Refluxbeschwerden und Refluxkrankheit

Reflux symptoms and gastroesophageal reflux disease (GERD) are common. However, reflux symptoms per se do not prove the presence of GERD. For a long time, proton pump inhibitors (PPI) were recommended without restriction both for uninvestigated reflux symptoms and for all phenotypes of GERD. Liberal prescribing behavior led to considerable overtreatment and neglect of effective general measures and treatment alternatives. The updated German guideline on GERD clearly emphasizes that only one treatment goal is relevant for the vast majority of patients—symptom control that is sufficient from the patient’s perspective. This can and should initially be addressed with general measures. PPIs are still an option, but with the exception of severe reflux esophagitis (Los Angeles grade C/D) and peptic stricture, they should initially only be prescribed for a limited period of time. A number of sufficiently effective substances (e.g., antacids, alginates, healing earth, Poliprotect [Aboca, Sansepolcro, Italy]) with a good safety profile are available as alternatives to PPIs, both in the acute management of uninvestigated reflux symptoms and in the long-term management of GERD without lesions in the esophagus (nonerosive reflux disease [NERD]) or with mild reflux esophagitis (Los Angeles grade A/B). Overtreatment should be avoided, especially in maintenance therapy. Barrett’s esophagus without symptoms and without concomitant reflux esophagitis is not an indication for PPI therapy. Endoscopic and surgical antireflux procedures should be reserved for patients with chronic, PPI-dependent and clearly confirmed GERD.