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Erschienen in: Die Gastroenterologie 3/2020

06.04.2020 | Gastroösophageale Refluxkrankheit | CME

Gastroösophageale Refluxerkrankung

Strukturierte Funktionsdiagnostik auf der Basis der Lyon-Klassifikation

verfasst von: PD Dr. A. Kandulski, P. Dobsch, F.-X. Dechant, M. Müller-Schilling

Erschienen in: Die Gastroenterologie | Ausgabe 3/2020

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Zusammenfassung

Symptome der gastroösophagealen Refluxerkrankung sind häufig. In den sog. westlichen Industrienationen geben 20–30 % der erwachsenen Bevölkerung an, unter typischem Sodbrennen wenigstens einmal in der Woche zu leiden. Aufgrund der hohen Prävalenz ist eine empirische Therapie mit Protonenpumpenhemmern (PPI) im klinischen Alltag der erste Ansatz im Management der gastroösophagealen Refluxerkrankung, die in ihrer chronischen Form eine endoskopische Diagnostik sowie ein modernes Refluxmonitoring erfordert. Im klinischen Management dieser Patienten stellt sich häufig die Frage, wann und welche diagnostischen Methoden angewandt werden sollten und insbesondere ob die Diagnostik unter einer Therapie mit PPI („on“ PPI) durchgeführt oder ob diese pausiert werden sollte („off“ PPI). In den letzten 2 Jahren wurden in der „Lyon“-Klassifikation für die Funktionsdiagnostik und das diagnostische Management grundlegende Neuerungen definiert, die in dieser Arbeit zusammengefasst werden.
Literatur
1.
Zurück zum Zitat El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880PubMed El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880PubMed
2.
Zurück zum Zitat Boeckxstaens G, El-Serag HB, Smout AJPM, Kahrilas PJ (2014) Symptomatic reflux disease: the present, the past and the future. Gut 63:1185–1193PubMedPubMedCentral Boeckxstaens G, El-Serag HB, Smout AJPM, Kahrilas PJ (2014) Symptomatic reflux disease: the present, the past and the future. Gut 63:1185–1193PubMedPubMedCentral
3.
Zurück zum Zitat Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Bianchi LK et al (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920PubMed Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Bianchi LK et al (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920PubMed
4.
Zurück zum Zitat Roman S, Gyawali CP, Savarino E, Yadlapati R, Zerbib F, Wu J et al (2017) Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil 29:1–15PubMed Roman S, Gyawali CP, Savarino E, Yadlapati R, Zerbib F, Wu J et al (2017) Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil 29:1–15PubMed
5.
Zurück zum Zitat Savarino E, Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Prakash Gyawali C (2017) Expert consensus document: advances in the physiological assessment and diagnosis of GERD. Nat Rev Gastroenterol Hepatol 14:665–676PubMed Savarino E, Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Prakash Gyawali C (2017) Expert consensus document: advances in the physiological assessment and diagnosis of GERD. Nat Rev Gastroenterol Hepatol 14:665–676PubMed
7.
Zurück zum Zitat Prakash Gyawali C, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM et al (2018) Modern diagnosis of GERD: the Lyon consensus. Gut 67:1351–1362PubMed Prakash Gyawali C, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM et al (2018) Modern diagnosis of GERD: the Lyon consensus. Gut 67:1351–1362PubMed
8.
Zurück zum Zitat Kandulski A, Peitz U, Mönkemüller K, Neumann H, Weigt J, Malfertheiner P (2013) GERD assessment including pH metry predicts a high response rate to PPI standard therapy. BMC Gastroenterol 13:12PubMedPubMedCentral Kandulski A, Peitz U, Mönkemüller K, Neumann H, Weigt J, Malfertheiner P (2013) GERD assessment including pH metry predicts a high response rate to PPI standard therapy. BMC Gastroenterol 13:12PubMedPubMedCentral
9.
Zurück zum Zitat Kulig M, Nocon M, Vieth M, Leodolter A, Jaspersen D, Labenz J et al (2004) Risk factors of gastroesophageal reflux disease: methodology and first epidemiological results of the proGERD study. J Clin Epidemiol 57:580–589PubMed Kulig M, Nocon M, Vieth M, Leodolter A, Jaspersen D, Labenz J et al (2004) Risk factors of gastroesophageal reflux disease: methodology and first epidemiological results of the proGERD study. J Clin Epidemiol 57:580–589PubMed
10.
Zurück zum Zitat Kandulski A, Jechorek D, Caro C, Weigt J, Wex T, Mönkemüller K et al (2013) Histomorphological differentiation of non-erosive reflux disease and functional heartburn in patients with PPI-refractory heartburn. Aliment Pharmacol Ther 38:643–651PubMed Kandulski A, Jechorek D, Caro C, Weigt J, Wex T, Mönkemüller K et al (2013) Histomorphological differentiation of non-erosive reflux disease and functional heartburn in patients with PPI-refractory heartburn. Aliment Pharmacol Ther 38:643–651PubMed
11.
Zurück zum Zitat Savarino E, Zentilin P, Mastracci L, Dulbecco P, Marabotto E, Gemignani L et al (2013) Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn. J Gastroenterol 48:473–482PubMed Savarino E, Zentilin P, Mastracci L, Dulbecco P, Marabotto E, Gemignani L et al (2013) Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn. J Gastroenterol 48:473–482PubMed
12.
Zurück zum Zitat Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA (2013) ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 108:679–692 (quiz 693)PubMed Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA (2013) ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 108:679–692 (quiz 693)PubMed
13.
Zurück zum Zitat Kahrilas PJ, Smout AJPM (2010) Esophageal disorders. Am J Gastroenterol 105:747–756PubMed Kahrilas PJ, Smout AJPM (2010) Esophageal disorders. Am J Gastroenterol 105:747–756PubMed
14.
Zurück zum Zitat Muthusamy VR, Lightdale JR, Acosta RD, Chandrasekhara V, Chathadi KV, Eloubeidi MA et al (2015) The role of endoscopy in the management of GERD. Gastrointest Endosc 81:1305–1310PubMed Muthusamy VR, Lightdale JR, Acosta RD, Chandrasekhara V, Chathadi KV, Eloubeidi MA et al (2015) The role of endoscopy in the management of GERD. Gastrointest Endosc 81:1305–1310PubMed
16.
Zurück zum Zitat Pandolfino JE (2014) Esophageal function testing. Gastrointest Endosc Clin N Am 24:xiii–xivPubMed Pandolfino JE (2014) Esophageal function testing. Gastrointest Endosc Clin N Am 24:xiii–xivPubMed
17.
Zurück zum Zitat Pandolfino JE, Vela MF (2009) Esophageal-reflux monitoring. Gastrointest Endosc 69:917–930.e1PubMed Pandolfino JE, Vela MF (2009) Esophageal-reflux monitoring. Gastrointest Endosc 69:917–930.e1PubMed
18.
Zurück zum Zitat Sifrim D, Castell D, Dent J, Kahrilas PJ (2004) Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut 53(7):1024–1031PubMedPubMedCentral Sifrim D, Castell D, Dent J, Kahrilas PJ (2004) Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut 53(7):1024–1031PubMedPubMedCentral
19.
Zurück zum Zitat Pandolfino JE, Richter JE, Ours T, Guardino JM, Chapman J, Kahrilas PJ (2003) Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol 98:740–749PubMed Pandolfino JE, Richter JE, Ours T, Guardino JM, Chapman J, Kahrilas PJ (2003) Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol 98:740–749PubMed
20.
Zurück zum Zitat Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM et al (2015) The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27:160–174PubMed Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM et al (2015) The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27:160–174PubMed
21.
Zurück zum Zitat Kandulski A, Malfertheiner P, Weigt J (2013) Modern diagnostic tools for esophageal pathologies. Internist (Berl) 54:279–286 Kandulski A, Malfertheiner P, Weigt J (2013) Modern diagnostic tools for esophageal pathologies. Internist (Berl) 54:279–286
22.
Zurück zum Zitat Koop H, Fuchs KH, Labenz J, Lynen Jansen P, Messmann H, Miehlke S et al (2014) S2k guideline: gastroesophageal reflux disease guided by the German society of gastroenterology: AWMF register no. 021-013. Z Gastroenterol 52:1299–1346PubMed Koop H, Fuchs KH, Labenz J, Lynen Jansen P, Messmann H, Miehlke S et al (2014) S2k guideline: gastroesophageal reflux disease guided by the German society of gastroenterology: AWMF register no. 021-013. Z Gastroenterol 52:1299–1346PubMed
23.
Zurück zum Zitat Fass R (2007) Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol 41:131–137PubMed Fass R (2007) Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol 41:131–137PubMed
24.
Zurück zum Zitat Savarino E, Zentilin P, Savarino V (2013) NERD: An umbrella term including heterogeneous subpopulations. Nat Rev Gastroenterol Hepatol 10:371–380PubMed Savarino E, Zentilin P, Savarino V (2013) NERD: An umbrella term including heterogeneous subpopulations. Nat Rev Gastroenterol Hepatol 10:371–380PubMed
25.
Zurück zum Zitat Bredenoord AJ, Weusten BLAM, Smout AJPM (2005) Symptom association analysis in ambulatory gastro-oesophageal reflux monitoring. Gut 54:1810–1817PubMedPubMedCentral Bredenoord AJ, Weusten BLAM, Smout AJPM (2005) Symptom association analysis in ambulatory gastro-oesophageal reflux monitoring. Gut 54:1810–1817PubMedPubMedCentral
26.
Zurück zum Zitat Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F (2016) Esophageal disorders. Gastroenterology 150:1368–1379 Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F (2016) Esophageal disorders. Gastroenterology 150:1368–1379
27.
Zurück zum Zitat Nikaki K, Woodland P, Sifrim D (2016) Adult and paediatric GERD: diagnosis, phenotypes and avoidance of excess treatments. Nat Rev Gastroenterol Hepatol 13:529–542PubMed Nikaki K, Woodland P, Sifrim D (2016) Adult and paediatric GERD: diagnosis, phenotypes and avoidance of excess treatments. Nat Rev Gastroenterol Hepatol 13:529–542PubMed
28.
Zurück zum Zitat Fass R, Ofman JJ, Gralnek IM, Johnson C, Camargo E, Sampliner RE et al (1999) Clinical and economic assessment of the omeprazole test in patients with symptoms suggestive of gastroesophageal reflux disease. Arch Intern Med 159:2161–2168PubMed Fass R, Ofman JJ, Gralnek IM, Johnson C, Camargo E, Sampliner RE et al (1999) Clinical and economic assessment of the omeprazole test in patients with symptoms suggestive of gastroesophageal reflux disease. Arch Intern Med 159:2161–2168PubMed
29.
Zurück zum Zitat Fass R, Ofman JJ, Sampliner RE, Camargo L, Wendel C, Fennerty MB (2000) The omeprazole test is as sensitive as 24‑h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive oesophagitis. Aliment Pharmacol Ther 14:389–396PubMed Fass R, Ofman JJ, Sampliner RE, Camargo L, Wendel C, Fennerty MB (2000) The omeprazole test is as sensitive as 24‑h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive oesophagitis. Aliment Pharmacol Ther 14:389–396PubMed
30.
Zurück zum Zitat Richter JE, Pandolfino JE, Vela MF, Kahrilas PJ, Lacy BE, Ganz R et al (2013) Utilization of wireless pH monitoring technologies: a summary of the proceedings from the esophageal diagnostic working group. Dis Esophagus 26:755–765PubMed Richter JE, Pandolfino JE, Vela MF, Kahrilas PJ, Lacy BE, Ganz R et al (2013) Utilization of wireless pH monitoring technologies: a summary of the proceedings from the esophageal diagnostic working group. Dis Esophagus 26:755–765PubMed
31.
Zurück zum Zitat Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC et al (2013) Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg 217:586–597PubMed Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC et al (2013) Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg 217:586–597PubMed
32.
Zurück zum Zitat Penagini R, Sweis R, Mauro A, Domingues G, Vales A, Sifrim D (2015) Inconsistency in the diagnosis of functional heartburn: usefulness of prolonged wireless ph monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease. J Neurogastroenterol Motil 21:265–272PubMedPubMedCentral Penagini R, Sweis R, Mauro A, Domingues G, Vales A, Sifrim D (2015) Inconsistency in the diagnosis of functional heartburn: usefulness of prolonged wireless ph monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease. J Neurogastroenterol Motil 21:265–272PubMedPubMedCentral
33.
Zurück zum Zitat Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D et al (2006) Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 55:1398–1402PubMedPubMedCentral Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D et al (2006) Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 55:1398–1402PubMedPubMedCentral
34.
Zurück zum Zitat Zerbib F, Roman S, Ropert A, Des Varannes SB, Pouderoux P, Chaput U et al (2006) Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol 101:1956–1963PubMed Zerbib F, Roman S, Ropert A, Des Varannes SB, Pouderoux P, Chaput U et al (2006) Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol 101:1956–1963PubMed
35.
Zurück zum Zitat van Malenstein H, Farré R, Sifrim D (2008) Esophageal dilated intercellular spaces (DIS) and nonerosive reflux disease. Am J Gastroenterol 103:1021–1028PubMed van Malenstein H, Farré R, Sifrim D (2008) Esophageal dilated intercellular spaces (DIS) and nonerosive reflux disease. Am J Gastroenterol 103:1021–1028PubMed
36.
Zurück zum Zitat Farré R, van Malenstein H, De Vos R, Geboes K, Depoortere I, Vanden Berghe P et al (2008) Short exposure of oesophageal mucosa to bile acids, both in acidic and weakly acidic conditions, can impair mucosal integrity and provoke dilated intercellular spaces. Gut 57:1366–1374PubMed Farré R, van Malenstein H, De Vos R, Geboes K, Depoortere I, Vanden Berghe P et al (2008) Short exposure of oesophageal mucosa to bile acids, both in acidic and weakly acidic conditions, can impair mucosal integrity and provoke dilated intercellular spaces. Gut 57:1366–1374PubMed
37.
Zurück zum Zitat Zentilin P, Savarino V, Mastracci L, Spaggiari P, Dulbecco P, Ceppa P et al (2005) Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group. Am J Gastroenterol 100:2299–2306PubMed Zentilin P, Savarino V, Mastracci L, Spaggiari P, Dulbecco P, Ceppa P et al (2005) Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group. Am J Gastroenterol 100:2299–2306PubMed
38.
Zurück zum Zitat Yerian L, Fiocca R, Mastracci L, Riddell R, Vieth M, Sharma P et al (2011) Refinement and reproducibility of histologic criteria for the assessment of microscopic lesions in patients with gastroesophageal reflux disease: the esohisto project. Dig Dis Sci 56:2656–2665PubMed Yerian L, Fiocca R, Mastracci L, Riddell R, Vieth M, Sharma P et al (2011) Refinement and reproducibility of histologic criteria for the assessment of microscopic lesions in patients with gastroesophageal reflux disease: the esohisto project. Dig Dis Sci 56:2656–2665PubMed
39.
Zurück zum Zitat Fiocca R, Mastracci L, Riddell R, Takubo K, Vieth M, Yerian L et al (2010) Development of consensus guidelines for the histologic recognition of microscopic esophagitis in patients with gastroesophageal reflux disease: the Esohisto project. Hum Pathol 41:223–231PubMed Fiocca R, Mastracci L, Riddell R, Takubo K, Vieth M, Yerian L et al (2010) Development of consensus guidelines for the histologic recognition of microscopic esophagitis in patients with gastroesophageal reflux disease: the Esohisto project. Hum Pathol 41:223–231PubMed
40.
Zurück zum Zitat Patel A, Wang D, Sainani N, Sayuk GS, Gyawali CP (2016) Distal mean nocturnal baseline impedance on pH-impedance monitoring predicts reflux burden and symptomatic outcome in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 44:890–898PubMedPubMedCentral Patel A, Wang D, Sainani N, Sayuk GS, Gyawali CP (2016) Distal mean nocturnal baseline impedance on pH-impedance monitoring predicts reflux burden and symptomatic outcome in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 44:890–898PubMedPubMedCentral
41.
Zurück zum Zitat Frazzoni M, Savarino E, de Bortoli N, Martinucci I, Furnari M, Frazzoni L et al (2016) Analyses of the post-reflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-pH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol 14:40–46PubMed Frazzoni M, Savarino E, de Bortoli N, Martinucci I, Furnari M, Frazzoni L et al (2016) Analyses of the post-reflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-pH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol 14:40–46PubMed
42.
Zurück zum Zitat Kessing BF, Bredenoord AJ, Weijenborg PW, Hemmink GJM, Loots CM, Smout AJPM (2011) Esophageal acid exposure decreases intraluminal baseline impedance levels. Am J Gastroenterol 106:2093–2097PubMed Kessing BF, Bredenoord AJ, Weijenborg PW, Hemmink GJM, Loots CM, Smout AJPM (2011) Esophageal acid exposure decreases intraluminal baseline impedance levels. Am J Gastroenterol 106:2093–2097PubMed
43.
Zurück zum Zitat Martinucci I, de Bortoli N, Savarino E, Piaggi P, Bellini M, Antonelli A et al (2014) Esophageal baseline impedance levels in patients with pathophysiological characteristics of functional heartburn. Neurogastroenterol Motil 26:546–555PubMed Martinucci I, de Bortoli N, Savarino E, Piaggi P, Bellini M, Antonelli A et al (2014) Esophageal baseline impedance levels in patients with pathophysiological characteristics of functional heartburn. Neurogastroenterol Motil 26:546–555PubMed
44.
Zurück zum Zitat Kandulski A, Weigt J, Caro C, Jechorek D, Wex T, Malfertheiner P (2015) Esophageal intraluminal baseline impedance differentiates gastroesophageal reflux disease from functional heartburn. Clin Gastroenterol Hepatol 13:1075–1081PubMed Kandulski A, Weigt J, Caro C, Jechorek D, Wex T, Malfertheiner P (2015) Esophageal intraluminal baseline impedance differentiates gastroesophageal reflux disease from functional heartburn. Clin Gastroenterol Hepatol 13:1075–1081PubMed
45.
Zurück zum Zitat Keller J (2018) What is the impact of high-resolution manometry in the functional diagnostic workup of gastroesophageal reflux disease? Visc Med 34:101–108PubMedPubMedCentral Keller J (2018) What is the impact of high-resolution manometry in the functional diagnostic workup of gastroesophageal reflux disease? Visc Med 34:101–108PubMedPubMedCentral
46.
Zurück zum Zitat Savarino E, Gemignani L, Pohl D, Zentilin P, Dulbecco P, Assandri L et al (2011) Oesophageal motility and bolus transit abnormalities increase in parallel with the severity of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 34:476–486PubMed Savarino E, Gemignani L, Pohl D, Zentilin P, Dulbecco P, Assandri L et al (2011) Oesophageal motility and bolus transit abnormalities increase in parallel with the severity of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 34:476–486PubMed
Metadaten
Titel
Gastroösophageale Refluxerkrankung
Strukturierte Funktionsdiagnostik auf der Basis der Lyon-Klassifikation
verfasst von
PD Dr. A. Kandulski
P. Dobsch
F.-X. Dechant
M. Müller-Schilling
Publikationsdatum
06.04.2020
Verlag
Springer Medizin
Erschienen in
Die Gastroenterologie / Ausgabe 3/2020
Print ISSN: 2731-7420
Elektronische ISSN: 2731-7439
DOI
https://doi.org/10.1007/s11377-020-00440-z

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