Z Gastroenterol 2007; 45(11): 1141-1149
DOI: 10.1055/s-2007-963631
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Standards und Innovationen in der Diagnostik der gastroösophagealen Refluxkrankheit

Standards and Innovations in the Diagnosis of Gastroesophageal Reflux DiseaseJ. Weigt1 , K. Mönkemüller1 , S. Kolfenbach1 , P. Malfertheiner1
  • 1Klinik für Gastroenterologie, Hepatologie und Infektiologie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg
Further Information

Publication History

Manuskript eingetroffen: 13.7.2007

Manuskript akzeptiert: 5.10.2007

Publication Date:
19 November 2007 (online)

Zusammenfassung

Die gastroösophageale Refluxkrankheit (GERD) nimmt eine zentrale Rolle in der Patientenversorgung ein. Ein Großteil der Patienten, vor allem in den westlichen Industriestaaten, leidet an Symptomen einer Refluxkrankheit. Der Artikel gibt eine Übersicht über die wichtigsten Verfahren zur Diagnostik der GERD. Standardverfahren wie pH-Metrie, Bilitec und Manometrie, aber auch neue diagnostische Verfahren wie die Impedanzmessung und die Bravo pH-Metrie werden in Funktion und Anwendung beschrieben. Auch endoskopische Standards und neue Verfahren wie Chromo- und Magnifikationsendokopie, narrow band imanging (NBI) und computed virtual chromoendoscopy (CVC) werden dargestellt. Nicht alle, dieser teilweise neuen Verfahren müssen bei jedem Patienten Anwendung finden. Vielmehr erachten wir es für sinnvoll, die Untersuchungsmethoden, deren Vor- und Nachteile, genau zu kennen. Nur so ist es möglich, sie gezielt einzusetzen. Ziel der Untersuchungen ist die Charakterisierung der GERD bei dem jeweiligen Patienten, um eine gezielte Therapie anwenden zu können.

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases in the world. This article gives an overwiew about diagnostic procedures for GERD. Standard procedures such as pH-metry, Bilitec and manometry and also new diagnostic tools such as combined multichannel intraluminal impedance (MII) and pH-metry and Bravo Capsule are described in detail. Established endoscopy criteria as well as innovative techniques such as magnification, narrow band imaging and computed virtual chromoendoscopy are also presented. Not all of these procedures need to be used in every patient. Therefore, it is important to know the technical aspects, indications, advantages and disadvantages of each method in order to appropriately use any of these tests. The final goal is to characterise GERD and provide the patient with an appropriate therapy.

Literatur

  • 1 Mönkemüller K, Malfertheiner P. Is non-erosive reflux disease (NERD) an inflammatory condition?.  CML Gastroenterology. 2006;  25 81-87
  • 2 Vakil N, Zanten S V, Kahrilas van P. et al . The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.  Am J Gastroenterol. 2006;  101 1900-1920; quiz 1943
  • 3 Sifrim D, Blondeau K. New techniques to evaluate esophageal function.  Dig Dis. 2006;  24 243-251
  • 4 Fass R. Distinct phenotypic presentations of gastroesophageal reflux disease: a new view of the natural history.  Dig Dis. 2004;  22 100-107
  • 5 Savary M, Miller G. L’oesophage.  Manuel et atlas d’endoscopie. 1977;  80-92
  • 6 Armstrong D, Emde C, Inauen W. et al . Diagnostic assessment of gastroesophageal reflux disease: what is possible vs. what is practical?.  Hepatogastroenterology. 1992;  39 Suppl 1 3-13
  • 7 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
  • 8 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
  • 9 Sharma P, Dent J, Armstrong D. et al . The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria.  Gastroenterology. 2006;  131 1392-1399
  • 10 Kiesslich R, Kanzler S, Vieth M. et al . Minimal change esophagitis: prospective comparison of endoscopic and histological markers between patients with non-erosive reflux disease and normal controls using magnifying endoscopy.  Dig Dis. 2004;  22 221-227
  • 11 Yoshikawa I, Yamasaki M, Yamasaki T. et al . Lugol chromoendoscopy as a diagnostic tool in so-called endoscopy-negative GERD.  Gastrointest Endosc. 2005;  62 698-703
  • 12 Coenraad M, Masclee A A, Straathof J W. et al . Is Barrett’s esophagus characterized by more pronounced acid reflux than severe esophagitis?.  Am J Gastroenterol. 1998;  93 1068-1072
  • 13 Koek G H, Tack J, Sifrim D. et al . The role of acid and duodenal gastroesophageal reflux in symptomatic GERD.  Am J Gastroenterol. 2001;  96 2033-2040
  • 14 Masclee A A, Best A C, Graaf de R. et al . Ambulatory 24-hour pH-metry in the diagnosis of gastroesophageal reflux disease. Determination of criteria and relation to endoscopy.  Scand J Gastroenterol. 1990;  25 225-230
  • 15 Smith de J L, Opekun A R, Larkai E. et al . Sensitivity of the esophageal mucosa to pH in gastroesophageal reflux disease.  Gastroenterology. 1989;  96 683-689
  • 16 Jamieson J R, Stein H J, DeMeester T R. et al . Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility.  Am J Gastroenterol. 1992;  87 1102-1111
  • 17 Pehl C, Keller J, Merio R. et al . Esophageal 24 hour-pH metry. Recommendations of the German Society of Neurogastroenterology and Motility and the Study Group for Gastrointestinal Functional Disorders and Function Diagnostics of the Austrian Society of Gastroenterology and Hepatology.  Z Gastroenterol. 2003;  41 545-556
  • 18 Johnson L F, DeMeester T R. Development of the 24-hour intraesophageal pH monitoring composite scoring system.  J Clin Gastroenterol. 1986;  8 Suppl 1 52-58
  • 19 Mainie I, Tutuian R, Castell D O. Comparison between the combined analysis and the DeMeester Score to predict response to PPI therapy.  J Clin Gastroenterol. 2006;  40 602-605
  • 20 Taghavi S A, Ghasedi M, Saberi-Firoozi M. et al . Symptom association probability and symptom sensitivity index: preferable but still suboptimal predictors of response to high dose omeprazole.  Gut. 2005;  54 1067-1071
  • 21 Weusten B L, Roelofs J M, Akkermans L M. et al . The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data.  Gastroenterology. 1994;  107 1741-1745
  • 22 Emde C, Cilluffo T, Bauerfeind P. et al . Combined esophageal and gastric pH-metry in healthy volunteers. Influence of cable through LES and effect of misoprostol.  Dig Dis Sci. 1989;  34 79-82
  • 23 Baldi F, Longanesi A, Ferrarini F. Esophageal and gastric acidity determination: its value and limitations.  Minerva Chir. 1991;  46 77-81
  • 24 Jacob P, Kahrilas P J, Herzon G. Proximal esophageal pH-metry in patients with „reflux laryngitis”.  Gastroenterology. 1991;  100 305-310
  • 25 Issing W J, Karkos P D, Perreas K. et al . Dual-probe 24-hour ambulatory pH monitoring for diagnosis of laryngopharyngeal reflux.  J Laryngol Otol. 2004;  118 845-848
  • 26 Weusten B L, Akkermans L M, vanBerge-Henegouwen G P. et al . Dynamic characteristic of gastro-oesophageal reflux in ambulatory patients with gastro-oesophageal reflux disease and normal control subjects.  Scand J Gastroenterol. 1995;  30 731-737
  • 27 Jung B, Steinbach J, Beaumont C. et al . Lack of association between esophageal acid sensitivity detected by prolonged pH monitoring and Bernstein testing.  Am J Gastroenterol. 2004;  99 410-415
  • 28 Castell D O, Vela M. Combined multichannel intraluminal impedance and pH-metry: an evolving technique to measure type and proximal extent of gastroesophageal reflux.  Am J Med. 2001;  111 Suppl 8 A 157S-159S
  • 29 Tutuian R, Castell D O. Multichannel intraluminal impedance: general principles and technical issues.  Gastrointest Endosc Clin N Am. 2005;  15 257-264
  • 30 Silny J. Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility.  J Gastrointest Motil. 1991;  3 151-162
  • 31 Sifrim D. Acid, weakly acidic and non-acid gastro-oesophageal reflux: differences, prevalence and clinical relevance.  Eur J Gastroenterol Hepatol. 2004;  16 823-830
  • 32 Mainie I, Tutuian R, Shay S. et al . Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring.  Gut. 2006;  55 1398-1402
  • 33 Tutuian R, Castell D O. Reflux monitoring: role of combined multichannel intraluminal impedance and pH.  Gastrointest Endosc Clin N Am. 2005;  15 361-371
  • 34 Castell D O, Mainie I, Tutuian R. Non-acid gastroesophageal reflux: documenting its relationship to symptoms using multichannel intraluminal impedance (MII).  Trans Am Clin Climatol Assoc. 2005;  116 321-333; discussion 333 - 324
  • 35 Tamhankar A P, Peters J H, Portale G. et al . Omeprazole does not reduce gastroesophageal reflux: new insights using multichannel intraluminal impedance technology.  J Gastrointest Surg. 2004;  8 890-897 discussion 897 - 898
  • 36 Dekel R, Martinez-Hawthorne S D, Guillen R J. et al . Evaluation of symptom index in identifying gastroesophageal reflux disease-related noncardiac chest pain.  J Clin Gastroenterol. 2004;  38 24-29
  • 37 Pandolfino J E, Shi G, Zhang Q. et al . Measuring EGJ opening patterns using high resolution intraluminal impedance.  Neurogastroenterol Motil. 2005;  17 200-206
  • 38 Zentilin P, Iiritano E, Dulbecco P. et al . Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet.  Dig Liver Dis. 2006;  38 226-232
  • 39 Roman S, Poncet G, Serraj I. et al . Characterization of reflux events after fundoplication using combined impedance-pH recording.  Br J Surg. 2007;  94 48-52
  • 40 Vela M F, Tutuian R, Katz P O. et al . Baclofen decreases acid and non-acid post-prandial gastro-oesophageal reflux measured by combined multichannel intraluminal impedance and pH.  Aliment Pharmacol Ther. 2003;  17 243-251
  • 41 Wong W M, Bautista J, Dekel R. et al . Feasibility and tolerability of transnasal/per-oral placement of the wireless pH capsule vs. traditional 24-h oesophageal pH monitoring - a randomized trial.  Aliment Pharmacol Ther. 2005;  21 155-163
  • 42 Ward E M, Devault K R, Bouras E P. et al . Successful oesophageal pH monitoring with a catheter-free system.  Aliment Pharmacol Ther. 2004;  19 449-454
  • 43 Pandolfino J E, Richter J E, Ours T. et al . Ambulatory esophageal pH monitoring using a wireless system.  Am J Gastroenterol. 2003;  98 740-749
  • 44 Fass R, Hell R, Sampliner R E. et al . Effect of ambulatory 24-hour esophageal pH monitoring on reflux-provoking activities.  Dig Dis Sci. 1999;  44 2263-2269
  • 45 Tu C H, Lee Y C, Wang H P. et al . Ambulatory esophageal pH monitoring by using a wireless system: a pilot study in Taiwan.  Hepatogastroenterology. 2004;  51 1586-1589
  • 46 Remes-Troche J M, Ibarra-Palomino J, Carmona-Sanchez R I. et al . Performance, tolerability, and symptoms related to prolonged pH monitoring using the Bravo system in Mexico.  Am J Gastroenterol. 2005;  100 2382-2386
  • 47 des Varannes S B, Mion F, Ducrotte P. et al . Simultaneous recordings of oesophageal acid exposure with conventional pH monitoring and a wireless system (Bravo).  Gut. 2005;  54 1682-1686
  • 48 Ahlawat S K, Novak D J, Williams D C. et al . Day-to-day variability in acid reflux patterns using the BRAVO pH monitoring system.  J Clin Gastroenterol. 2006;  40 20-24
  • 49 Triester S L, Leighton J A, Budavari A I. et al . Severe chest pain from an indwelling Bravo pH probe.  Gastrointest Endosc. 2005;  61 317-319
  • 50 Fajardo N R, Wise J L, Locke 3 rd G R. et al . Esophageal perforation after placement of wireless Bravo pH probe.  Gastrointest Endosc. 2006;  63 184-185
  • 51 Pandolfino J E, Zhang Q, Schreiner M A. et al . Acid reflux event detection using the Bravo wireless versus the Slimline catheter pH systems: why are the numbers so different?.  Gut. 2005;  54 1687-1692
  • 52 Kauer W K, Peters J H, DeMeester T R. et al . Composition and concentration of bile acid reflux into the esophagus of patients with gastroesophageal reflux disease.  Surgery. 1997;  122 874-881
  • 53 Chen X, Yang G, Ding W Y. et al . An esophagogastroduodenal anastomosis model for esophageal adenocarcinogenesis in rats and enhancement by iron overload.  Carcinogenesis. 1999;  20 1801-1808
  • 54 Menges M, Muller M, Zeitz M. Increased acid and bile reflux in Barrett’s esophagus compared to reflux esophagitis, and effect of proton pump inhibitor therapy.  Am J Gastroenterol. 2001;  96 331-337
  • 55 Girelli C M, Cuvello P, Limido E. et al . Duodenogastric reflux: an update.  Am J Gastroenterol. 1996;  91 648-653
  • 56 Baldini F, Bechi P, Cianchi F. et al . Analysis of the optical properties of bile.  J Biomed Opt. 2000;  5 321-329
  • 57 Vaezi M F, Richter J E. Duodenogastroesophageal reflux and methods to monitor nonacidic reflux.  Am J Med. 2001;  111 Suppl 8 A 160S-168S
  • 58 Vaezi M F, Richter J E. Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease.  Gastroenterology. 1996;  111 1192-1199
  • 59 Vaezi M F, Lacamera R G, Richter J E. Validation studies of Bilitec 2000: an ambulatory duodenogastric reflux monitoring system.  Am J Physiol. 1994;  267 G1050-1057
  • 60 Kauer W K, Burdiles P, Ireland A P. et al . Does duodenal juice reflux into the esophagus of patients with complicated GERD? Evaluation of a fiberoptic sensor for bilirubin.  Am J Surg. 1995;  169 98-103
  • 61 Champion G, Richter J E, Vaezi M F. et al . Duodenogastroesophageal reflux: relationship to pH and importance in Barrett’s esophagus.  Gastroenterology. 1994;  107 747-754
  • 62 Caldwell M T, Lawlor P, Byrne P J. et al . Ambulatory oesophageal bile reflux monitoring in Barrett’s oesophagus.  Br J Surg. 1995;  82 657-660
  • 63 Bechi P, Pucciani F, Baldini F. et al . Long-term ambulatory enterogastric reflux monitoring. Validation of a new fiberoptic technique.  Dig Dis Sci. 1993;  38 1297-1306
  • 64 Barrett M W, Myers J C, Watson D I. et al . Detection of bile reflux: in vivo validation of the Bilitec fibreoptic system.  Dis Esophagus. 2000;  13 44-50
  • 65 Vaezi M F, Singh S, Richter J E. Role of acid and duodenogastric reflux in esophageal mucosal injury: a review of animal and human studies.  Gastroenterology. 1995;  108 1897-1907
  • 66 Byrne J P, Romagnoli R, Bechi P. et al . Duodenogastric reflux of bile in health: the normal range.  Physiol Meas. 1999;  20 149-158
  • 67 Sifrim D, Holloway R, Silny J. et al . Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings.  Gastroenterology. 2001;  120 1588-1598
  • 68 Dekel R, Pearson T, Wendel C. et al . Assessment of oesophageal motor function in patients with dysphagia or chest pain - the Clinical Outcomes Research Initiative experience.  Aliment Pharmacol Ther. 2003;  18 1083-1089
  • 69 Lemme E M, Moraes-Filho J P, Domingues G. et al . Manometric findings of esophageal motor disorders in 240 Brazilian patients with non-cardiac chest pain.  Dis Esophagus. 2000;  13 117-121

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