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

Zusammenfassung

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

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

• Literatur

• 1 Labenz J, Labenz C. Prävalenz und natürlicher Verlauf der gastroösophagealen Refluxkrankheit. Gastroenterologe 2016; 11: 102-109
• 2 El-Serag HB, Sweet S, Winchester CC. et al. Update on the epidemiology of gastro-oesophageal reflux disease: A systematic review. Gut 2014; 63: 871-880
• 3 Vakil N, van Zanten SV, Kahrilas P. et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920
• 4 Koop H, Fuchs KH, Labenz J. et al. S2k guideline: gastroesophageal reflux disease guided by the German Society of Gastroenterology: AWMF register no. 021–013. Z Gastroenterol 2014; 52: 1299-1346
• 5 Mössner J. The indications, applications, and risks of proton pump inhibitors – a review after 25 years. Dtsch Arztebl Int 2016; 113: 477-483
• 6 El-Serag H, Becher A, Jones R. Systematic review: persistent reflux symptoms on proton pump inhibitor therapy in primary care and community studies. Aliment Pharmacol Ther 2010; 32: 720-737
• 7 Labenz J, Labenz G, Stephan D. et al. Unzureichende Symptomkontrolle unter Langzeittherapie mit PPI bei GERD – Fakt oder Fiktion?. MMW Fortschr Med 2016; 158 (Suppl. 04) 7-11
• 8 Boeckxstaens G, El-Serag HB, Smout AJPM. et al. Symptomatic reflux disease: the present, the past and the future. Gut 2014; 63: 1185-1193
• 9 Jackson MA, Goodrich JK, Maxan ME. et al. Proton pump inhibitors alter the composition of the gut microbiota. Gut 2016; 65: 749-756
• 10 Fletscher J, Wirz A, Young J. et al. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology 2001; 121: 775-783
• 11 Mitchell DR, Derakhshan MH, Robertson EV. et al. The Role of the Acid Pocket in Gastroesophageal Reflux Disease. J Clin Gastroenterol 2016; 50: 111-119
• 12 Beaumont H, Bennink RJ, de Jong J. et al. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut 2010; 59: 441-451
• 13 Rohof WO, Bennink RJ, Smout AJ. et al. An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2013; 11: 1585-1591
• 14 Woodland P, Batista-Lima F, Lee C. et al. Topical protection of human esophageal mucosal integrity. Am J Physiol Gastrointest Liver Physiol 2015; 308: G975-G980
• 15 Strugala V, Dettmar PW, Sarratt K. et al. A Randomized, controlled, crossover trial to investigate times to onset of the perception of soothing and cooling by over-the-counter heartburn treatments. J Int Med res 2010; 38: 449-457
• 16 Thomas E, Wade E, Crawford G. et al. Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pockettargeting alginate-antacid (Gaviscon Double Action) – a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2014; 39: 595-602
• 17 Lai IR, Wu MS, Lin JT. Prospective, randomized, and active controlled study of the efficacy of alginic acid and antacid in the treatment of patients with endoscopy-negative reflux disease. World J Gastroenterol 2006; 12: 747-754
• 18 Pouchain D, Bigard MA, Liard F. et al. Gaviscon^® vs. omeprazole in symptomatic treatment of moderate gastroesophageal reflux. A direct comparative randomised trial. BMC Gastroenterol 2012; 23: 12-18
• 19 Lindow SW, Regnéll P, Sykes J. et al. An open-label, multicentre study to assess the safety and efficacy of a novel reflux suppressant (Gaviscon Advance) in the treatment of heartburn during pregnancy. Int J Clin Pract 2003; 57: 175-179
• 20 George N, Abdallah J, Maradey-Romero C. et al. Review article: the current treatment of non-cardiac chest pain. Aliment Pharmacol Ther 2016; 43: 213-239
• 21 Ness-Jensen E, Lindam A, Lagergren J. et al. Weight loss and reduction in gastroesophageal reflux. A prospective population-based cohort study: the HUNT study. Am J Gastroenterol 2013; 108: 376-382
• 22 Schey R, Dickman R, Parthasarathy S. et al. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease. Gastroenterology 2007; 133: 1787-1795
• 23 Manabe N, Haruma K, Ito M. et al. Efficacy of adding sodium alginate to omeprazole in patients with nonerosive reflux disease: a randomized clinical trial. Dis Esophagus 2012; 25: 373-380
• 24 Reimer C, Lodrup AB, Smith G. et al. Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor. Aliment Pharmacol Ther. 2016 DOI: 10.1111/apt.13567 [Epub ahead of print]
• 25 Weijenborg PW, de Schepper HS, Smout AJ. et al. Effects of antidepressants in patients with functional esophageal disorders or gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol 2015; 13: 251-259
• 26 Hunt RH, Yuan Y, Scarpignato C. Editorial: healing of refractory reflux oesophagitis–an ongoing unmet clinical need. Aliment Pharmacol Ther 2014; 40: 987-989
• 27 Labenz J. Facts and fantasies in extra-oesophageal symptoms in GORD. Best Pract Res Clin Gastroenterol 2010; 24: 893-904
• 28 Adcock JJ. TRPV1 receptors in sensitisation of cough and pain reflexes. Pulm Pharmacol Ther 2009; 22: 65-70
• 29 Morice AH. The cough hypersensitivity syndrome: A novel paradigm for understanding cough. Lung 2010; 188: S87-S90
• 30 Gibson PG, Vertigan AE. Management of chronic refractory cough. BMJ 2015; 351: h5590
• 31 Vertigan AE, Theodoros DG, Winkworth AL. et al. Chronic cough: a tutorial for speech-language pathologists. J Med Speech-Lang Pathol 2007; 15: 189-206
• 32 Desjardin M, Roman S, des Varannes SB. et al. Pharyngeal pH alone is not reliable for the detection of pharyngeal reflux events: A study with oesophageal and pharyngeal pH-impedance monitoring. United European Gastroenterology Journal 2014; 1: 438-444
• 33 Galmiche JP, Hatlebakk J, Attwood S. et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA 2011; 305: 1969-1977
• 34 Ganz RA, Peters JH, Horgan S. et al. Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med 2013; 368: 719-727
• 35 Ganz RA, Edmundowicz SA, Taiganides PA. et al. Long-term outcomes of patients receiving a magnetic sphincter augmentation device for gastroesophageal reflux. Clin Gastroenterol Hepatol 2016; 14: 671-677
• 36 Banerjee R, Pratap N, Kalpala R. et al. Effect of electrical stimulation of the lower esophageal sphincter using endoscopically implanted temporary stimulation leads in patients with reflux disease. Surg Endosc 2014; 28: 1003-1009
• 37 Kapelle WF, Bredenoord AJ, Conchillo JM. et al. Electrical stimulation therapy of the lower oesophageal sphincter for refractory gastro-oesophageal reflux disease – interim results of an international multicentre trial. Aliment Pharmacol Ther 2015; 42: 614-625