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Z Gastroenterol 2007; 45(11): 1169-1179
DOI: 10.1055/s-2007-963531
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Medikamentöse Therapieoptimierung bei gastroösophagealer Refluxkrankheit und ihren Komplikationen

Therapeutic Strategies for Gastro-Esophageal Reflux DiseaseJ. Labenz1, 2 , A. Leodolter1
  • 1Medizinische Klinik, Ev. Jung-Stilling-Krankenhaus, Akademisches Lehrkrankenhaus der Universität Bonn
  • 2Medizinische Fakultät der Universität Duisburg-Essen
Further Information

Publication History

Manuskript eingetroffen: 11.7.2007

Manuskript akzeptiert: 13.8.2007

Publication Date:
19 November 2007 (online)

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Zusammenfassung

Die gastroösophageale Refluxkrankheit (GERD) ist in industrialisierten Ländern häufig. Kürzlich wurde eine neue Definition und Klassifikation der Refluxkrankheit basierend auf einem weltweiten Konsensus publiziert. Demnach kann sich die GERD mit ösophagealen und extraösophagealen Syndromen präsentieren, letztere werden gemäß der Evidenzlage in etablierte und mögliche Assoziationen unterteilt. Protonenpumpeninhibitoren (PPI) sind die Medikamente der Wahl für alle Schweregrade der GERD. Die individuelle Therapiestrategie mit einem PPI (z. B. Dosierung, Einnahmedauer) hängt maßgeblich von der klinischen Präsentation ab. Ganz allgemein kann festgehalten werden, dass das Ausmaß der Säurereduktion durch einen PPI korreliert ist mit klinisch bedeutsamen Therapiezielen: Geschwindigkeit und Ausmaß der Symptomkontrolle, Heilung der Refluxösophagitis, symptomatische und endoskopische Remissionserhaltung. Die Wirksamkeit einer PPI-Therapie kann im Einzelfall durch Wechsel des Präparates und/oder durch Erhöhung der Einnahmefrequenz gesteigert werden. Die aktuelle Datenlage spricht für ein ausgezeichnetes Sicherheitsprofil der PPI ohne relevante Unterschiede zwischen einzelnen Substanzen.

Abstract

Gastroesophageal reflux disease (GERD) is a common condition in industrialised countries. According to a recently published, globally accepted definition and classification of GERD, clinical presentations include oesophageal and extraoesophageal syndromes, with extraoesophageal syndromes divided into established and proposed associations. Proton pump inhibitors (PPI) are the drug class of choice for all patients with GERD, irrespective of the severity. The individual strategy of treatment (e. g., dose and duration of PPI) depends on the clinical presentation. As a rule, the magnitude of acid control gained by PPIs is related to clinically meangingful outcome parameters: speed and extent of symptom control, healing of reflux oesophagitis, maintenance of symptomatic and endoscopic remission of the disease. In individual cases, the efficacy of PPI therapy can be improved by switching from one compound to another and by increasing the frequency of dosing. Current evidence suggests that PPI therapy is remarkably safe without any relevant differences between the PPIs on the market.

Schlüsselwörter

gastroösophageale Refluxkrankheit - GERD - Montreal-Definition - Protonenpumpeninhibitoren - PPI

Key words

gastroesophageal reflux disease - GERD - Montreal definition - proton pump inhibitors - PPI

Literatur

  • 1 Moayyedi P, Axon A TR. Review article: gastro-oesophageal reflux disease - the extent of the problem.  Aliment Pharmacol Ther. 2005;  22 (Suppl 1) 11-19
    Google Scholar
  • 2 Nocon M, Labenz J, Willich S N. Lifestyle factors and symptoms of gastro-oesophageal reflux - a population-based study.  Aliment Pharmacol Ther. 2006;  23 169-174
    Google Scholar
  • 3 Boeckxstaens G EE. Review article: the pathophysiology of gastro-oesophageal reflux disease.  Aliment Pharmacol Ther. 2007;  26 149-160
    Google Scholar
  • 4 Vakil N, V. Zanten van S, Kahrilas P. et al . The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.  Am J Gastroenterol. 2006;  101 1900-1920
    Google Scholar
  • 5 Meining A, Classen M. The role of diet and lifestyle measures in the pathogenesis and treatment of gastroesophageal reflux disease.  Am J Gastroenterol. 2000;  95 2692-2697
    Google Scholar
  • 6 Koop H. Gastroösophageale Refluxkrankheit - Ergebnisse einer evidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten.  Z Gastroenterol. 2005;  143 163-194
    Google Scholar
  • 7 Chiba N, De Gara C J, Wilkinson J M. et al . Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis.  Gastroenterology. 1997;  112 1798-1810
    Google Scholar
  • 8 Fackler W K, Ours T M, Vaezi M F. et al . Long-term effect of H 2RA therapy on nocturnal acid breakthrough.  Gastroenterology. 2002;  122 625-632
    Google Scholar
  • 9 Katz P O, Scheiman J M, Barkun A N. Review article: acid -related disease - what are the unmet clinical needs?.  Aliment Pharmacol Ther. 2006;  23 (Suppl 2) 9-22
    Google Scholar
  • 10 Bell N J, Burget D, Howden C W. et al . Appropriate acid suppression for the management of gastro-oesophageal reflux disease.  Digestion. 1992;  51 (Suppl 1) 59-67
    Google Scholar
  • 11 Crawley J, Hamelin B, Gallagher E. How satisfied are chronic heartburn sufferers with the results they get from prescription strength heartburn medication?.  Gastroenterology. 2000;  118 A210
    Google Scholar
  • 12 Katz P O, Ginsberg G G, Hoyle P E. Relationship between intragastric acid control and healing status in the treatment of moderate to severe erosive oesophagitis.  Aliment Pharmacol Ther. 2007;  25 617-628
    Google Scholar
  • 13 Miwa H, Sasaki M, Furuta T. et al . Efficacy of rabeprazole on heartburn symptom resolution in patients with non-erosive and erosive gastro-oesophageal reflux disease: a multicenter study from Japan.  Aliment Pharmacol Ther. 2007;  26 69-77
    Google Scholar
  • 14 Holzer P. Taste receptors in the gastrointestinal tract. V. Acid sensing in the gastrointestinal tract.  Am J Physiol Gastrointest Liver Physiol. 2007;  292 G699-G705
    Google Scholar
  • 15 Gerson L P, Boparai V, Ullah N. et al . Oesophageal and gastric pH profiles in patients with gastro-oesophageal reflux disease and Barrett’s oesophagus treated with proton pump inhibitors.  Aliment Pharmacol Ther. 2004;  20 637-643
    Google Scholar
  • 16 Spechler S J, Sharma P, Traxler B. et al . Gastric and esophageal pH in patients with Barrett’s esophagus treated with three esomeprazole dosages: a randomized, double-blind, crossover trial.  Am J Gastroenterol. 2006;  101 1964-1971
    Google Scholar
  • 17 Sachs G, Shin J M, Howden C W. Review article: the clinical pharmacology of proton pump inhibitors.  Aliment Pharmacol Ther. 2006;  23 (Suppl 2) 2-8
    Google Scholar
  • 18 Minor Jr P, Katz P O, Chen Y. et al . Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole: a five-way crossover study.  Am J Gastroenterol. 2003;  98 2616-2620
    Google Scholar
  • 19 Röhss K, Wilder-Smith C, Nauclér E. et al . Esomeprazole 20 mg provides more effective intragastric acid control than maintenance-dose rabeprazole, lansoprazole or pantoprazole in healthy volunteers.  Clin Drug Invest. 2004;  24 1-7
    Google Scholar
  • 20 Charbel S, Khandwala F, Vaezi M F. The role of esophageal pH monitoring in symptomatic patients on PPI therapy.  Am J Gastroenterol. 2005;  100 283-289
    Google Scholar
  • 21 Kahrilas P J, Falk G W, Johnson D A. et al . Esomeprazole improves healing and symptom resolution as compared with omeprazole in reflux esophagitis patients: a randomized controlled study.  Aliment Pharmacol Ther. 2000;  14 1249-1258
    Google Scholar
  • 22 Vakil N. Review article: new pharmacological agents for the treatment of gastro-oesophageal reflux disease.  Aliment Pharmacol Ther. 2004;  19 1041-1049
    Google Scholar
  • 23 Laine L, Ahnen D, McClain C. et al . Review article : potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors.  Aliment Pharmacol Ther. 2000;  14 651-668
    Google Scholar
  • 24 Jalving M, Koornstra J J, Wesseling J. et al . Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy.  Aliment Pharmacol Ther. 2006;  24 1341-1348
    Google Scholar
  • 25 Laheij R J, Sturkenboom M C, Hassing R J. et al . Risk of community-aquired pneumonia and use of gastric acid suppressive drugs.  J Am Med Ass. 2004;  292 1955-1960
    Google Scholar
  • 26 Leonard J, Marshall J K, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression.  Am J Gastroenterol. 2007;  102 1-10
    Google Scholar
  • 27 Yang Y X, Lewis J D, Epstein S. et al . Long-term proton pump inhibitor therapy and risk of hip fracture.  J Am Med Ass. 2006;  296 2947-2953
    Google Scholar
  • 28 Yearsley K A, Gilby L J, Ramadas A V. et al . Proton pump inhibitor therapy is a risk factor for Clostridium difficile-associated diarrhoea.  Aliment Pharmacol Ther. 2006;  24 613-619
    Google Scholar
  • 29 Hunfeld N GM, Geus W P, Kuipers E J. Systematic review: rebound acid hypersecretion after therapy with proton pump inhibitors.  Aliment Pharmacol Ther. 2007;  25 39-46
    Google Scholar
  • 30 Labenz J, Petersen K U, Rösch W. et al . A summary of Food and Drug Administration-reported adverse events and drug interactions occurring during therapy with omeprazole, lansoprazole and pantoprazole.  Aliment Pharmacol Ther. 2003;  17 1015-1019
    Google Scholar
  • 31 Geevasinga N, Coleman P L, Webster A C. et al . Proton pump inhibitors and acute interstitial nephritis.  Clin Gastroenterol Hepatol. 2006;  4 597-604
    Google Scholar
  • 32 Williams C, McColl K EL. Review article: proton pump inhibitors and bacterial overgrowth.  Aliment Pharmacol Ther. 2006;  23 3-10
    Google Scholar
  • 33 Kuipers E J. Proton pump inhibitors and gastric neoplasia.  Gut. 2006;  55 1217-1221
    Google Scholar
  • 34 Malfertheiner P, Megraud F, O’Morain C. et al . Current concepts in the management of Helicobacter pylori infection - The Maastricht III Consensus Report.  Gut. 2007;  56 772-781
    Google Scholar
  • 35 Kulig M, Nocon M, Vieth M. et al . Risk factors of gastroesophageal reflux disease: methodology and first epidemiological results of the ProGERD study.  J Clin Epidemiol. 2004;  57 580-589
    Google Scholar
  • 36 Morgner-Miehlke A, Koop H, Blum A L. et al . Abklärung und Therapie von Refluxbeschwerden.  Z Gastroenterol. 2006;  44 399-410
    Google Scholar
  • 37 Hansen N A, Bergheim R, Fagertun H. et al . A randomised prospective study comparing the effectiveness of esomeprazole treatment strategies in clinical practice for 6 months in the management of patients with symptoms of gastroesophageal reflux disease.  Int J Clin Pract. 2005;  59 665-671
    Google Scholar
  • 38 Hansen N A, Wahlqvist P, Jorgensen E. et al . Six-month management of patients following treatment for gastroesophageal disease reflux symptoms - a Norwegian randomized, prospective study comparing the costs and effectiveness of esomeprazole and ranitidine treatment strategies in a general medical practitioners setting.  Int J Clin Pract. 2005;  59 655-664
    Google Scholar
  • 39 Labenz J, Nocon M, Lind T. et al . Prospective follow-up data from the ProGERD study suggest that GERD is not a categorial disease.  Am J Gastroenterol. 2006;  101 2457-2462
    Google Scholar
  • 40 Fullard M, Kang J Y, Neild P. et al . Systematic review: does gastro-oesophageal reflux disease progress?.  Aliment Pharmacol Ther. 2006;  24 33-45
    Google Scholar
  • 41 Labenz J, Morgner-Miehlke A. An update on the available treatments for non-erosive reflux disease.  Expert Opin Pharmacother. 2006;  7 47-56
    Google Scholar
  • 42 Watson R G, Tham T C, Johnston B T. et al . Double-blind cross-over study of omeprazole in the treatment of patients with reflux symptoms and physiological levels of acid reflux - the `sensitive oesophagus’.  Gut. 1997;  40 587-590
    Google Scholar
  • 43 Dean B B, Gano A D, Knight Jr K. et al . Effectiveness of proton pump inhibitors in nonerosive reflux disease.  Clin Gastroenterol Hepatol. 2004;  2 656-664
    Google Scholar
  • 44 Armstrong D, Talley N J, Lauritsen K. et al . The role of acid suppression in patients with endoscopy-negative reflux disease: the effect of treatment with esomeprazole or omeprazole.  Aliment Pharmacol Ther. 2004;  20 413-421
    Google Scholar
  • 45 Labenz J, Borkenstein D P, Leodolter A. et al . Gastroösophageale Refluxkrankheit.  Dtsch Med Wochenschr. 2006;  131 E17-E31
    Google Scholar
  • 46 Broekaert D, Fischler B, Sifrim D. et al . Influence of citalopram, a selective serotonin reuptake inhibitor, on oesophageal hypersensitivity: a double-blind, placebo controlled study.  Aliment Pharmacol Ther. 2006;  23 365-370
    Google Scholar
  • 47 Vakil N. Review article: the role of surgery in gastro-oesophageal reflux disease.  Aliment Pharmacol Ther. 2007;  25 1365-1372
    Google Scholar
  • 48 Fenton P, Terry M L, Galloway D. et al . Is there a role for laparoscopic fundoplication in patients with non-erosive reflux disease (NERD)?.  Gastroenterology. 2000;  118 A-481
    Google Scholar
  • 49 Cremonini F, Wise J, Moayyedi P. et al . Diagnostic and therapeutic use of proton pump inhibitors in non-cardiac chest pain: metaanalysis.  Am J Gastroenterol. 2005;  100 1226-1232
    Google Scholar
  • 50 Lundell L R, Dent J, Bennett J R. et al . Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification.  Gut. 1999;  45 172-180
    Google Scholar
  • 51 Labenz J, Malfertheiner P. Treatment of uncomplicated reflux disease.  World J Gastroenterol. 2005;  11 4291-4299
    Google Scholar
  • 52 Bardhan K D, Achim A, Riddermann T. et al . A clinical trial comparing pantoprazole and esoomeprazole to explore the concept of achieving `complete remission’ in gastro-oesophageal reflux disease.  Aliment Pharmacol Ther. 2007;  25 1461-1469
    Google Scholar
  • 53 Pace F, Tonini M, Pallota S. et al . Systematic review: maintenance treatment of gastro-oesophageal reflux disease with proton pump inhibitors taken ‘on demand’.  Aliment Pharmacol Ther. 2007;  26 195-204
    Google Scholar
  • 54 Sjöstedt S, Befrits R, Sylvan A. et al . Daily treatment with esomeprazole is superior to that taken on-demand for maintenance of healed erosive oesophagitis.  Aliment Pharmacol Ther. 2005;  22 183-191
    Google Scholar
  • 55 Sontag S J, Sonnenberg A, Schnell T G. et al . The long-term natural history of gastroesophageal reflux disease.  J Clin Gastroenterol. 2006;  40 398-404
    Google Scholar
  • 56 Labenz J, Armstrong D, Lauritsen K. et al . A randomized comparative study of esomeprazole 40 mg versus pantoprazole 40 mg for healing erosive oesophagitis: the EXPO study.  Aliment Pharmacol Ther. 2005;  21 739-746
    Google Scholar
  • 57 Labenz J, Armstrong D, Lauritsen K. et al . Esomeprazole 20 mg vs. pantoprazole 20 mg for maintenance therapy of healed erosive oesophagitis: results from the EXPO study.  Aliment Pharmacol Ther. 2005;  22 803-811
    Google Scholar
  • 58 Shaheen N J. Advances in Barrett’s esophagus and esophageal adenocarcinoma.  Gastroenterology. 2005;  128 1544-1566
    Google Scholar
  • 59 Armstrong D. Review article: towards consistency in the endoscopic diagnosis of Barrett’s oesophagus and columnar metaplasia.  Aliment Pharmacol Ther. 2004;  20 (Suppl 5) 40-47
    Google Scholar
  • 60 Cooper B T, Chapman W, Neumann C S. et al . Continous treatment of Barrett’s oesophagus patients with proton pump inhibitors up to 13 years: observations on regression and cancer incidence.  Aliment Pharmacol Ther. 2006;  23 727-733
    Google Scholar
  • 61 Hillman H C, Chirgakis L, Shadbolt B. et al . Proton-pump inhibitor therapy and the development of dysplasia in patients with Barrett’s oesophagus.  Med J Aust. 2004;  180 387-391
    Google Scholar
  • 62 Malfertheiner P, Lind T, Willich S. et al . Prognostic influence of Barrett’s oesophagus and Helicobacter pylori infection on healing of erosive gastro-oesophageal reflux disease (GORD) and symptom resolution in non-erosive GORD: report from the ProGORD study.  Gut. 2005;  54 746-751
    Google Scholar
  • 63 Richter J E. Review article: extraoesophageal manifestations of gastro-oesophageal reflux disease.  Aliment Pharmacol Ther. 2005;  22 (Suppl 1) 70-80
    Google Scholar
  • 64 Chang A B, Lasserson T J, Kiljander T O. et al . Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux.  Brit med J. 2006;  332 11-17
    Google Scholar
  • 65 Qadeer M A, Phillips C O, Rocio Lopez A. et al . Proton pump inhibitor therapy for suspected GERD-related chronic laryngitis: a meta-analysis of randomized controlled trials.  Am J Gastroenterol. 2006;  101 1-9
    Google Scholar
  • 66 Havemann B D, Henderson C, El-serag H. The association between gastroesophageal reflux disease and asthma: a systematic review.  Gastroenterology. 2007;  132 A-483
    Google Scholar
  • 67 Coughlan J L, Gibson P G, Henry R L. Medical treatment for reflux oesophagitis does not consistently improve asthma control: a systematic review.  Thorax. 2001;  56 198-204
    Google Scholar
  • 68 Kiljander T O, Harding S M, Field S K. et al . Effects of esomeprazole 40 mg twice daily on asthma. A randomized placebo-controlled study.  Am J Respir Crit Care Med. 2006;  173 1091-1097
    Google Scholar
  • 69 Wang H S, Wilgus J, Anderson A. et al . Gastroesophageal reflux protects against parodontal disease while worsening dental erosions.  Gastroenterology. 2007;  132 (Suppl 2) A-480
    Google Scholar
  • 70 Guda N, Partington S, Vakil N. Symptomatic gastro-oesophageal reflux, arousals and sleep quality in patients undergoing polysomnography for possible obstructive sleep apnoea.  Aliment Pharmacol Ther. 2004;  20 1153-1159
    Google Scholar
  • 71 Johnson D A, Orr W C, Crawley J A. et al . Effect of esomeprazole on nighttime heartburn and sleep quality in patients with GERD: a randomized, placebo-controlled trial.  Am J Gastroenterol. 2005;  100 1914-1922
    Google Scholar

Prof. Dr. Joachim Labenz

Medizinische Klinik, Ev. Jung-Stilling-Krankenhaus, Akademisches Lehrkrankenhaus der Universität Bonn

Wichernstr. 40

57074 Siegen

Phone: ++ 49/2 71/3 33 45 69

Fax: ++ 49/2 71/3 33 42 42

Email: J.Labenz@t-online.de