Hopp til hovedinnhold

Komplikasjoner til magesår

Sist revidert:
Sist revidert av:
Definisjon:
Fire viktige komplikasjoner forekommer ved magesår: blødning, perforasjon, penetrasjon og obstruksjon
Forekomst:
Blødning er hyppigst og ses særlig etter bruk av ulcerogene medisiner. Komplikasjoner blir sjeldnere etter eradikasjon av Helicobacter pylori
Symptomer:
Hematemese/melena, magesmerter, kvalme, brekninger
Funn:
Avhenger av alvorlighetsgraden. Ved livstruende blødning kan pasienten gå i sjokk
Diagnostikk:
Hovedundersøkelsen er endoskopi, men i noen tilfeller kan røntgen og ultralyd være aktuelt
Behandling:
Er ofte initialt medisinsk, men i noen tilfeller er livreddende kirurgi påkrevd
  1. Vakil NB. Overview of the complications of peptic ulcer disease. UpToDate, last updated Oct 28, 2019 . www.uptodate.com  
  2. Quan S, Frolkis A, Milne K, et al. Upper-gastrointestinal bleeding secondary to peptic ulcer disease: Incidence and outcomes. World J Gastroenterol. Dec 14, 2014; 20(46): 17568–17577. . doi:10.3748/wjg.v20.i46.17568 DOI  
  3. Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg 2010; 251:51. PubMed  
  4. Sadic J, Borgström A, Manjer J, et al. Bleeding peptic ulcer - time trends in incidence, treatment and mortality in Sweden. Aliment Pharmacol Ther 2009; 30:392. PubMed  
  5. Bashinskaya B, Nahed BV, Redjal N, et al. Trends in Peptic Ulcer Disease and the Identification of Helicobacter Pylori as a Causative Organism: Population-based Estimates from the US Nationwide Inpatient Sample. J Glob Infect Dis 2011; 3:366. PubMed  
  6. Chan FK, Leung WK. Peptic-ulcer disease. Lancet 2002; 360: 933-41. PubMed  
  7. Vestergård A, Bredahl K, Schaffalitzky de Muckadell OB, Pedersen OB, Møller Hansen J. Blødende peptisk ulcus. Ugeskr Læger 2009; 171: 235. Ugeskrift for Læger  
  8. Laine L. Clinical practice. Upper Gastrointestinal Bleeding Due to a Peptic Ulcer. N Engl J Med 2016; 374:2367. PubMed  
  9. Winstead NS, Wilcox CM. Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage: a cost-effectiveness analysis. Aliment Pharmacol Ther 2007; 26: 1371-7. PubMed  
  10. Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med 2008; 359: 928-37. PubMed  
  11. Baradarian, R, Ramdhaney, S, Chapalamadugu, R, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol 2004; 99: 619. PubMed  
  12. Wang CH, Ma MH, Chou HC, et al. High-dose vs non-high-dose proton pump inhibitors after endoscopic treatment in patients with bleeding peptic ulcer: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med 2010; 170: 751-8. PubMed  
  13. Neumann I, Letelier LM, Rada G, et al. Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding. Cochrane Database Syst Rev 2013 Jun 12;6:CD007999. Cochrane (DOI)  
  14. Griffiths WJ, Neumann DA, Welsh JD. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med 1979; 300: 1411. New England Journal of Medicine  
  15. Laine L, Cohen H, Brodhead J, et al. Prospective evaluation of immediate versus delayed refeeding and prognostic value of endoscopy in patients with upper gastrointestinal hemorrhage. Gastroenterology 1992; 102: 314. Gastroenterology  
  16. Lau JY, Leung WK, Wu JC, et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007; 356: 1631-40. New England Journal of Medicine  
  17. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002; 347: 1175-86. New England Journal of Medicine  
  18. Lanas A, Hunt R. Prevention of anti-inflammatory drug-induced gastrointestinal damage: benefits and risks of therapeutic strategies. Ann Med 2006; 38: 415-28. PubMed  
  19. Barkun AN, Bardou M, Kuipers AJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152: 101-13. Annals of Internal Medicine  
  20. Gisbert JP, Khorrami S, Carballo F et al. H. pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer. Cochrane Database Syst Rev, issue 2, 2004. The Cochrane Library  
  21. Hilton D, Iman N, Burke GJ, Moore A, O'Mara G, Signorini D, et al. Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study. Am J Gastroenterol 2001; 96: 380-4. PubMed  
  22. Aziz F. Surgical treatment of perforated peptic ulcer. Medscape, last updated Apr 27, 2016. emedicine.medscape.com  
  • Terje Johannessen, professor i allmennmedisin, Trondheim (tilpasning til NEL)