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Diagnosis of Gastroesophageal Reflux Disease (GERD)

Diagnostik bei gastroösophagealer Refluxkrankheit (GERD)

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Zusammenfassung

GRUNDLAGEN: Die gastroösophageale Refluxkrankheit (GERD) betrifft etwa 20–40% der Bevölkerung in Europa und den USA. Sie ist mit Verlust der Lebensqualität, Ösophagusfunktion und Änderung der Morphologie assoziiert. METHODIK: Übersicht mit level of evidence III–IV Arbeiten über GERD-Diagnostik. ERGEBNISSE: GERD-Symptome (Sodbrennen, Aufstoßen, Schluckstörung, Husten) sind mit saurem und nicht saurem Reflux, beeinträchtigter Ösophagusmotilität und pathologischer Morphologie (Stenose, Striktur, Ulkus, Ring; Zylinderepithelösophagus, CLE) assoziiert. Aus CLE mit intestinaler Metaplasie (Barrett-Ösophagus) kann sich über Dysplasie das Adenokarzinom des Ösophagus entwickeln. Korrelation der Symptome mit den Daten der Impedanz-pH-Metrie ermöglicht den Nachweis oder Ausschluss von GERD und sollte bei jenen durchgeführt werden, die GERD-Symptome bei normaler pH-Metrie haben. Bei der Endoskopie sollte auch eine normale Übergangszone biopsiert werden, um mikroskopischen CLE (± intestinaler Metaplasie, Dysplasie) auszuschließen. Die Bedeutung der hoch auflösenden Manometrie in der GERD-Diagnostik wird derzeit untersucht. SCHLUSSFOLGERUNGEN: Anamnese, klinische Untersuchung und Erhebung der Lebensqualität sind von größter Bedeutung in der GERD-Diagnostik. Neue Technologien tragen dazu bei, zu untersuchen, ob GERD-Symptome auch wirklich durch Reflux verursacht werden.

Summary

BACKGROUND: Gastroesophageal reflux disease (GERD) affects approximately 20–40% of individuals in Europe and North America and represents a disorder associated with "losses" (loss of life quality, esophageal function and morphology). METHODS: Review of level of evidence III–IV papers on diagnosis of GERD. RESULTS: GERD symptoms (heartburn, regurgitation, dysphagia, cough, wheezing) are associated with pathologic acidic and/or nonacidic gastroesophageal reflux, impaired esophageal motility and lower esophageal sphincter function and pathologic morphology: stricture, ulcus, ring web formation; columnar lined esophagus (CLE); intestinal metaplasia (i.e. Barrett esophagus) which may progress towards dysplasia and adenocarcinoma of the esophagus. Symptom correlation with data obtained by combined pH- and intraluminal impedance monitoring represents a sensitive tool for assessment of presence or absence of GERD and should be offered to those with GERD symptoms and normal pH-monitoring. Endoscopy should include biopsy sampling of a normal appearing esophago-gastric junction for exclusion of microscopic CLE with or without intestinal metaplasia and/or dysplasia. The value of high-resolution manometry for diagnosis of GERD is still under investigation. CONCLUSIONS: Patient history, physical examination and assessment of life quality are of major importance for diagnosis of GERD. Novel technologies have profoundly contributed towards those responsible being able to ascertain whether symptoms are in fact being caused by gastroesophageal reflux.

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Authors and Affiliations

  1. Manometry Unit, Medical University Vienna, Vienna, Austria

    Johannes Lenglinger, Claudia Ringhofer, Margit Eisler & Martin Riegler

  2. Division of General Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria

    Elena Devyatko, Enrico Cosentini & Johannes Zacherl

  3. Department of Clinical Pathology, Medical University Vienna, Vienna, Austria

    Fritz Wrba

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  1. Johannes Lenglinger
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  2. Claudia Ringhofer
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Correspondence to Martin Riegler.

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Lenglinger, J., Ringhofer, C., Eisler, M. et al. Diagnosis of Gastroesophageal Reflux Disease (GERD). Eur Surg 38, 227–243 (2006). https://doi.org/10.1007/s10353-006-0260-x

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