaining in importance and require an interdisciplinarily coordinated diagnostic and therapeutical management. This situation results particularly from the fact that reflux-induced adenocarcinomas of the distal esophagus and the cardia, in contrast to the remaining neoplasias of the upper gastrointestinal tract, are increasing tremendously in incidence. As the extent of such a reflux does not always correlate with the subjective symptoms, symptom-lacking patients, in particular, run the risk of suffering from reflux-induced complications. Diagnosticians are therefore required to early recognize precancerous conditions and lesions. The first step towards this is initiated by the verification of the gastroesophageal or the duodeno-gastroesophageal reflux, and continued in the diagnostics of reflux-induced mucosal metaplasia in Barrett's esophagus as a precancerous lesion. For this, the traditional diagnostic tools, such as imaging and endocsopy with biopsy, as well as recently established methods for objectivation of the reflux with the help of esophagus manometry and pH-metry can presently be used. The spectrum for treating reflux diseases and reflux-induced complications includes not only conservative therapies, but also modern, invasive possiblities of intervention. The therapy of choice depends both on the symptoms and on the extent of the diagnostically secured reflux-induced secondary disease.
Schlüsselwörter:
Gastroösophagealer Reflux - Barrett-Ösophagus - Adenokarzinom - Diagnostik - Therapie
Key words:
Gastroesophageal reflux - Barrett's esophagus - Adenocarcinoma - Diagnostic - Therapy
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Prof. Dr. H. Lippert
Klinik für Chirurgie Otto-von-Guericke Universität Magdeburg
Leipziger Straße 44
39120 Magdeburg
Phone: 0391/6715500
Fax: 0391/6715570
Email: Hans.Lippert@medizin.uni-magdeburg.de