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Magesår

Sist oppdatert: Sist revidert:
Sist revidert av:


Definisjon:
Magesår i magesekk eller duodenum forårsaket av bakterien Helicobacter pylori (Hp) eller bruk av ulcerogene medikamenter
Forekomst:
Ca 10% av befolkningen vil i løpet av livet utvikle magesår, forekomsten er avtakende
Symptomer:
Varierer fra person til person. Episodiske magesmerter som ofte lindres av mat og antacida. Noen har nattsmerter
Funn:
Ingen spesifikke kliniske funn
Diagnostikk:
Avføringsprøve eller serologisk prøve vil kunne avdekke Hp-infeksjon. Gastroskopi bekrefter sår
Behandling:
Trippelterapi med protonpumpehemmer + to antibiotika
  1. Fashner J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection. Am Fam Physician 2015; 91(4): 236-242. www.aafp.org  
  2. Lanas A, Chand FKL. Peptic ulcer disease. Lancet 2017; 390: 613–24. doi:10.1016/ S0140-6736(16)32404-7
  3. Aro P, Storskrubb T, Ronkainen J, et al. Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study. Am J Epidemiol 2006; 163: 1025-34. American Journal of Epidemiology  
  4. Vakil NB. Peptic ulcer disease: Epidemiology, etiology, and pathogenesis. UpToDate, last updated Mar 02, 2020. UpToDate  
  5. Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013. PubMed  
  6. Lee Lynch K. Peptic ulcer disease. BMJ Best Practice, last updated 10 Sep 2020. bestpractice.bmj.com  
  7. Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician 2007; 76: 1005-12. PubMed  
  8. Ziegler AB. The role of proton pump inhibitors in acute stress ulcer prophylaxis in mechanically ventilated patients. Dimens Crit Care Nurs 2005; 24: 109-14. PubMed  
  9. Papatheodoridis GV, Sougioultzis S, Archimandritis AJ. Effects of Helicobacter pylori and nonsteroidal anti-inflammatory drugs on peptic ulcer disease: a systematic review. Clin Gastroenterol Hepatol 2006; 4:130. PubMed  
  10. Anand BS. Peptic ulcer disease. Medscape, last updated Oct 03, 2018. emedicine.medscape.com  
  11. Nasjonale retningslinjer: Antibiotika i sykehus. Ulcussykdom. Helsedirektoratet. Sist faglig oppdatert 08. januar 2018. www.helsedirektoratet.no  
  12. Tielleman T, Bujanda D, Cryer B. Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am. 2015;25(3):415-428. PubMed  
  13. Chan FK, Ching JY, Hung LC, et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005; 352:238. New England Journal of Medicine  
  14. Helsedirektoratet (2021). Nasjonal faglig retningslinje for antibiotika i primærhelsetjenesten nettdokument. Oslo: Helsedirektoratet (sist faglig oppdatert 16. november 2021, lest 16. november 2021).
  15. Martinez JP, Mattu A. Abdominal pain in the elderly. Emerg Med Clin North Am 2006; 24: 371-88. PubMed  
  16. Best LM, Takwoingi Y, Siddique S, et al. Non-invasive diagnostic tests for Helicobacter pylori infection. Cochrane Database Syst Rev. 2018 Mar 15;(3):CD012080. Cochrane (DOI)  
  17. Megraud F, Lehours P. Helicobacter pylori detection and antimicrobial susceptibility testing. Clin Microbiol Rev 2007; 20: 280-322. PubMed  
  18. Calvet X, Ramirez-Lázaro MJ, Montserrat A, et al. Comparative accuracy of 3 monoclonal stool tests for diagnosis of Helicobacter pylori infection among patients with dyspepsia. Clin Infect Dis 2010; 50: 323-8. PubMed  
  19. Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112:212-239. PubMed  
  20. Ford AC, Gurusamy KS, Delaney B, et al. Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive people. Cochrane Database Syst Rev. 2016;(4):CD003840. Cochrane (DOI)  
  21. Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F. Meta-analysis: Duration of first-line proton-pump inhibitor-based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007; 147: 553-62. Annals of Internal Medicine  
  22. Yuan Y, Ford AC, Khan KJ, et al. Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Database Syst Rev 2013 Dec 11;12:CD008337. Cochrane (DOI)  
  23. Larsen AL, Ragnhildstveit E, et al. Resistance rates of metronidazole and other antibacterials in Helicobacter pylori from previously untreated patients in Norway. APMIS 2013; 121(4): 353-8 PubMed  
  24. Szajewska H, Horvath A, Piwowarczyk A. Meta-analysis: the effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment. Aliment Pharmacol Ther 2010; 32: 1060-79. PubMed  
  25. Zhao Y, Li Y, Hu J, et al. The Effect of Helicobacter pylori Eradication in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis of Randomized Controlled Studies. Dig Dis. 2020;38(4):261-268. PMID: 32396919.
  26. Chan FKL, Ching JYL, Hung LCT. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005; 352: 238-44. PubMed  
  27. Sanabria A, Villegas MI, Morales Uribe CH. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD004778. DOI: 10.1002/14651858.CD004778.pub3 DOI  
  28. Zeng M, Mao X-H, Li J-X, et al. Efficacy, safety, and immunogenicity of an oral recombinant Helicobacter pylori vaccine in children in China: A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015. doi: 10.1016/S0140-6736(15)60579-7 DOI  
  29. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152: 101-13. PubMed  
  30. Würtz M, Grove EL, Kristensen SD, Hvas A-M. The antiplatelet effect of aspirin is reduced by proton pump inhibitors in patients with coronary artery disease. Heart 2009; e-pub: PMID:19910291. PubMed  
  31. Niv Y. H pylori recurrence after successful eradication. World J Gastroenterol. 2008 Mar 14;14(10):1477-8. PMID: 18330934. PubMed  
  32. Lau JY, Sung J, Hill C, et al. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion 2011; 84:102. PubMed  
  33. Forsmo HM, Vandvik PO, Glomsaker T. Ulcus perforatum - et 12-årsmateriale. Tidsskr Nor Lægeforen 2005; 125: 1822-4. Tidsskrift for Den norske legeforening  
  34. Jarbol DE, Kragstrup J, Stovring H, Havelund T, Schaffalitzky de Muckadell OB. Proton pump inhibitor or testing for Helicobacter pylori as the first step for patients presenting with dyspepsia? A cluster randomized trial. Am J Gastroenterol 2006; 101: 1200-8. PubMed  
  35. Thorat MA, Cuzick J. Prophylactic use of aspirin: systematic review of harms and approaches to mitigation in the general population. Eur J Epidemiol 2015; 30:5. PubMed  
  • Terje Johannessen, professor i allmennmedisin, Trondheim
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Per Martin Kleveland, professor i gastroenterologi, Norges teknisk-naturvitenskapelige universitet og overlege gastroenterologisk avdeling St. Olavs Hospital, Trondheim