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Stellenwert der Funktionsdiagnostik in der Gastroenterologie

Importance of functional diagnostics in gastroenterology

  • Schwerpunkt: Funktionsdiagnostik in der Inneren Medizin
  • Published:
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Zusammenfassung

In diesem Übersichtsbeitrag werden wichtige und häufig angewendete Untersuchungsmethoden der gastrointestinalen Funktionsdiagnostik vorgestellt. Ebenso wird auf seltener eingesetzte Spezialuntersuchungen eingegangen. Der H2-Atemtest ist einfach durchzuführen, ubiquitär verfügbar und erlaubt den Nachweis von Laktose‑, Fruktose- oder Sorbitmalabsorption. Weiterhin wird der Test mit Glukose bei Verdacht auf eine intestinale bakterielle Fehlbesiedlung und mit Laktulose zur Messung der Dünndarmpassagezeit durchgeführt. Der 13C-Atemtest findet Anwendung zum nichtinvasiven Nachweis einer Helicobacter-pylori-Infektion und zur Beurteilung der gastrointestinalen Transitzeit, der Leberfunktion sowie der exokrinen Pankreasfunktion. Der Sekretin-Cholezystokinin(CCK)-Test war der Goldstandard zur Beurteilung der Pankreasfunktion, diese wird heute mit der Elastasebestimmung im Stuhl gemessen, einem einfacheren, aber weniger sensitiven nichtinvasiven Test. Szintigraphie und Kapseluntersuchungen mit pH- und Temperatursonden sind die wichtigsten Methoden zur Bestimmung der Magenentleerung sowie Dünndarm- und Kolontransitzeit. Zur Beurteilung einer Obstipation werden Abdomenübersichtsaufnahmen nach Einnahme röntgendichter Marker durchgeführt (Hinton-Test). Für die Diagnose einer funktionellen Ösophaguserkrankung ist die Manometrie unverzichtbar. Bei Verdacht auf eine Sphinkter-Oddi-Dysfunktion wird diese aufgrund der Gefahr, eine Pankreatitis zu induzieren, nur noch gelegentlich eingesetzt. Zum Nachweis einer nichterosiven Refluxerkrankung dient die 24 h-pH-Metrie, ggf. mit Impedanzmessung. Neuere Verfahren, wie spezielle MRT-Sequenzen, die sonographische Bestimmung der Gallenblasenejektionsfraktion, die Analyse von Magenmotorik und -kontraktilität sowie die Lumendarstellung in Echtzeit, bedürfen vor dem routinemäßigen Einsatz einer weiteren Evaluation.

Abstract

In this review article important and frequently used investigation methods for gastrointestinal functional diagnostics are presented. Some other rarely used special investigations are also explained. The hydrogen breath test is simple to carry out, ubiquitously available and enables the detection of lactose, fructose and sorbitol malabsorption. Furthermore, by the application of glucose, the test can be carried out when there is a suspicion of abnormal intestinal bacterial colonization and using lactulose for measuring small intestinal transit time. The 13C urea breath test is applied for non-invasive determination of Helicobacter pylori infections and assessment of gastrointestinal transit time, liver and exocrine pancreas functions. The secretin cholecystokinin test was the gold standard for the detection of exocrine pancreas insufficiency. However, measurement of pancreatic elastase in stool is less invasive but also less sensitive. Scintigraphy and capsule investigations with pH and temperature probes constitute important methods for determination of gastric emptying, intestinal and colon transit times. For evaluation of constipation panoramic abdominal images are taken after intake of radiologically opaque markers (Hinton test). For the diagnosis of functional esophageal diseases manometry is indispensable. In addition, manometry is only occasionally used for diagnosing a dysfunction of the sphincter of Oddi, due to the danger of inducing pancreatitis. A 24 h pH-metry is applied for the detection of non-erosive gastroesophageal reflux disease and, if necessary, with impedance measurements. Recent investigation procedures, e. g. specific MRI sequences, sonographic determination of gall bladder ejection fraction, analysis of gastric accomodation or real-time lumen imaging, require further evaluation prior to clinical application.

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Danksagung

Wir bedanken uns bei Frau Dagmar Thamm für die Unterstützung und Bereitstellung der Daten der Atemtests.

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Authors and Affiliations

  1. Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland

    M. Hollenbach, A. Hoffmeister & J. Mössner

  2. Klinik und Poliklinik für Innere Medizin I (Gastroenterologie, Hepatologie, Gastrointestinale Onkologie), Department für Innere Medizin, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland

    J. Rosendahl

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  1. M. Hollenbach
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  4. J. Mössner
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Correspondence to M. Hollenbach.

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Interessenkonflikt

M. Hollenbach, A. Hoffmeister, J. Rosendahl und J. Mössner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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J. Mössner, Leipzig

M. Reincke, München

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Hollenbach, M., Hoffmeister, A., Rosendahl, J. et al. Stellenwert der Funktionsdiagnostik in der Gastroenterologie. Internist 59, 25–37 (2018). https://doi.org/10.1007/s00108-017-0359-0

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