Erstlinienmanagement bei gastroösophagealem Reflux
Tóm tắt
Die Ernährung kann Häufigkeit und Schwere von Refluxsymptomen entscheidend beeinflussen. Die Beeinflussung der Magendehnung (z. B. Volumen der Mahlzeit), Magenentleerung (z. B. Kaloriengehalt) und Säuresekretion (z. B. Kalzium, bestimmte Aminosäuren) durch Nahrungsmittel kann gastroösophagealen Reflux fördern. Fettgehalt und Alkohol modifizieren die ösophageale Sensibilität und können die Wahrnehmung der Refluxbeschwerden ändern. Gezielte Veränderungen des Lebensstils umfassen demzufolge die Einnahme kleinerer Mahlzeiten mit geringerem Kalorien- und Fettgehalt, eine Gewichtsabnahme sowie den Verzicht auf einen Verdauungsschlaf. Wenn Veränderungen der Ernährungsgewohnheiten zur Symptomkontrolle nicht ausreichen, können Over-the-counter(OTC)-Medikamente bei Patienten mit intermittierenden und geringgradigen Refluxsymptomen nützlich sein. Hierzu gehören Antazida, die die Magensäure neutralisieren, und Alginatpräparate (Gaviscon®), die die Position der sog. Säuretasche vom gastroösophagealen Übergang wegverlagern. Bei schwereren Symptomen stehen Protonenpumpeninhibitoren (PPI) in vielen Ländern freiverkäuflich zur Verfügung. OTC-Medikamente stellen eine effektive und kosteneffiziente Therapie für gewisse Patientengruppen dar. Alarmsymptome (z. B. Dysphagie, signifikanter Gewichtsverlust) bzw. fehlendes Ansprechen auf die Therapie sollten durch den Apotheker erkannt werden und zu einer fachärztlichen Betreuung führen. Für eine optimale Therapie sollten Häufigkeit und Schwere der Symptome sowie Langzeitkomplikationen einer PPI-Therapie berücksichtigt werden.
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