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Diagnose ösophagealer Motilitätsstörungen

Diagnosis of esophageal motility disorders

  • Schwerpunkt: Reflux und Dysphagie
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Bei der klinischen Beurteilung von Patienten mit Schluckproblemen ist es wesentlich, zwischen pharyngealer und ösophagealer Dysphagie zu unterscheiden. Zur Differenzialdiagnose der ösophagealen Dysphagie sollte nach Ausschluss struktureller Ursachen mittels Endoskopie eine physiologische Untersuchung der Schluckbeschwerden erfolgen. Grundsätzlich kann eine ösophageale Motilitätsstörung oder eine reduzierte Dehnbarkeit bzw. Durchlässigkeit des ösophagogastralen Übergangs eine Dysphagie provozieren. Auch Patienten mit einer viszeralen Hypersensibilität klagen gehäuft über das Gefühl von steckenbleibender Nahrung in der Speiseröhre. Eine hochauflösende Manometrie (HRM) wird derzeit als Goldstandard zur Identifizierung ösophagealer Motilitätsstörungen erachtet. Nach der Chicago-Klassifikation wird die Achalasie als bestbeschriebene Motilitätsstörung in 3 Typen unterschieden. Vor allem die Identifikation von Typ II mit „panösophagealer Druckerhöhungen“ bei Wasserschlucken ist relevant, da dieser Typ nach endoskopischer oder chirurgischer Behandlung eine gute Prognose aufweist. Andere Motilitätsstörungen, wie ein diffuser Ösophagusspasmus, eine Hyperkontraktilität des Ösophagus und eine schwere Hypomotilität, können ebenfalls eine Dysphagie hervorrufen. Eine gleichzeitige Messung mittels HRM und intraluminaler Impedanz (HRIM) ermöglicht die Bewertung von Motilität und Boluspassage. Insbesondere in Kombination mit einer standardisierten Testmahlzeit ist HRIM ein sehr leistungsfähiger Test zur Identifikation der Dysphagieursache. Der vorliegende Artikel diskutiert die Relevanz der ösophagealen Funktionsprüfung, insbesondere der HRM, bei Patienten mit ösophagealen Motilitätsstörungen.

Abstract

The first priority in the clinical assessment of patients with difficulty swallowing is to distinguish between pharyngeal and esophageal dysphagia. Then, after exclusion of structural and mucosal pathology by endoscopy, physiological investigations are performed to identify the cause of esophageal dysfunction and symptoms. The aim of manometry is to detect impaired motility in the tubular esophagus and reduced relaxation or opening of the esophagogastric junction (EGJ) that can lead to bolus retention and provoke dysphagia. In addition, patients with visceral hypersensitivity often complain about the sensation of bolus retention in the esophagus. High resolution manometry (HRM) is the reference standard for the diagnosis of esophageal motility disorders. According to the Chicago Classification, achalasia, which is the best described type of motility disorder, is divided into three types. In particular, the diagnosis of type II with “panesophageal pressurization” when swallowing water is relevant because good outcomes are achieved with endoscopic or surgical treatment. Other motility disorders identified by HRM including distal esophageal spasm, hypercontractile esophageal contractions, and aperistalsis (absent contractility) may also cause dysphagia. Simultaneous measurement with HRM and intraluminal impedance (HRIM) can be helpful to assess both esophageal motility and bolus passage. HRIM is a very powerful test that can often identify the causes of dysphagia when combined with a standardized test meal. This article describes the application of various tests of esophageal function, in particular HRM, in the diagnosis of esophageal motility disorders.

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Authors and Affiliations

  1. Klinik für Gastroenterologie und Hepatologie, UniversitätsSpital Zürich, Rämistrasse 100, 8091, Zürich, Schweiz

    M. Hollenstein, W. Schwizer &  M. Fox

  2. Gastroenterologie-Zentrum Stephanshorn, Brauerstrasse 95, 9016, St. Gallen, Schweiz

    W. Schwizer

  3. Bauchzentrum: Gastroenterologie, St. Claraspital, Kleinriehenstrasse 30, 8016, Basel, Schweiz

    M. Fox

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  1. M. Hollenstein
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  2. W. Schwizer
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  3. M. Fox
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Correspondence to M. Fox.

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Interessenkonflikt

M. Fox ist Vorsitzender der internationalen Arbeitsgruppe für gastrointestinale Motilität und Funktion. Diese Organisation wird u. a. von den Herstellern hochauflösender Manometriegeräte unterstützt. M. Hollenstein und W. Schwizer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Fried, Zürich

J.F. Riemann, Ludwigshafen

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Hollenstein, M., Schwizer, W. & Fox, M. Diagnose ösophagealer Motilitätsstörungen. Gastroenterologe 11, 82–91 (2016). https://doi.org/10.1007/s11377-016-0046-z

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  • DOI: https://doi.org/10.1007/s11377-016-0046-z

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