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Gastroparese

Definition, Diagnostik und Therapie

Gastroparesis

Definition, diagnostics, and therapy

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Zusammenfassung

Die Gastroparese ist ein Syndrom, das in Abwesenheit einer mechanischen Obstruktion durch eine objektivierbar verzögerte Magenentleerung in Verbindung mit den Leitsymptomen Übelkeit, Erbrechen, vorzeitiges Sättigungsgefühl, Oberbauchschmerzen und Blähungen charakterisiert ist. Idiopathische Faktoren, Diabetes mellitus und postoperative Situationen stellen die häufigsten Ursachen dar. Drei diagnostische Methoden werden eingesetzt, um eine verzögerte Magenentleerung zu verifizieren und zu objektivieren: die Magenentleerungsszintigraphie als Goldstandard, die kabellose Motilitätskapsel und der 13C-Octanoat-Atemtest. Zu den Zielen der medikamentösen Therapie zählen die Normalisierung des Ernährungszustands, die Optimierung der Blutzuckereinstellung und die Symptomlinderung in Verbindung mit einer verbesserten Magenentleerung. Als Erstlinientherapie werden prokinetisch wirksame Substanzen verabreicht. Stehen Übelkeit und Erbrechen im Vordergrund, kommen antiemetisch wirksame Substanzen zur Anwendung. Eine Magenschrittmacherimplantation und operative Verfahren sind weitere therapeutische Alternativen.

Abstract

Gastroparesis is characterized by a constellation of upper gastrointestinal symptoms in association with delayed gastric emptying in the absence of mechanical outlet obstruction from the stomach. Major symptoms are nausea, vomiting, early satiety or postprandial fullness, bloating, and abdominal or epigastric pain. Idiopathic, diabetic, and postsurgical causes represent the most common etiologies. Diagnostic procedures for the evaluation of gastroparesis comprise gastric emptying scintigraphy (gold standard), 13C-octanoate breath testing, and a wireless motility capsule. Management of gastroparesis includes normalization of nutritional state, relief of symptoms, glycemic control, and improvement of gastric emptying. Medical treatment entails use of prokinetic drugs, which are currently the first-line therapy. Nausea and vomiting might be positively influenced by antiemetic drugs. Gastric electronic stimulation and surgical interventions should be used in well-defined patients and represent a therapeutic option in tertiary centers.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. U. von Arnim gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    U. von Arnim

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von Arnim, U. Gastroparese. Internist 56, 625–630 (2015). https://doi.org/10.1007/s00108-014-3604-9

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  • DOI: https://doi.org/10.1007/s00108-014-3604-9

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