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Gastroenterologie up2date 2016; 12(03): 193-208
DOI: 10.1055/s-0042-112518
Ösophagus/Magen/Duodenum
© Georg Thieme Verlag KG Stuttgart · New York

Ulkuskrankheit – Update

Herbert Koop
,
Joachim Labenz
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Publikationsverlauf

Publikationsdatum:
19. September 2016 (online)

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Kernaussagen

Epidemiologie und Diagnostik

  • Das epidemiologische Bild der Ulkuskrankheit hat sich in Mitteleuropa erheblich verändert (ältere Patienten, vermehrt Ulzera durch ulzerogene Pharmaka wie ASS und NSAR).

  • Bei jedem Ulkus muss nach einer H.p.-Infektion gefahndet werden.

  • Zum sicheren Nachweis einer H.p.-Infektion sind 2 separate Testverfahren einzusetzen.

Therapie

  • Beim Ulkus muss eine bestehende H.p.-Infektion immer behandelt werden.

  • Die Wahl des primären Therapieschemas richtet sich wesentlich nach der Wahrscheinlichkeit von Antibiotikaresistenzen.

  • Spätestens nach zweimalig fehlgeschlagener H.p.-Eradikation ist eine Resistenzbestimmung dringend zu empfehlen.

  • Die Indikation für eine weitere Therapie mit potenziell ulzerogenen Pharmaka sollte bei Patienten mit ASS- bzw. NSAR-induzierten Ulzera stets kritisch überprüft werden.

Rezidivprophylaxe und Prävention

  • Bei Fortführung einer ASS- bzw. NSAR-Therapie stellt die Begleitmedikation mit einem Protonenpumpenblocker beim Ulkuspatienten die sicherste Option dar.

  • Ein generelles Screening auf H.p. vor einer geplanten ASS- bzw. NSAR-Therapie ist derzeit nicht zu empfehlen.

  • Eine Rezidivprophylaxe beim Non-H.p.-non-NSAR-Ulkus ist in der Regel langfristig anzulegen.

 

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