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Diagnostik und Therapie atypischer Refluxsymptome bei fehlendem PPI-Ansprechen

Diagnosis and therapy of atypical reflux symptoms when PPI therapy fails

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Zusammenfassung

Die gastroösophageale Refluxkrankheit (GERD) ist eine häufige chronische Krankheit mit 2 Formen: einerseits geprägt durch typische Symptome wie Sodbrennen und saures Aufstoßen; andererseits vornehmlich durch atypische Symptome wie z. B. chronischer Husten, Heiserkeit, Halsschmerzen, Globussensationen im Hals, Zungenbrennen, rezidivierende Sinusitiden, Asthma bronchiale, dentale Erosionen, retrosternale Schmerzen oder Räusperzwang durch Schleimproduktion. Zur Standardtherapie gehört eine medikamentöse Säuresuppression durch Protonenpumpenhemmer. Viele Patienten, insbesondere die mit atypischen Beschwerden, sprechen jedoch nicht adäquat auf die Therapie an. Erst nach sicherer Identifikation der GERD-Patienten durch eine valide Diagnostik kann eine modifizierte pharmakologische oder interventionelle Therapie individualisiert werden. Können atypische GERD-Symptome nicht objektiviert werden, liegt eher keine GERD vor. Andere Ursachen der Symptome müssen dann in Erwägung gezogen und behandelt werden.

Abstract

Gastroesophageal reflux disease (GERD) is a frequent chronic disorder occurring in two forms: on the one hand, typical symptoms such as heartburn and acid regurgitation are seen, while on the other hand atypical (extraesophageal) symptoms such as chronic cough, hoarseness, recurrent sinusitis, globus sensations in the throat, a burning feeling on the tongue, dental erosions and the constant need to clear the throat can be associated with gastroesophageal reflux. The standard therapeutic medical procedure comprises the administration of acid-suppressive agents, proton pump inhibitors (PPI). However, this therapy has proved to be ineffective in a number of patients, especially in atypical GERD. Only after reliable identification of the GERD patient by using valid diagnostic tools medical or interventional therapeutic options can be applied individually. In the absence of atypical GERD symptoms, the diagnosis of GERD becomes very unlikely and other causes of the symptoms need to be taken into consideration.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: PD Dr. M. Bajbouj war als Referent für die Fa. Neuwirth Medical Products (Vertreiber der Restech®-Sonde) tätig.

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  1. II. Medizinische Klinik, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81575, München, Deutschland

    M. Bajbouj

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  1. M. Bajbouj
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Correspondence to M. Bajbouj.

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Bajbouj, M. Diagnostik und Therapie atypischer Refluxsymptome bei fehlendem PPI-Ansprechen. HNO 60, 193–199 (2012). https://doi.org/10.1007/s00106-011-2430-9

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