Zusammenfassung
Symptomatik, diagnostisches und therapeutisches Vorgehen sowie die Langzeitprognose einer gastroösophagealen Refluxkrankheit unterscheiden sich bei pädiatrischen Patienten ganz erheblich in Abhängigkeit vom Alter. Besonders bei Säuglingen sind die Symptome völlig unspezifisch, und die Abgrenzung einer gastroösophagealen Refluxkrankheit vom noch physiologischen Reflux oder einer Kuhmilchallergie ist sehr schwierig. Patienten mit einem besonders hohen Risiko für eine gastroösophageale Refluxkrankheit sind Kinder mit Zerebralparese oder angeborenen Ösophagusfehlbildungen, bei denen die Indikation für eine obere Endoskopie großzügig gestellt werden muss. Die diagnostischen Methoden müssen bei Kindern ja nach Alter, Symptom und Fragestellung komplementär eingesetzt werden. Bei nachgewiesener gastroösophagealer Refluxkrankheit sind Protonenpumpenhemmer auch bei Kindern Mittel erster Wahl. Allerdings sollten sie bei Säuglingen und jungen Kindern nicht probatorisch eingesetzt werden. Die Indikation und Typ einer operativen Antirefluxoperation sollte von einem Kindergastroenterolgen gemeinsam mit einem Kinderchirurgen gestellt werden.
Abstract
The symptomatics, diagnostic and therapeutic procedures as well as the long-term prognosis of gastroesophageal reflux disease show considerable differences in pediatric patients depending on age. For infants in particular the symptoms are completely unspecific and a differentiation of gastroesophageal reflux disease from a residual physiological reflux or cows’ milk allergy is very difficult. Patients with an especially high risk of gastroesophageal reflux disease are children with a central palsy or congenital esophageal malformations, in whom the indications for endoscopy of the upper gastrointestinal tract must be liberally considered. The diagnostic methods for children must be complementary employed according to age, symptoms and the problem in question. For proven gastroesophageal reflux disease, proton pump inhibitors are the first choice medication even for children. However, for infants and young children they should not be used on a trial basis. The indications and type of antireflux surgery should be decided by a pediatric gastroenterologist together with a pediatric surgeon.
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Prell, C., Koletzko, S. Gastroösophageale Refluxkrankheit im Kindes- und Jugendalter. Gastroenterologe 6, 461–470 (2011). https://doi.org/10.1007/s11377-010-0509-6
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DOI: https://doi.org/10.1007/s11377-010-0509-6