Klinisch relevante Atemtests in der gastroenterologischen Diagnostik - Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität sowie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen

 

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Zusammenfassung

H₂- und ¹³C-Atemtests sind wertvolle, nicht invasive diagnostische Verfahren in der Gastroenterologie. H₂-Atemtests sind klinisch etabliert zur Diagnostik einer Kohlenhydratmalabsorption und -unverträglichkeit (H₂-Atemtests mit Laktose, Fruktose, Saccharose, Sorbit), einer bakteriellen Fehlbesiedlung (H₂-Glukose-Atemtest) und zur Messung des orozökalen Transits (H₂-Laktulose-Atemtest). Der ¹³C-Harnstoffatemtest gilt als Goldstandard zur Diagnostik einer Helicobacter-pylori-Infektion. Darüber hinaus gehören ¹³C-Atemtests zur Messung der Magenentleerung mittlerweile zu den klinisch etablierten Verfahren. ¹³C-Atemtests zur Messung der exokrinen Pankreasfunktion und Leberfunktion werden klinisch ebenfalls eingesetzt, bieten aber derzeit keine wesentlichen Vorteile gegenüber anderen diagnostischen Verfahren. Ein Nachteil sämtlicher Atemtests besteht in der fehlenden Standardisierung der Testverfahren, obwohl Änderungen der Testlösung bzw. -mahlzeit, der Testdurchführung und -auswertung erheblichen Einfluss auf die Ergebnisse haben können. Dieser Artikel gibt deshalb die Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität sowie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen zur Durchführung klinisch relevanter H₂- und ¹³C-Atemtests wieder. Dargestellt werden Indikationen, praktische Durchführung und Analyse der jeweiligen Untersuchungen. Die Empfehlungen stützen sich in erster Linie auf die verfügbare Literatur, berücksichtigen aber auch die praktischen Erfahrungen der Autoren, zumal zahlreiche Fragestellungen zur optimalen Durchführung einzelner Tests nicht durch adäquate Studien geklärt sind.

Abstract

H₂- and ¹³C-breath tests are valuable non-invasive diagnostic tools for gastroenterological diseases. H₂-breath tests are clinically established for the diagnosis of carbohydrate intolerance resulting from malabsorption (H₂-breath tests with lactose, fructose, saccharose, sorbitol), of bacterial overgrowth (glucose H₂-breath test) and for measurement of orcoceal transit time (lactulose H₂-breath test). The ¹³C-urea breath test is regarded as the “gold standard” procedure for the diagnosis of Helicobacter pylori infection. Moreover, ¹³C-breath tests for measurement of gastric emptying can be considered as clinically established, meanwhile. ¹³C-breath tests for the evaluation of pancreatic exocrine function or liver function can also be used clinically; however, they currently offer no substantial advantage over other diagnostic procedures. A major disadvantage of all breath tests is that they lack standardization although modifications of the test meal or solution, of the test performance and of the evaluation of data may markedly influence the results. Thus, this article presents the recommendations of the German Society of Neurogastroenterology and Motility and of the German Society of Digestive and Metabolic Diseases for clinically relevant H₂- and ¹³C-breath tests. Indications for the examinations, the procedures to be followed, the analysis of the obtained data and the conclusions to be drawn are delineated. The literature on which the recommendations are based is reviewed. However, personal experience of the authors is also taken into account since numerous questions regarding optimal test performance are not clarified by adequate studies.

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Jutta Keller

Israelitisches Krankenhaus, Medizinische Klinik

Orchideenstieg 14

22297 Hamburg

Phone: 0 40/5 11 25-50 41

Fax: 0 40/5 11 25-50 45

Email: keller@ik-h.de