Medikamentöse Therapieoptimierung bei gastroösophagealer Refluxkrankheit und ihren Komplikationen

Zusammenfassung

Die gastroösophageale Refluxkrankheit (GERD) ist in industrialisierten Ländern häufig. Kürzlich wurde eine neue Definition und Klassifikation der Refluxkrankheit basierend auf einem weltweiten Konsensus publiziert. Demnach kann sich die GERD mit ösophagealen und extraösophagealen Syndromen präsentieren, letztere werden gemäß der Evidenzlage in etablierte und mögliche Assoziationen unterteilt. Protonenpumpeninhibitoren (PPI) sind die Medikamente der Wahl für alle Schweregrade der GERD. Die individuelle Therapiestrategie mit einem PPI (z. B. Dosierung, Einnahmedauer) hängt maßgeblich von der klinischen Präsentation ab. Ganz allgemein kann festgehalten werden, dass das Ausmaß der Säurereduktion durch einen PPI korreliert ist mit klinisch bedeutsamen Therapiezielen: Geschwindigkeit und Ausmaß der Symptomkontrolle, Heilung der Refluxösophagitis, symptomatische und endoskopische Remissionserhaltung. Die Wirksamkeit einer PPI-Therapie kann im Einzelfall durch Wechsel des Präparates und/oder durch Erhöhung der Einnahmefrequenz gesteigert werden. Die aktuelle Datenlage spricht für ein ausgezeichnetes Sicherheitsprofil der PPI ohne relevante Unterschiede zwischen einzelnen Substanzen.

Abstract

Gastroesophageal reflux disease (GERD) is a common condition in industrialised countries. According to a recently published, globally accepted definition and classification of GERD, clinical presentations include oesophageal and extraoesophageal syndromes, with extraoesophageal syndromes divided into established and proposed associations. Proton pump inhibitors (PPI) are the drug class of choice for all patients with GERD, irrespective of the severity. The individual strategy of treatment (e. g., dose and duration of PPI) depends on the clinical presentation. As a rule, the magnitude of acid control gained by PPIs is related to clinically meangingful outcome parameters: speed and extent of symptom control, healing of reflux oesophagitis, maintenance of symptomatic and endoscopic remission of the disease. In individual cases, the efficacy of PPI therapy can be improved by switching from one compound to another and by increasing the frequency of dosing. Current evidence suggests that PPI therapy is remarkably safe without any relevant differences between the PPIs on the market.

Schlüsselwörter

gastroösophageale Refluxkrankheit - GERD - Montreal-Definition - Protonenpumpeninhibitoren - PPI

Key words

gastroesophageal reflux disease - GERD - Montreal definition - proton pump inhibitors - PPI

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