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Gastroesofageal refluxsjukdom (GERD)

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Definition:
Gastroesofageal refluxsjukdom (GERD) är ett tillstånd som orsakas av reflux av ventrikel-/duodenalinnehåll till matstrupen och som medför sänkt livskvalitet och därmed ofta behov av läkemedelsbehandling
Förekomst:
Prevalensen av GERD i Europa är 12–24 %.
Symtom: 
Halsbränna - svidande, brännande obehag som stiger uppåt i bröstet, sura uppstötningar. Lindring från antacida, protonpumpshämmare eller histamin-2-receptorantagonister. Åtföljande symtom kan vara sväljsvårigheter, heshet, icke-kardiella bröstsmärtor och kronisk hosta
Kliniska fynd:
Den kliniska undersökningen ger sällan fynd av betydelse för diagnosen, men skada på tandemaljen kan ses efter långvarig refluxsjukdom utan adekvat behandling.
Diagnostik:
Inga biokemiska prover har diagnostiskt värde. Provbehandling med protonpumpshämmare ger tillfredsställande sensitivitet och specificitet. Endoskopisk undersökning av esofagus krävs bland patienter med varningssymtom (sväljsvårigheter, hematemes, blod i avföringen, järnbristanemi, viktnedgång) och bland patienter som inte svarar på symtomatisk behandling inom 4 veckor.
Behandling:
Symtomlindring och förebyggande av komplikationer med läkemedel som skyddar slemhinnan, oftast genom att minska syraproduktionen i magsäcken. Livsstilsförändring har effekt på symtomen, men är sällan tillräckligt i sig självt. Laparoskopisk antirefluxkirurgi i enstaka fall.
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  • Lars Agréus, professor och distriktsläkare, Öregrunds vårdcentral
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet