Gå direkt till huvudinnehållet

Magsår

Senast reviderad:
Sakkunnig:


Definition:
Sår i magsäcken eller tolvfingertarmen orsakad av bakterien Helicobacter pylori (Hp) eller användning av ulcerogena läkemedel.
Förekomst:
Cirka 5–10 % av befolkningen utvecklar magsår någon gång i livet, förekomsten är dock avtagande
Symtom:
Symtomen varierar från person till person. Episodiska buksmärtor som ofta lindras med mat och antacida. Vissa har nattliga smärtor.
Kliniska fynd:
Inga specifika kliniska fynd.
Diagnostik:
Hp-test bekräftar Hp-infektion. Gastroskopi bekräftar magsår.
Behandling:
Behandlingen består av trippelbehandling, det vill säga protonpumpshämmare i kombination med två antibiotika.
  1. Talley NJ, Vakil N. Practice Parameters Committee of the American College of Gastroenterology: guidelines for the management of dyspepsia. Am J Gastroenterol 2005; 100: 2324-37. PubMed  
  2. Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017 Aug 5;390(10094):613-624. doi: 10.1016/S0140-6736(16)32404-7. Epub 2017 Feb 25. PMID: 28242110 PubMed  
  3. Aro P, Storskrubb T, Ronkainen J, Bolling-Sternevald E, Engstrand L, Vieth M, Stolte M, Talley NJ, Agréus L. Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study. Am J Epidemiol. 2006 Jun 1;163(11):1025-34. doi: 10.1093/aje/kwj129. Epub 2006 Mar 22. PMID: 16554343 PubMed  
  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 Jul;112(7):988-1013. doi: 10.1038/ajg.2017.154. Epub 2017 Jun 20. Erratum in: Am J Gastroenterol. 2017 Sep;112(9):1484. PMID: 28631728 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. Bytzer P, Teglbjaerg PS, for the Danish Ulcer Study Group. Helicobacter pylori-negative duodenal ulcers: prevalence, clinical characteristics, and prognosis-results from a randomized trial with 2-year follow-up. Am J Gastroenterol 2001; 96: 1409-16. PubMed  
  10. 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  
  11. Hernandez-Diaz S, Rodriguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/ perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med 2000; 160: 2093-9. PubMed  
  12. Anglin R, Yuan Y, Moayyedi P, Tse F, Armstrong D, Leontiadis GI. Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol. 2014 Jun;109(6):811-9. doi: 10.1038/ajg.2014.82. Epub 2014 Apr 29. PMID: 24777151 PubMed  
  13. Cerezo JG, Hristov RL, Carcas Sansuán AJ, Vázquez Rodríguez JJ. Outcome trials of COX-2 selective inhibitors: global safety evaluation does not promise benefits. Eur J Clin Pharm 2003; 59: 169-175. PubMed  
  14. Garcia Rodriguez LA, et al. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies. British Journal of Clinical Pharmacology 2001; 52: 563-71. PubMed  
  15. Derry S, Loke YK. Risk of gastrointestinal haemorrhage withlong term use of aspirin: meta-analysis. BMJ 2000; 321: 1183-7. PubMed  
  16. 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. PMID: 15659723 PubMed  
  17. Anand BS. Peptic ulcer disease. Medscape, last updated Oct 03, 2018. emedicine.medscape.com  
  18. Outredd dyspepsi, okomplicerade duodenal- och ventrikelsår samt funktionell dyspepsi (2019). Nationellt vårdprogram från SGF och SFAM genom Agreus L, Lööf L, Simren M, Ekesbo R, Seensalu R, Ehnberg A, Engstrand L, Staël von Holstein C. www.svenskgastroenterologi.se  
  19. 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. doi: 10.1002/14651858.CD008337.pub2. PMID: 24338763 PubMed  
  20. Delaney B, Moayyedi P, Forman D. Helicobacter pylori infection. Clinical Evidence 2001; 6: 364-77. PubMed  
  21. Malfertheiner P, Megraud F, O'Morain C and for the European Helicobacter Study Group. Current concepts in the management of Helicobacter pylori infection: the Maastricht III consensus report. Gut 2007; 56: 772-81. PMID: 26187502 PubMed  
  22. 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  
  23. 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 PubMed  
  24. Hsu PI, Lai KH, Lin CK, et al. A Prospective Randomized Trial of Esomeprazole- versus Pantoprazole-Based Triple Therapy for Helicobacter pylori Eradication. Am J Gastroenterol 2005; 100: 2387-92. PubMed  
  25. Veldhuyzen van Zanten SJ, Flook N, et al. An evidence-based approach to the management of univestigated dyspepsia in the era of Helicobacter pylori. Can Med Assoc J 2000; 162 (suppl 12): S3-S23. PMID: 10870511 PubMed  
  26. Laine L. CLINICAL PRACTICE. Upper Gastrointestinal Bleeding Due to a Peptic Ulcer. N Engl J Med 2016; Jun 16;374(24: 2367-76. pmid:27305194 PubMed  
  27. Rostom A, Dube C, Wells G, Tugwell P, Welch V, Jolicoeur E, McGowan J. Prevention of NSAID-induced gastroduodenal ulcers (Cochrane Review). In: The Cochrane Library, Issue 4, 2002. PMID: 12519573 PubMed  
  28. SBU. Blödande magsår. En systematisk litteraturöversikt. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2011. www.sbu.se  
  29. Würtz M, Grove EL, Kristensen SD, Hvas A-M. The aniplatelet effect of aspirin is reduced by proton pump inhibitors in patients with coronary artery disease. Heart 2009; e-pub: PMID:19910291. PubMed  
  30. Petersen H, Kristensen P, Johannessen T, Kleveland PM, Dybdahl JH. The natural course of peptic ulcer disease and its predictors. Scand J Gastroenterol 1995; 30: 17-24 PubMed  
  31. Niv Y. H pylori recurrence after successful eradication. World J Gastroenterol. 2008 Mar 14;14(10):1477-8. PMID: 18330934. PubMed  
  32. Martinez JP, Mattu A. Abdominal pain in the elderly. Emerg Med Clin North Am 2006; 24: 371-88. PubMed  
  33. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102-13. doi: 10.1159/000323958. Epub 2011 Apr 14. PMID: 21494041 PubMed  
  • Lars Agréus, professor och distriktsläkare, Öregrunds vårdcentral
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet