Hopp til innhold
NHI.no
Annonse
Informasjon

Brystbrannsykdom - reflukssykdom

En slapp lukkemuskel mellom spiserøret og magesekken medfører at syre lekker opp i spiserøret. Det etser slimhinnen og gir symptomer som halsbrann, sure oppstøt, sviende smerter i mellomgulvet.

GERD
Årsaken til brystbrann er først og fremst en slapp lukkemuskel i overgangen mellom magesekk og spiserør.

Sist oppdatert:

6. nov. 2020

Hva er brystbrannsykdom?

Magesekk med refluxproblemerMagesekk med refluxproblemer

Brystbrann oppstår ved at magesyre (saltsyre) fra magesekken (gastro) kommer opp i spiserøret (øsofagus), det vil si at syren forflytter seg motsatt "fartsretningen". Det at magesyre på denne måten strømmer feil vei eller "oppover/bakover" i fordøyelseskanalen, betegnes på fagspråket refluks.

Annonse

Det finnes mange navn på denne tilstanden. Gastroøsofageal reflukssykdom (GØRS) er den medisinske termen på denne lidelsen. Noen kaller det bare reflukssykdom. For å gjøre tilstanden lettere å gjenkjenne, har vi valgt å kalle den brystbrannsykdom.

Tilstanden medfører altså brystbrann (noen sier halsbrann) og/eller sviende smerter i øvre del av magen eller nedre del av brystet. Nesten alle har vi opplevd brystbrann, så hva må til for å kalle det sykdom? Jo, sykdomsbetegnelsen innebærer at reflukssymptomene er så plagsomme at du opplever nedsatt livskvalitet og føler behov for behandling.

Ved reflukssykdom kan det foreligge betennelsesforandringer i slimhinnen i nedre del av spiserøret (øsofagitt), men hos over halvparten er slimhinnen helt normal ved undersøkelse.

Brystbrannsykdom forekommer hos 10-20 prosent av befolkningen. De fleste av disse er uten synlig betennelse i spiserøret.

Dette dokumentet er basert på det profesjonelle dokumentet Gastroøsofageal reflukssykdom . Referanselisten for dette dokumentet vises nedenfor

  1. Baird DC, Harker DJ, Karmes AS. Diagnosis and treatment of gastroesophageal reflux in infants and children. Am Fam Physician. 2015 Oct 15;92(8):705-717.
  2. Katzka DA, Kahrilas PJ. Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ. 2020 Nov 23;371:m3786. PMID: 33229333. PubMed
  3. Armstrong D, Marshall JK, Chiba N, et al; Canadian Association of Gastroenterology GERD Consensus Group. Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults - update 2004. Can J Gastroenterol. 2005 Jan;19(1):15-35. PubMed
  4. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastrooesophageal reflux disease: a systematic review. Gut 2005; 54: 710-7. Gut
  5. Essilfie I, Lihaug Hoff DA, Hatlebakk JG. Behandling av gastroøsofageal reflukssykdom. Tidsskr Nor Lægeforen 2007; 127: 3082-4. PubMed
  6. Sifrim D. Relevance of volume and proximal extent of reflux in gastro-oesophageal reflux disease. Gut 2005; 54: 175-8. Gut
  7. Chang AB, Lasserson TJ, Gaffney J, et al. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev, issue 1, 2011;CD004823. Cochrane (DOI)
  8. Kahrilas PJ, Howden CW, Hughes N, et al. Response of chronic cough to acid-suppressive therapy in patients with gastroesophageal reflux disease. Chest 2013 Mar;143(3):605-12 . pmid:23117307. PubMed
  9. Kahrilas PJ. Clinical manifestations and diagnosis of gastroesophageal reflux in adults. UpToDate, last updated Jan 28, 2020. www.uptodate.com
  10. Bujanda DE, Hachem C. Barrett's Esophagus. Mo Med. 2018 May-Jun;115(3):211-213. PMID: 30228724. PubMed
  11. Hampel H, Abraham NS and El-Serag HB. Meta-analysis: Obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 2005; 143: 199-211. PubMed
  12. Pandolfino JE. Helicobacter pylori and gastroesophageal reflux disease. UpToDate, last updated Jan 28, 2020. UpToDate
  13. DeVault KR, Castell DO, American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005; 100:190. PubMed
  14. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101:1900. PubMed
  15. Johnsson F, Hatlebakk JG, Klintenberg AC et al. One-week esomeprazole treatment: an effective confirmatory test in patients with suspected gastroesophageal reflux disease. Scand J Gastroenterol 2004; 38: 354-9. PubMed
  16. Vakil NB, Traxler B, Levine D. Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment. Clin Gastroenterol Hepatol 2004; 2: 665. PubMed
  17. American Lung Association Asthma Clinical Research Centers, Mastronarde JG, Anthonisen NR, et al. Efficacy of esomeprazole for treatment of poorly controlled asthma. N Engl J Med. 2009;360:1487-1499. PubMed
  18. Harvey RF, Lane JA, Murray LJ, et al. Randomised controlled trial of effects of helicobacter pylori infection and its eradication on heartburn and gastro-oesophageal reflux: Bristol helicobacter project. BMJ 2004; 328: 1417-9. British Medical Journal
  19. Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. Gastroenterology 2008; 135: 1383-91. Gastroenterology
  20. Wang WH, Huang JQ, Zheng GF, et al. Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain?: a meta-analysis. Arch Intern Med 2005; 165: 1222-8. PubMed
  21. Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V. Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol 2008; 103: 267-75. PubMed
  22. Wiener GJ, Morgan TM, Copper JB, Wu WC, Castell DO, Sinclair JW, et al. Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci 1998; 33:1127-33. PubMed
  23. Katz PO, et al. Guidelines for the diagnosis and management of gastroesophageal reflux disease published correction appears in Am J Gastroenterol. 2013;108(10): 1672. Am J Gastroenterol. 2013;108(3):308–328.
  24. Zuckerman MJ, Carrion AF. Gastro-oesophageal reflux disease. BMJ Best Practice, last updated 26 Nov, 2019. bestpractice.bmj.com
  25. Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. UpToDate, last updated Apr 01, 2020. UpToDate
  26. Epstein D, Bojke L, Sculpher MJ. The reflux trial group. Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: a cost effectiveness study. BMJ 2009; 338: b2576. BMJ (DOI)
  27. Grant AM, Boachie C, Cotton SC, et al. Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease: 5-year follow-up of multicentre randomised trial (the REFLUX trial). Health Technol Assess 2013 Jun;17(22):1-167. doi: 10.3310/hta17220. DOI
  28. Galømiche J-P, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazol treatment for chronic GERD. JAMA 2011; 305: 1969-77. Journal of the American Medical Association
  29. Xie Y, Bowe B, Yan Y, et al. Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study. BMJ 2019; 365: l1580. PMID: 31147311 PubMed
  30. Hatlebakk JG. Behandling av gastroøsofageal refluks hos gravide. Tidsskr Nor Lægeforen 2004; 124: 797-8. PubMed
  31. Phupong V, Hanprasertpong T. Interventions for heartburn in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011379.pub2 Cochrane (DOI)
  32. Matok I, Gorodischer R, Koren G et al. The safety of H(2)-blockers use during pregnancy. J Clin Pharmacol 2010; 50(1): 81-7. pmid:19789371 PubMed
  33. Gill SK, O'Brien L, Einarson TR, Koren G. The safety of proton pump inhibitors (PPIs) in pregnancy: a meta-analysis. Am J Gastroenterol 2009; 104(6): 1541. pmid:19491869 PubMed
  34. Hatlebakk JG, Emken BE, Glazkov V, Hoff DA, Hausken T. Correct use of proton pump inhibitors for gastro-oesophageal reflux disease. Tidsskr Nor Laegeforen 2013; 133: 43-46. pmid:23306993 PubMed
  35. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28. PubMed
  36. Sigterman KE, van Pinxteren B, Bonis PA, Lau J, Numans ME. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD002095. DOI: 10.1002/14651858.CD002095.pub5. DOI
  37. Veldhuyzen van Zanten SJ, Chiba N, Armstrong D et al. A randomized trial comparing omeprazole, ranitidine, cisapride or placebo in helicobacter pylori negative primary care patients with dyspepsia: the CADET-HN study. Am J Gastroenterol 2005; 100: 1489-90. PubMed
  38. Teng M, Khoo AL, Zhao YJ et al. Meta-analysis of the effectiveness of esomeprazole in gastroesophageal reflux disease and Helicobacter pylori infection. J Clin Pharm Ther. 2015;40(4):368-75 PubMed
  39. Pace F, Tonini M, Pallotta S, Molteni P, Porro GB. Systematic review: maintenance treatment of gastro-oesophageal reflux disease with proton pump inhibitors taken `on-demand` Aliment Pharmacol Ther 2007; 26: 195-204.
  40. Song H, Zhu J, Lu D. Long-term proton pump inhibitor (PPI) use and the development of gastric pre-malignant lesions. Cochrane Database of Syst Rev 2014; 12: CD010623. doi:10.1002/14651858.CD010623.pub2 DOI
  41. Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017 Mar;152(4):706-15. PubMed
  42. Kiljander TO, Junghard O, Beckman O, Lind T. Effect of esomeprazole 40 mg once or twice daily on asthma: a randomized, placebo-controlled study. Am J Respir Crit Care Med 2010; 181: 1042-8. PubMed
  43. Chang AB, Lasserson TJ, Kiljander TO, Connor FL, Gaffney JT, Garske LA. Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux. BMJ 2006; 332: 11-14. British Medical Journal
  44. Trondsen E, Johannessen HO, Buanes T, Ræder J. Dagkirurgisk laparoskopisk fundoplikasjon for gastro- øsofageal reflukssykdom. Tidsskr Nor Lægeforen 2002; 122: 2692-5. PubMed
  45. Maret-Ouda J, Wahlin K, El-Serag HB, et al. Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux. JAMA 2017; 318: 939-46. pmid:28898377 PubMed
  46. Grant AM, Wileman SM, Ramsay CR, et al, for the REFLUX Trial Group. Minimal access surgery compared with medical management for chronic gastro-oesophageal reflux disease: UK collaborative randomised trial. BMJ 2008; 337: a2664. PubMed
  47. Grant AM, Cotton SC, Boachie C, et al. Minimal access surgery compared with medical management for gastro-oesophageal reflux disease: five year follow-up of a randomised controlled trial (REFLUX). BMJ 2013; 346: f1908. doi:10.1136/bmj.f1908 DOI
  48. Gögenur I, Øberg E, Bisgaard T, Rosenberg J. Endoskopisk behandling af gastroøsofageal reflukssygdom. Ugeskr Læger 2005; 167: 2869-74. PubMed
  49. American Lung Association Asthma Clinical Research Centers, Mastronarde JG, Anthonisen NR, et al. Efficacy of esomeprazole for treatment of poorly controlled asthma. N Engl J Med. 2009 Apr 9;360(15):1487-99. PubMed
  50. Chang AB, Lasserson TJ, Kiljander TO, et al. Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux. BMJ 2006; 332: 11-7. PubMed
  51. Maret-Ouda J, Wahlin K, Artama M, et al. Risk of Esophageal Adenocarcinoma After Antireflux Surgery in Patients With Gastroesophageal Reflux Disease in the Nordic Countries. JAMA Oncology 2018. doi:10.1001/jamaoncol.2018.3054 DOI
  52. Panzuto F, Di GE, Capurso G et al. Large hiatal hernia in patients with iron deficiency anaemia: a prospective study on prevalence and treatment. Aliment Pharmacol Ther 2004; 19: 663-70. PubMed
  53. Spechler SJ. Managing Barrett's oesophagus. BMJ 2003; 326: 892-4. British Medical Journal
Annonse
Annonse