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Erstlinienmanagement bei gastroösophagealem Reflux

Diät und Therapie mit rezeptfreien Medikamenten

First-line management of gastroesophageal reflux

Diet and treatment with nonprescription drugs

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

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Zusammenfassung

Die Ernährung kann Häufigkeit und Schwere von Refluxsymptomen entscheidend beeinflussen. Die Beeinflussung der Magendehnung (z. B. Volumen der Mahlzeit), Magenentleerung (z. B. Kaloriengehalt) und Säuresekretion (z. B. Kalzium, bestimmte Aminosäuren) durch Nahrungsmittel kann gastroösophagealen Reflux fördern. Fettgehalt und Alkohol modifizieren die ösophageale Sensibilität und können die Wahrnehmung der Refluxbeschwerden ändern. Gezielte Veränderungen des Lebensstils umfassen demzufolge die Einnahme kleinerer Mahlzeiten mit geringerem Kalorien- und Fettgehalt, eine Gewichtsabnahme sowie den Verzicht auf einen Verdauungsschlaf.

Wenn Veränderungen der Ernährungsgewohnheiten zur Symptomkontrolle nicht ausreichen, können Over-the-counter(OTC)-Medikamente bei Patienten mit intermittierenden und geringgradigen Refluxsymptomen nützlich sein. Hierzu gehören Antazida, die die Magensäure neutralisieren, und Alginatpräparate (Gaviscon®), die die Position der sog. Säuretasche vom gastroösophagealen Übergang wegverlagern. Bei schwereren Symptomen stehen Protonenpumpeninhibitoren (PPI) in vielen Ländern freiverkäuflich zur Verfügung. OTC-Medikamente stellen eine effektive und kosteneffiziente Therapie für gewisse Patientengruppen dar. Alarmsymptome (z. B. Dysphagie, signifikanter Gewichtsverlust) bzw. fehlendes Ansprechen auf die Therapie sollten durch den Apotheker erkannt werden und zu einer fachärztlichen Betreuung führen. Für eine optimale Therapie sollten Häufigkeit und Schwere der Symptome sowie Langzeitkomplikationen einer PPI-Therapie berücksichtigt werden.

Abstract

Dietary factors have important effects on gastrointestinal function. Any factor that increases gastric distention (e. g. meal volume), slows gastric emptying (e. g. calorie load), or promotes acid secretion (e. g. calcium, certain amino acids) increases the risk of gastroesophageal reflux. Further factors that modulate esophageal sensitivity (e. g., fat content, alcohol) may have an impact on the frequency and severity of reflux symptoms. Specific dietary interventions that reduce esophageal acid exposure and reflux symptoms include weight loss, not lying down after a meal, reduction of meal size, and avoiding high-calorie, high-fat foods. If dietary interventions are not sufficient to control symptoms, then over-the-counter (OTC) medications can provide effective treatment for individuals with intermittent and/or mild reflux symptoms. These include simple antacids that neutralize gastric acid and antacid–alginate preparations (e. g. Gaviscon®) that displace the so-called “acid pocket” at the esophagogastric junction and suppress both acid and nonacid reflux events. For more severe symptoms, proton pump inhibitors (PPI) are available without prescription in many countries. The availability of OTC treatment medications can provide appropriate and, almost certainly, cost-effective treatment for some people. However, for patients who choose not to visit a medical practitioner, it is important that the presence of alarm symptoms (e. g., dysphagia, weight loss) or therapy-resistant disease is recognized by the pharmacist dispensing these medications. In this situation specialist attention and endoscopic investigation are always required. Furthermore, the frequency and severity of symptoms plus long-term complications particularly of PPI therapy should be considered to ensure that optimal treatment is delivered.

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Authors and Affiliations

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

    H. Heinrich, B. Misselwitz, D. Pohl & M. Fox

  2. Bauchzentrum, Clara Spital Basel, Basel, Schweiz

    M. Fox

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  1. H. Heinrich
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  2. B. Misselwitz
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  3. D. Pohl
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  4. M. Fox
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Correspondence to H. Heinrich.

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H. Heinrich, B. Misselwitz, D. Pohl und M. Fox 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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Heinrich, H., Misselwitz, B., Pohl, D. et al. Erstlinienmanagement bei gastroösophagealem Reflux. Gastroenterologe 11, 119–124 (2016). https://doi.org/10.1007/s11377-016-0047-y

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