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DOI: 10.1055/s-2008-1027156
© Georg Thieme Verlag KG Stuttgart · New York
Prävalenz eines pathologischen Duodeno-Gastro-Ösophagealen Refluxes (DGER) bei Patienten mit klinischen Beschwerden einer Refluxerkrankung
Prevalence of a Pathological DGER (Duodeno-Gastric-Oesophageal Reflux) in Patients with Clinical Symptoms of Reflux DiseasePublication History
Manuskript eingetroffen: 6.9.2007
Manuskript akzeptiert: 18.1.2008
Publication Date:
22 April 2008 (online)

Zusammenfassung
Grundlagen: Nach derzeitigem Stand der Forschung gilt ein Duodeno-Gastro-Ösophagealer Reflux (DGER) als unabhängiger Risikofaktor sowohl für die Entstehung einer Refluxösophagitis als auch für die Ausbildung einer Barrett-Metaplasie der Speiseröhre. Mit der Bilitec-2000-Untersuchung ist es mittlerweile möglich, das Ausmaß eines DGER quantitativ zu bestimmen. Daten über die Prävalenz eines pathologischen DGER stehen ebenso wenig zur Verfügung wie eine leitliniengerechte Therapie. Methoden: 146 Patienten mit klinischen Beschwerden einer Refluxerkrankung wurden in die Untersuchung eingeschlossen. Alle Patienten erhielten neben der Standarddiagnostik bestehend aus der Abfrage klinischer Symptome mittels Fragebogen, Gastroskopie, 24h-pH-Metrie und Ösophagusmanometrie eine quantitative Messung des DGER. Ergebnisse: Von 146 Patienten wiesen 74 (51 %, 39 Männer, 34 Frauen) einen pathologischen DGER auf. Hiervon zeigten 28 Patienten einen isolierten DGER (19 %), 46 Patienten einen kombinierten Reflux (DGER und Magensäurereflux) (32 %). Ein isolierter Magensäurereflux konnte bei weiteren 28 Patienten (19 %) diagnostiziert werden. Das quantitative Ausmaß eines DGER korrelierte mit dem Nachweis einer komplizierten Refluxerkrankung mit endoskopischen Zeichen einer Refluxösophagitis oder einer Barrett-Schleimhaut. Schlussfolgerung: 1. Patienten mit den klinischen Beschwerden einer GERD weisen eine hohe Prävalenz eines pathologischen DGER auf. 2. Der kombinierte Einsatz einer 24h-pH-Metrie und der Bilitec-Untersuchung verbessert die diagnostische Genauigkeit bei der Abklärung einer GERD. 3. Analog dem sauren Reflux nimmt der DGER mit der Schwere der Schleimhautläsionen der Speiseröhre zu.
Abstract
Background: According to recent studies DGER (duodeno-gastric-oesophageal reflux) is considered as an independent risk factor for the development of reflux esophagitis and the Barrett metaplasia. The Bilitec 2000 allows a qualitative and quantitative measurement of DGER in patients with symptoms of reflux disease. The aim of the present study was to investigate the prevalence of DGER in patients with reflux symptoms. Methods: 146 patients with symptoms of gastro-oesophageal reflux disease were enrolled in this study. Patients underwent upper gastrointestinal endoscopy, oesophageal manometry and simultaneous 24 h oesophageal pH and bilirubin monitoring. The presence of pathological DGER and its relations to the symptom pattern, distal oesophageal acid exposure and endoscopic findings were analysed. Results: In 74 out of 146 patients (51 %, 39 men, 34 women) a DGER could be detected. Twenty-eight (32 %) of these patients suffered from an isolated DGER, while 46 (32 %) had a combined acid and DGER reflux. An isolated acid reflux was found in additional 28 (19 %) patients. The degrees of both acid and DGER were significantly higher in those patients with oesophageal lesions. Conclusions: 1. There is a high prevalence of DGER in patients with the clinical symptoms of a reflux disease. 2. The combined measurement of acid reflux and DGER helps to better define the cause of reflux symptoms. 3. In analogy to the acid reflux DGER increases with the gravity of oesophageal lesions.
Schlüsselwörter
Refluxösophagitis - Barrett-Metaplasie - GERD - Bilitec - DGERD
Key words
Refluxoesophagititis - Barrett-Oesophagus - GERD - Bilitec - DGERD
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Dr. Steffen Kunsch
Universitätsklinikum Marburg
Baldingerstraße
35043 Marburg
Email: kunsch@med.uni-marburg.de