Download PDF
Informationen aus Orthodontie & Kieferorthopädie 2018; 50(04): 277-284
DOI: 10.1055/a-0677-7428
Übersichtsartikel
© Georg Thieme Verlag KG Stuttgart · New York

Gastroösophageale Refluxkrankheit: Fokus auf zahnmedizinischen Aspekten

Gastroesophageal Reflux Disease: Focus on Dental Aspects
Herbert Koop
1   ehem. Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch
,
Joachim Labenz
2   Abteilung Innere Medizin, Diakonie Klinikum GmbH, Jung-Stilling-Krankenhaus Siegen
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2018 (online)

Also available at
    Permissions and Reprints

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
 

  • Literatur

  • 1 Koop H, Fuchs KH, Labenz J. et al. S2k-Leitlinie: Gastroösophageale Refluxkrankheit unter Federführung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten. AWMF Register Nr. 021-013. Z Gastroenterol 2014; 52: 1299-1346
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 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
    CrossrefPubMedGoogle Scholar
  • 3 Fletcher J, Wirz A, Young J. et al. Unbuffered highly acid gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology 2001; 121: 775-783
    CrossrefPubMedGoogle Scholar
  • 4 Koop H, Labenz J. Gastroösophageale Refluxkrankheit – Update 2018. Gastroenterol Up2date 2018; 14: 67-84
    PubMedGoogle Scholar
  • 5 Weijenborg PW, Bredenoord AJ. How reflux causes symptoms: reflux perception in gastroesophageal reflux disease. Best Pract Res Clin Gastroenterol 2013; 27: 353-364
    CrossrefPubMedGoogle Scholar
  • 6 Thomson AB, Barkun AN, Armstrong D. et al. The prevalence of clinical significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment – Prompt Endodoscopy (CADET-PE) study. Aliment Pharmacol Therap 2003; 17: 1481-1491
    CrossrefPubMedGoogle Scholar
  • 7 Boeckxstaens G, El-Serag HB, Smout AJPM. et al. Symptomatic reflux disease: the present, the past and the future. Gut 2014; 63: 1185-1193
    CrossrefPubMedGoogle Scholar
  • 8 Koop H. Verordnungspraxis und Risiken von Protonenpumpenblockern – Fiktion und Fakten. Z Gastroenterol 2018; 56: 264-274
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Labenz J, Koop H. Gastroösophageale Refluxkrankheit – was tun, wenn PPI nicht ausreichend wirksam, verträglich oder erwünscht ist?. Dtsch Med Wschr 2017; 153: 356-366
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Kahliras PJ, Jonsson A, Denison H. et al. Regurgitation is less responsive to acid suppression than heartburn in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2012; 10: 612-619
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 Skubleny D, Switzer NJ, Dang J. et al. Linx® magnetic sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc 2017; 31: 3078-3084
    CrossrefPubMedGoogle Scholar
  • 13 Kapelle WFW, Bredenoort AJ, Conchillo JM. et al. Electrical stimulation therapy of the lower oesophageal sphincter for refractory gastro-oesophageal reflux disease – interim results from a international multicentre trial. Aliment Pharmacol Ther 2015; 42: 614-625
    CrossrefPubMedGoogle Scholar
  • 14 Richter JE, Kumar A, Lipka S. et al. Efficacy of laparoscopic Nissen fundoplication vs transoral incisionless fundoplication or proton pump inhibitors in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis. Gastroenterology 2018; 154: 1298-1308
    CrossrefPubMedGoogle Scholar
  • 15 Vaezzi MF, Katzka D, Zerbib F. Extraesophageal symptoms and diseases attributed to GERD: where is the pendulum swinging now?. Clin Gastroenterol Hepatol 2018; 16: 1018-1029
    CrossrefPubMedGoogle Scholar
  • 16 Jaspersen D, Labenz J, Willich SN. et al. Long-term clinical course of extra-oesophageal manifestations in patients with gastro-oesophageal reflux disease: a prospective follow-up analysis based on the PROGERD study. Dig Liver Dis 2006; 38: 233-238
    CrossrefPubMedGoogle Scholar
  • 17 Herregods TVK, Pauwels A, Jafari J. et al. Determinants of reflux-induced chronic cough. Gut 2017; 66: 2057-2062
    CrossrefPubMedGoogle Scholar
  • 18 Munoz JV, Herreros B, Sanchiz V. et al. Dental and periodontal lesions in patients with gastro-oesophageal reflux disease. Dig Liver Dis 2003; 35: 461-467
    CrossrefPubMedGoogle Scholar
  • 19 Friesen LR, Bohaty B, Onikul R. et al. Is histologic esophagitis associated with dental erosion: a cross-sectional observational study?. BMC Oral Health 2017; 17: 116
    CrossrefPubMedGoogle Scholar
  • 20 Vinesh E, Masthan KMK, Kumar MS. et al. A clinicopathologic study of oral changes in gastroesophageal reflux disease, gastritis, and ulcerative colitis. J Contemp Dent Pract 2016; 17: 943-947
    CrossrefPubMedGoogle Scholar
  • 21 Loffeld RJLF. Incisor teeth status in patients with reflux oesophagitis. Digestion 1996; 57: 388-390
    CrossrefPubMedGoogle Scholar
  • 22 Farahmand F, Sabbanghian M, Ghodousi S. et al. Gastroesophageal reflux disease and tooth erosion: a cross-sectional observational study. Gut Liver 2013; 7: 278-281
    CrossrefPubMedGoogle Scholar
  • 23 Milani DC, Venturini APC, Callegari-Jacques SM. et al. Gastro-oesophageal reflux disease and dental erosions in adults: influence of acidified food intake and impact on quality of life. Eur J Gastroenterol Hepatol 2016; 28: 797-801
    CrossrefPubMedGoogle Scholar
  • 24 Ganesh M, Hertzberg A, Nurko S. et al. Acid than rather non-acid reflux burden is a predictor of tooth erosion. J Ped Gastroenterol Nutr 2016; 62: 309-313
    CrossrefPubMedGoogle Scholar
  • 25 Schroeder PL, Filler SJ, Ramirez B. et al. Dental erosion and acid reflux disease. Ann Intern Med 1995; 122: 809-815
    PubMedGoogle Scholar
  • 26 Wilder-Smith CH, Materna A, Martig L. et al. Gastro-oesophageal reflux is common in oligosymptomatic patients with dental erosion: a pH-impedance and endoscopic study. United European. Gastroenterol J 2015; 3: 174-181
    PubMedGoogle Scholar
  • 27 Boehmer CJM, Klinkenberg-Knol EC, Nierzen-de Boer MC. et al. Dental erosions and gastro-oesophageal reflux in institutionalized intellectually disabled individuals. Oral Dis 1997; 3: 272-275
    PubMedGoogle Scholar
  • 28 Wilder-Smith CH, Wilder-Smith P, Kawakami-Wong H. et al. Quantification of dental erosions in patients with GERD using optical coherence tomography before and after double-blind, randomized treatment with esomepazole or placebo. Am J Gastroenterol 2009; 104: 2788-2795
    CrossrefPubMedGoogle Scholar
  • 29 Wilder-Smith CH, Materna A, Martig L. et al. Longitudinal study of gastroesophageal reflux and erosive tooth wear. BMC Gastroenterol 2017; 17: 113
    CrossrefPubMedGoogle Scholar
  • 30 Thota P, Vennalaganti P, Vennalaganti S. et al. Low risk of high-grade dysplasia or esophageal adenocarcinoma among patients with Barrett’s esophagus less than 1 cm (irregular Z-line) within 5 years of index endoscopy. Gastroenterology 2017; 152: 987-992
    CrossrefPubMedGoogle Scholar
  • 31 Anaparthy R, Gaddam S, Kanakadandi V. et al. Association between length of Barrett’s esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol 2013; 11: 1430-1436
    CrossrefPubMedGoogle Scholar
  • 32 Parasa S, Vennalaganti S, Gaddam S. et al. Development and validation of a model to determine risk of progression of Barrett’s esophagus to neoplasia. Gastroenterology 2018; 154: 1282-1289
    CrossrefPubMedGoogle Scholar
  • 33 Codipilly DC, Chandar AK, Singh S. et al. The effect of endoscopic surveillance in patients with Barrett’s esophagus: a systematic review and meta-analysis. Gastroenterology 2018; 154: 2068-2086
    CrossrefPubMedGoogle Scholar
  • 34 Krishnamorrthi R, Singh S, Ragunathan K. et al. Factors associated with progression of Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018; 16: 1046-1055
    CrossrefPubMedGoogle Scholar