Gastroösophageale Refluxkrankheit: Fokus auf zahnmedizinischen Aspekten

Zusammenfassung

In der Leitlinie zur gastroösophagealen Refluxkrankheit sind die Prinzipien von Diagnostik und Therapie aufgrund bestehender Evidenz definiert. Grundlage der Diagnostik ist eine ausführliche Anamnese, ergänzt durch eine Gastroskopie, während funktionsdiagnostische Untersuchungen mittels pH-Metrie oder (besser) Impedanz-pH-Metrie bestimmten Konstellationen (insbesondere Therapieversagern) vorbehalten sind. In der Therapie dominiert für alle Schweregrade eine Säuresekretionshemmung mittels Protonenpumpeninhibitoren (PPI), wenngleich heute auch ein (ggf. zusätzlicher) Einsatz von Alginaten diskutiert wird. Chirurgische Eingriffe sind nach sorgfältiger Patientenselektion eine Option, während andere Verfahren (Linx, elektrische Stimulation des unteren Ösophagus-Sphinkters, endoskopische Verfahren) insbesondere hinsichtlich der langfristigen Effektivität noch weiterer Studien bedürfen. Die pathophysiologischen Vorstellungen zu extraösophagealen Manifestationen der Refluxkrankheit machen derzeit gravierende Revisionen durch. Auch wenn dentale Erosionen als gesicherte Assoziation einer Refluxkrankheit gelten, ist die wissenschaftliche Basis dafür dürftig. Ein Barrett-Ösophagus bedarf aufgrund des Risikos einer malignen Transformation bei geeigneten Patienten eines strukturierten Überwachungsprogramms.

Abstract

Principals of diagnosis and treatment of gastroesophageal reflux disease are defined in the German guideline based upon current evidence. Mainstay of the diagnosis is a careful medical history amended by esophagoscopy whereas diagnostic procedures such as pH-metry or (preferably) impedence-pH-monitoring are reserved for well-defined indications, particularly non-responders. Acid suppression by proton pump inhibitors dominates reflux therapy which is preferred in all grades of severity although (additive) treatment with alginates is presently under discussion. Antireflux surgery is indicated in carefully selected patients whereas other procedures (Linx, electrical stimulation of the lower esophageal sphincter, endoscopic therapy) need to be investigated further, especially with regard to long-term efficacy. Recently, the pathophysiological concept of extraesophageal manifestations is reevaluated which probably will lead to fundamental changes in their understanding. Although dental erosions are regarded as established associations of reflux disease, the scientific evidence is scarce. In selected patients with Barrett’s esophagus, a surveillance program is indicated due to the risk of malignant transformation.

Schlüsselwörter

gastroösophageale Refluxkrankheit - dentale Erosionen - Diagnostik - Barrett-Ösophagus - extraösophageale Manifestationen - Protonenpumpeninhibitoren

Key words

gastroesophageal reflux disease - dental erosions - Barrett’s esophagus - extraesophageal manifestations - proton pump inhibitors

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