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Reflux und Hiatushernie im Spannungsfeld zwischen konservativer und operativer Therapie

Reflux and hiatus hernia in the controversy between conservative and operative therapy

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Zusammenfassung

Etwa 20 % der Bevölkerung sind von einer gastroösophagealen Refluxkrankheit (GERD) betroffen. Subjektiv-klinisches und objektiv-pathologisches Ausmaß der Krankheit sind sehr variabel, die ursächlichen pathophysiologischen Mechanismen vielfältig. Die Bedeutung der Hiatushernie für die GERD wird seit Jahrzehnten intensiv diskutiert. Zunächst sah man die Hiatushernie im Zentrum der Pathophysiologie, später wurde zunehmend die Funktion des unteren ösophagealen Sphinkters beachtet. Heute werden mit exakten diagnostischen Methoden weitere relevante pathophysiologische Kofaktoren erkannt und zur Therapieentscheidung herangezogen. Trotz der Standardisierung der operativen Technik und zunehmender Kritik gegenüber einer Langzeittherapie mit Protonenpumpeninhibitoren erfordert die Antirefluxchirurgie weiterhin eine sehr kritische Indikationsstellung auf der Basis umfassender diagnostischer Evaluierung.

Abstract

Approximately 20 % of the population are affected by gastroesophageal reflux disease (GERD). The subjective clinical and objective pathological extent of the disease is highly variable and the underlying pathophysiological mechanisms extraordinarily diverse. The importance of hiatus hernia for GERD has been intensively debated for decades. Hiatus hernia was initially considered to be at the center of the pathophysiology but later the function of the lower esophageal sphincter was increasingly considered to be of importance. Currently, additional relevant pathophysiological cofactors are being detected with the continuous improvement in diagnostic methods and used for therapeutic decision-making. Despite standardization of the operative technique and increasing criticism on long-term proton pump inhibitor (PPI) therapy, antireflux surgery still requires a very critical assessment of indications based on a comprehensive diagnostic evaluation.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S.M. Freys und J. Heimbucher haben von der Firma torax Medical Inc. Studienhonorare und Reisekostenerstattungen erhalten. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Chirurgische Klinik, Interdisziplinäres Bauchzentrum, Darmkrebszentrum Bremen West, DIAKO Ev. Diakonie-Krankenhaus gGmbH, Gröpelinger Heerstr. 406–408, 28239, Bremen, Deutschland

    S.M. Freys

  2. Chirurgische Klinik, Marienkrankenhaus Kassel, Kassel, Deutschland

    J. Heimbucher

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  1. S.M. Freys
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  2. J. Heimbucher
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Correspondence to S.M. Freys.

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Freys, S., Heimbucher, J. Reflux und Hiatushernie im Spannungsfeld zwischen konservativer und operativer Therapie. Chirurg 85, 1046–1054 (2014). https://doi.org/10.1007/s00104-014-2804-0

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  • DOI: https://doi.org/10.1007/s00104-014-2804-0

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