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Extraösophageale Refluxerkrankungen bei Kindern

Diagnostik und Therapie

Gastroesophageal reflux diseases in childhood

Diagnosis and therapy

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Zusammenfassung

Refluxassoziierte Erkrankungen der Atemwege müssen als diagnostische Herausforderung verstanden werden. Es gibt aktuell noch kein einzelnes Verfahren, dem ein unmittelbarer diagnostischer Rang zukommt und das den kausalen Zusammenhang eines pathologischen Refluxes mit einer chronischen Erkrankung der oberen und unteren Atemwege herstellen kann. Durch eine Kombination aus verschiedenen auf den Zusammenhang hinweisenden Verfahren (2-Punkt-Langzeit-pH-Metrie, Bronchoskopie, bronchoalveoläre Lavage, Quantifizierung fettbeladener Makrophagen, Gastroskopie und ösophageale Histologie) und eine konsequente Differenzial- bzw. Ausschlussdiagnostik kann die Diagnose einer refluxassoziierten Erkrankung mit hinreichender Präzision gestellt werden. Neben einer meist nicht nachhaltig erfolgreichen Therapie mit Protonenpumpenhemmern haben sich minimalinvasive chirurgische Verfahren wie die Hemifundoplikatio nach Thal bewährt.

Abstract

Gastroesophageal reflux diseases represent a diagnostic challenge, not least since no single diagnostic procedure has been able to establish a causal link between pathological reflux and chronic upper and lower airway diseases. By combining a variety of procedures which point to a link (multi-channel pH measurement, impedance measurement of the esophagus, video panendoscopy, bronchoalveolar lavage, and quantification of lipid-laden alveolar macrophages) and careful differential and exclusion diagnoses, reflux-related diseases can be diagnosed with sufficient precision. In addition to initially successful PPI therapy, surgical intervention (hemifundoplication) is the method of choice in children.

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  1. Darmstädter Kinderkliniken Prinzessin Margaret, Dieburgerstr. 31, 64287, Darmstadt, Deutschland

    P. Ahrens

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  1. P. Ahrens
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Ahrens, P. Extraösophageale Refluxerkrankungen bei Kindern. HNO 60, 206–215 (2012). https://doi.org/10.1007/s00106-011-2442-5

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