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Neu erkannte Nebenwirkungen von Protonenpumpeninhibitoren

Argumente Pro Fundoplicatio bei GERD?

Newly recognized side-effects of proton pump inhibitors

Arguments in favour of fundoplication for GERD?

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Zusammenfassung

Protonenpumpeninhibitoren (PPI) werden unter anderem zur medikamentösen Therapie der gastroösophagealen Refluxkrankheit (GERD) verwendet. PPI sind die meistverschriebenen und -verwendeten Medikament in der Gastroenterologie. PPI wurden bislang als sehr nebenwirkungsarm angesehen. In den letzten Jahren häufen sich allerdings Studienergebnisse zu neuen relevanten Nebenwirkungen. Wir liefern einen Überblick zur aktuellen Datenlage der PPI-Nebenwirkungen und diskutieren deren Relevanz für die Therapieverfahrenswahl bei GERD (medikamentöse Dauertherapie vs. Antirefluxchirurgie).

PPI sind nach neuen Daten assoziiert mit: osteoporosebedingten Frakturen, Clostridium-difficile-assoziierter Diarrhö (CDAD), nosokomialen und extranosokomialen Pneumonien, pharmakologischer Interaktion mit Clopidogrel und Acetylsalicylsäure und konsekutiv vermehrten kardiovaskulären Ereignissen, therapierefraktärer Hypomagnesiämie, Rebound-Refluxsymptomen etc. Die Nutzen-Risiko-Relation bei den PPIs sollte zunehmend kritischer beurteilt werden, da – insbesondere bei Langzeiteinnahme – die Nebenwirkungen die positiven Effekte überwiegen können. Die schweren PPI-Nebenwirkungen können als starkes Argument zugunsten der laparoskopischen Fundoplicatio bei GERD gelten.

Abstract

Among other indications proton pump inhibitors (PPIs) are used as medical treatment of gastroesophageal reflux disease (GERD) and are the most frequently prescribed and most frequently used drugs in gastroenterology. Until recently PPIs were regarded as very safe and associated with very few side-effects. However, during recent years study results have revealed many severe adverse events associated especially with long-term PPI use. We review the currently available evidence, regarding the side-effects of PPIs and discuss the potential impact on treatment strategies for GERD (conservative treatment vs. antireflux surgery).

Currently available data suggest that PPIs are associated with osteoporosis-related fractures, Clostridium difficile associated diarrhea (CDAD), community and hospital-acquired pneumonia, pharmacologic interaction with clopidogrel and acetylsalicylic acid with subsequent increased rate of cardiovascular events, refractory hypomagnesemia and rebound reflux symptoms etc. The risk-benefit ratio of PPIs is increasingly recognized as being less favourable. This leads to a more critical viewpoint and raises the question whether the side-effects of PPIs may outweigh the benefits, especially with long-term use. The side-effects of PPIs seem to make a strong argument in favour of laparoscopic fundoplication in the treatment of GERD.

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Notes

  1. AOR bei 1 Jahr, 1,22 [95%CI: 1,15–1,30]; bei 2 Jahren, 1,41 [95%CI: 1,28–1,56]; bei 3 Jahren, 1,54 [95%CI: 1,37–1,73]; bei 4 Jahren, 1,59 [95%CI: 1,39–1,80]; p<0,001 für alle statistischen Vergleiche.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral-, Gefäß und Kinderchirurgie, Zentrum für operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland

    B.H.A. von Rahden, J. Filser & C.-T. Germer

  2. II. Medizinische Klinik, Abteilung für Gastroenterologie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    M. Scheurlen

  3. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Nürnberg Nord, Nürnberg, Deutschland

    H.J. Stein

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  1. B.H.A. von Rahden
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  3. J. Filser
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von Rahden, B., Scheurlen, M., Filser, J. et al. Neu erkannte Nebenwirkungen von Protonenpumpeninhibitoren. Chirurg 83, 38–44 (2012). https://doi.org/10.1007/s00104-011-2173-x

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