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article 
App\Entity\Article {#528
  -id: 10
  -title: "GERD oder EoE: nicht immer leicht zu unterscheiden"
  -teaser: "<p>Die gastro&ouml;sophageale Refluxkrankheit (GERD) ist eine Volkskrankheit und betrifft im Westen etwa ein F&uuml;nftel der Bev&ouml;lkerung. Die zweith&auml;ufigste entz&uuml;ndliche Erkrankung der Speiser&ouml;hre nach der GERD ist die eosinophile &Ouml;sophagitis (EoE).</p>"
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    <p>Die gastro&ouml;sophageale Refluxkrankheit (GERD) ist eine Volkskrankheit und betrifft im Westen etwa ein F&uuml;nftel der Bev&ouml;lkerung. Die zweith&auml;ufigste entz&uuml;ndliche Erkrankung der Speiser&ouml;hre nach der GERD ist die eosinophile &Ouml;sophagitis (EoE). Von ihr sind pro 100.000 Einwohner*innen in westlichen L&auml;ndern etwa 34 Personen betroffen. Die EoE gilt damit als seltene Erkrankung, doch Studien zeigen, dass ihre H&auml;ufigkeit in den letzten Jahren stetig zugenommen hat.<sup>1&ndash;4</sup></p>\r\n
    \r\n
    <h2>Wie entstehen entz&uuml;ndliche Erkrankungen der Speiser&ouml;hre?</h2>\r\n
    \r\n
    <p>Bei der GERD ist der R&uuml;ckfluss von Mageninhalt in die Speiser&ouml;hre f&uuml;r die Entz&uuml;ndung und die charakteristischen Beschwerden, allen voran das Sodbrennen, verantwortlich. Eine genetische Veranlagung kann die Entstehung einer GERD beg&uuml;nstigen. Bei manchen Patient*innen spielt auch eine Zwerchfellhernie eine Rolle. Durch &Uuml;bergewicht und Rauchen steigt das Risiko f&uuml;r eine GERD an.<sup>2,5</sup></p>\r\n
    \r\n
    <p>Die EoE ist eine Erkrankung, f&uuml;r deren Entstehung mehrere Faktoren eine Rolle spielen. Das k&ouml;nnen Umweltfaktoren, Allergene (zum Beispiel Pollen, Hausstaubmilben, Nahrungsmittelallergene) und genetische Faktoren sein. Der f&uuml;r die EoE charakteristischen Entz&uuml;ndung der Speiser&ouml;hre liegt eine Immunreaktion zugrunde, die sich von &bdquo;normalen&ldquo; Allergien unterscheidet. Mit dem &uuml;blicherweise zum Nachweis einer Allergie eingesetzten Prick-Test ist das f&uuml;r die EoE verantwortliche Allergen deshalb nicht nachzuweisen.<sup>6,7</sup></p>\r\n
    \r\n
    <p>Oft haben Patient*innen mit EoE zus&auml;tzlich eine Atopie. Das bedeutet, dass sie eine erbliche Veranlagung haben, bei Kontakt mit allergieausl&ouml;senden Stoffen (Allergenen) eine &uuml;bersteigerte Abwehrreaktion und allergische Erkrankungen wie Asthma, Heuschnupfen oder Neurodermitis zu entwickeln. Die EoE z&auml;hlt selbst nicht zu den atopischen Erkrankungen, sie kann auch bei Menschen auftreten, die keine Allergien aufweisen.<sup>8</sup></p>\r\n
    \r\n
    <h2>Welche Beschwerden treten auf?</h2>\r\n
    \r\n
    <p>Das Kardinalsyndrom der GERD ist das Sodbrennen. Weitere h&auml;ufige Beschwerden sind ein Druckgef&uuml;hl im Brustraum, Luftaufsto&szlig;en, R&uuml;ckfluss von Speisebrei in den Mund (Regurgitation), Schluckst&ouml;rungen, chronischer Reizhusten und n&auml;chtlicher Hustenreiz.<sup>2</sup></p>\r\n
    \r\n
    <p>Bei der EoE sind es dagegen Schluckbeschwerden, die das Beschwerdebild der Patient*innen pr&auml;gen. Auftreten k&ouml;nnen aber auch Schluckblockaden (Essen bleibt im Hals stecken), Sodbrennen-&auml;hnliche Beschwerden, Brennen im Bereich hinter dem Brustbein und/oder Regurgitation.<sup>9</sup></p>\r\n
    \r\n
    <h2>Wie lassen sich GERD und EoE diagnostizieren?</h2>\r\n
    \r\n
    <h3>M&ouml;glichkeiten der Diagnose</h3>\r\n
    \r\n
    <p>F&uuml;r die Diagnose einer GERD gibt es keinen Goldstandard. Dem Arzt oder der &Auml;rztin steht keine Methode zur Verf&uuml;gung, mit der eine GERD in jedem Fall zuverl&auml;ssig nachgewiesen oder ausgeschlossen werden kann. Von einer GERD wird ausgegangen, wenn durch R&uuml;ckfluss von Mageninhalt in die Speiser&ouml;hre bel&auml;stigende Symptome und/oder L&auml;sionen in der Speiser&ouml;hre auftreten. Die Befragung der Patient*innen zu Symptomen, Lebensstil und Vorerkrankungen spielt eine wichtige Rolle. Weiterhin kommen technische Verfahren wie endoskopische und histologische Untersuchungen sowie funktionsdiagnostische Untersuchungen wie die pH-Metrie zum Einsatz.<sup>2</sup></p>\r\n
    \r\n
    <p>Auch bei der EoE spielt die Beschreibung der Symptome durch die Patient*innen eine wichtige Rolle in der Diagnostik. Dar&uuml;ber hinaus muss eine endoskopische Untersuchung der Speiser&ouml;hre erfolgen, bei der auch eine Gewebeprobe f&uuml;r die feingewebliche (histologische) Untersuchung entnommen wird.<sup>2</sup></p>\r\n
    \r\n
    <p>Im Gespr&auml;ch mit den Patient*innen ist zu bedenken, dass die Betroffenen oft schon lange an den Beschwerden leiden und Anpassungsstrategien entwickelt haben. Sie nehmen die Schluckbeschwerden nicht mehr als solche wahr. Hier gilt es, gezielt, aber indirekt nachzufragen:<sup>11,12</sup></p>\r\n
    \r\n
    <ul>\r\n
    \t<li>Brauchen Sie beim Essen l&auml;nger als andere?</li>\r\n
    \t<li>Schneiden Sie Ihr Essen sehr klein oder p&uuml;rieren Sie es?</li>\r\n
    \t<li>Bevorzugen Sie leicht rutschende Speisen (Brei, Pudding)?</li>\r\n
    \t<li>Meiden Sie das Essen in Gesellschaft?</li>\r\n
    \t<li>Trinken Sie nach jedem Bissen etwas nach?</li>\r\n
    </ul>\r\n
    \r\n
    <p>Die EoE wird oft erst sp&auml;t diagnostiziert. Viele Patient*innen weisen deshalb bei der Diagnose bereits Sp&auml;tfolgen wie Fibrosierung (Vernarbung), Verengungen der Speiser&ouml;hre durch Narbengewebe (Strikturen) sowie funktionelle St&ouml;rungen wie Schluckblockaden auf.<sup>10,13</sup></p>\r\n
    \r\n
    <h2>GERD und EoE nicht verwechseln</h2>\r\n
    \r\n
    <p>Die Symptome von GERD und EoE &uuml;berlappen sich teilweise, deshalb ist eine Unterscheidung zwischen den beiden Krankheitsbildern nicht immer leicht. Aber es gibt einige Faktoren, die helfen, zwischen den beiden Speiser&ouml;hrenerkrankungen zu unterscheiden:<sup>2,10,14</sup></p>\r\n
    \r\n
    <p><img alt="" src="/uploads/articles//infografik-gerd-eoe-656d833e74334.png" style="height:386px; width:592px" /></p>\r\n
    \r\n
    <h2>Wie lassen sich GERD und EoE behandeln?</h2>\r\n
    \r\n
    <p>Bei der GERD ist das Therapieziel die Linderung der Beschwerden, insbesondere des Sodbrennens. Meist l&auml;sst sich durch eine erfolgreiche Kontrolle der Symptome die Lebensqualit&auml;t der Patient*innen bereits drastisch steigern. Zu diesem Zweck verordnet der Arzt oder die &Auml;rztin Protonenpumpeninhibitoren (PPI) und andere Antirefluxmedikamente. Allgemeinma&szlig;nahmen spielen bei der Therapie der GERD und insbesondere zur Linderung des Sodbrennens eine wichtige Rolle. Folgende Tipps k&ouml;nnen den Patient*innen mit auf den Weg gegeben werden:<sup>2</sup></p>\r\n
    \r\n
    <ul>\r\n
    \t<li>Gewichtsreduktion durch gesunde Ern&auml;hrung und ausreichend Bewegung</li>\r\n
    \t<li>Erh&ouml;hung des Kopfendes des Bettes</li>\r\n
    \t<li>Vermeidung von sp&auml;ten Mahlzeiten</li>\r\n
    \t<li>Verzicht auf das Rauchen</li>\r\n
    </ul>\r\n
    \r\n
    <p>Reichen medikament&ouml;se Therapien und Lebensstilma&szlig;nahmen nicht aus, besteht die M&ouml;glichkeit einer operativen Behandlung der GERD mittels einer sogenannten Antirefluxoperation.<sup>2</sup></p>\r\n
    \r\n
    <p>Wie bei der GERD ist auch bei der EoE die Kontrolle der Symptome ein Ziel der Therapie. Das Hauptziel der EoE-Therapie ist aber, die Entz&uuml;ndung der Speiser&ouml;hre und die damit einhergehende Vernarbung und Verengung zu verhindern. Gem&auml;&szlig; Leitlinie werden entweder topische Kortikosteroide oder PPI oder eine Eliminationsdi&auml;t empfohlen. Bei der Eliminationsdi&auml;t werden die Nahrungsmittel aus dem Speiseplan gestrichen, die am h&auml;ufigsten mit Nahrungsmittelallergien assoziiert sind: Kuhmilchproteine, Weizen, Soja, Ei, N&uuml;sse und Fisch/Meeresfr&uuml;chte. Als Therapie der ersten Wahl bei erwachsenen EoE-Patient*innen gelten heute topische Kortikosteroide.<sup>2</sup></p>\r\n
    \r\n
    <p>&nbsp;</p>\r\n
    \r\n
    <p><strong>Quellen:</strong></p>\r\n
    \r\n
    <ol>\r\n
    \t<li>Labenz J, Labenz C. Pr&auml;valenz und nat&uuml;rlicher Verlauf der gastro&ouml;sophagealen Refluxkrankheit. Die Gastroenterologie. 2016;11(2):102&ndash;9.</li>\r\n
    \t<li>Madisch A et al. S2k-Leitlinie Gastro&ouml;sophageale Refluxkrankheit und eosinophile &Ouml;sophagitis der Deutschen Gesellschaft f&uuml;r Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) &ndash; M&auml;rz 2023 &ndash; AWMF-Registernummer: 021&ndash;013. Z Gastroenterol 2023; 61(07): 862&ndash;933.</li>\r\n
    \t<li>Soon IS, Decker Butzner J, Kaplan GG et al. Incidence and Prevalence of Eosinophilic Esophagitis in Children. JPGN 2013; 57(1):72&ndash;80.</li>\r\n
    \t<li>Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology 2018; 154(2):319&ndash;32.e3.</li>\r\n
    \t<li>Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900&ndash;1943.</li>\r\n
    \t<li>O&rsquo;Shea KM, Aceves SS, Dellon ES, Gupta SK, Spergel JM, Furuta GT et al. Pathophysiology of eosinophilic esophagitis. Gastroenterology 2018; 154(2):333&ndash;45.</li>\r\n
    \t<li>Simon D, Cianferoni A, Spergel JM, Aceves S, Holbreich M, Venter C et al. Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity. Allergy 2016; 71(5):611&ndash;20.</li>\r\n
    \t<li>Allergieinformationsdienst: Eosinophile Erkrankungen des Verdauungstrakts.</li>\r\n
    \t<li>Miehlke S. Clinical features of Eosinophilic esophagitis in children and adults. Best Pract Res Clin Gastroenterol. 2015 Oct;29(5):739&ndash;748.</li>\r\n
    \t<li>Reed CC, Ketchem CJ, Miller TL, Dellon ES. Psychiatric Comorbidities Are Highly Prevalent in Nonesophageal Eosinophilic Gastrointestinal Diseases. Clin Gastroenterol Hepatol. 2022;20(4):e664&ndash;e670.</li>\r\n
    \t<li>de Rooij WE, Bennebroek Evertsz&rsquo; F, Lei A, Bredenoord AJ. Mental distress among adult patients with eosinophilic esophagitis. Neurogastroenterol Motil. 2021;33(7):e14069.</li>\r\n
    \t<li>Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900&ndash;1943.</li>\r\n
    \t<li>Schoepfer AM, Safroneeva E, Bussmann C. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology 2013 Dec;145(6):1230-6.e1-2.</li>\r\n
    \t<li>Lucendo AJ, Molina-Infante J, Arias &Aacute;, von Arnim U, Bredenoord AJ, Bussmann C et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017; 5(3):335&ndash;58.</li>\r\n
    </ol>
    """
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:71
Show trace 
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:72
Show trace 
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:73
Show trace 
[
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    "file" => "/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/vendor/symfony/http-kernel/DataCollector/RequestDataCollector.php"
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Flashes

Flashes

Key Value
error 
[
  "Sie müssen eingeloggt sein um diesen Artikel lesen zu können!"
]

Server Parameters

Server Parameters

Defined in .env

Key Value
APP_ENV 
"dev"
APP_SECRET 
"a1d687c7188a8bbff1cb1e7504f8f22f"
DATABASE_URL 
"mysql://apofalk-academy:0az5otq1qeT1QVQK@127.0.0.1:3306/apofalk-academy"
GOOGLE_CAPTCHA_KEY 
"6LeMd_8qAAAAAIYtrI1v6HmANQgT4wNKYuMnDZ0c"
MAILER_DSN 
"smtp://apofalk@creatediv-ld.de:trU5MSwFK643w9o1@mail.your-server.de:587"
MAILER_NAME 
"apofalk.de"
MAILER_USER 
"info@creatediv.de"
MESSENGER_TRANSPORT_DSN 
"doctrine://default?auto_setup=0"
POINTS_FOR_ELEARNING 
"20"
POINTS_FOR_QUIZ 
"10"
POINTS_NEEDED_FOR_CLUB 
"60"
WKHTMLTOPDF_PATH 
"/usr/local/bin/wkhtmltopdf"

Defined as regular env variables

Key Value
APP_DEBUG 
"1"
CONTEXT_DOCUMENT_ROOT 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public"
CONTEXT_PREFIX 
""
DOCUMENT_ROOT 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public"
FCGI_ROLE 
"RESPONDER"
GATEWAY_INTERFACE 
"CGI/1.1"
HOME 
"/var/www/vhosts/dev-plesk.creatediv.local"
HTTP_ACCEPT 
"*/*"
HTTP_ACCEPT_ENCODING 
"gzip, br, zstd, deflate"
HTTP_CONNECTION 
"close"
HTTP_HOST 
"apofalk-academy.dev-plesk.creatediv.local"
HTTP_USER_AGENT 
"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)"
HTTP_X_ACCEL_INTERNAL 
"/internal-nginx-static-location"
HTTP_X_FORWARDED_FOR 
"216.73.216.96"
HTTP_X_FORWARDED_HOST 
"apofalk-academy.dev-creatediv.de"
HTTP_X_FORWARDED_SERVER 
"apofalk-academy.dev-creatediv.de"
HTTP_X_REAL_IP 
"192.168.20.3"
PATH 
"/usr/local/sbin:/usr/local/bin:/usr/sbin:/usr/bin:/sbin:/bin:/snap/bin"
PHP_SELF 
"/index.php"
QUERY_STRING 
""
REDIRECT_STATUS 
"200"
REDIRECT_UNIQUE_ID 
"aUIcxguFDvOcfu3b71xSHAAAAAA"
REDIRECT_URL 
"/fachartikel/gerd-oder-eoe-nicht-immer-leicht-zu-unterscheiden"
REMOTE_ADDR 
"192.168.20.3"
REMOTE_PORT 
"47512"
REQUEST_METHOD 
"GET"
REQUEST_SCHEME 
"http"
REQUEST_TIME 
1765940422
REQUEST_TIME_FLOAT 
1765940422.6991
REQUEST_URI 
"/fachartikel/gerd-oder-eoe-nicht-immer-leicht-zu-unterscheiden"
SCRIPT_FILENAME 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public/index.php"
SCRIPT_NAME 
"/index.php"
SERVER_ADDR 
"192.168.20.6"
SERVER_ADMIN 
"[no address given]"
SERVER_NAME 
"apofalk-academy.dev-plesk.creatediv.local"
SERVER_PORT 
"80"
SERVER_PROTOCOL 
"HTTP/1.0"
SERVER_SIGNATURE 
"<address>Apache Server at apofalk-academy.dev-plesk.creatediv.local Port 80</address>\n"
SERVER_SOFTWARE 
"Apache"
SYMFONY_DOTENV_VARS 
"APP_ENV,APP_SECRET,DATABASE_URL,MESSENGER_TRANSPORT_DSN,MAILER_DSN,MAILER_NAME,MAILER_USER,WKHTMLTOPDF_PATH,GOOGLE_CAPTCHA_KEY,POINTS_NEEDED_FOR_CLUB,POINTS_FOR_QUIZ,POINTS_FOR_ELEARNING"
UNIQUE_ID 
"aUIcxguFDvOcfu3b71xSHAAAAAA"
USER 
"dev-plesk"
proxy-nokeepalive 
"1"