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.

Sist oppdatert:
6. nov. 2020
Hva er brystbrannsykdom?
Magesekk med refluxproblemerBrystbrann 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.
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.
Vil du vite mer
Dette dokumentet er basert på det profesjonelle dokumentet Gastroøsofageal reflukssykdom . Referanselisten for dette dokumentet vises nedenfor
- 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.
- Katzka DA, Kahrilas PJ. Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ. 2020 Nov 23;371:m3786. PMID: 33229333. PubMed
- 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
- Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastrooesophageal reflux disease: a systematic review. Gut 2005; 54: 710-7. Gut
- Essilfie I, Lihaug Hoff DA, Hatlebakk JG. Behandling av gastroøsofageal reflukssykdom. Tidsskr Nor Lægeforen 2007; 127: 3082-4. PubMed
- Sifrim D. Relevance of volume and proximal extent of reflux in gastro-oesophageal reflux disease. Gut 2005; 54: 175-8. Gut
- 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)
- 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
- Kahrilas PJ. Clinical manifestations and diagnosis of gastroesophageal reflux in adults. UpToDate, last updated Jan 28, 2020. www.uptodate.com
- Bujanda DE, Hachem C. Barrett's Esophagus. Mo Med. 2018 May-Jun;115(3):211-213. PMID: 30228724. PubMed
- 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
- Pandolfino JE. Helicobacter pylori and gastroesophageal reflux disease. UpToDate, last updated Jan 28, 2020. UpToDate
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.
- Zuckerman MJ, Carrion AF. Gastro-oesophageal reflux disease. BMJ Best Practice, last updated 26 Nov, 2019. bestpractice.bmj.com
- Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. UpToDate, last updated Apr 01, 2020. UpToDate
- 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)
- 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
- 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
- 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
- Hatlebakk JG. Behandling av gastroøsofageal refluks hos gravide. Tidsskr Nor Lægeforen 2004; 124: 797-8. PubMed
- Phupong V, Hanprasertpong T. Interventions for heartburn in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011379.pub2 Cochrane (DOI)
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- Trondsen E, Johannessen HO, Buanes T, Ræder J. Dagkirurgisk laparoskopisk fundoplikasjon for gastro- øsofageal reflukssykdom. Tidsskr Nor Lægeforen 2002; 122: 2692-5. PubMed
- 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
- 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
- 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
- Gögenur I, Øberg E, Bisgaard T, Rosenberg J. Endoskopisk behandling af gastroøsofageal reflukssygdom. Ugeskr Læger 2005; 167: 2869-74. PubMed
- 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
- 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
- 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
- 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
- Spechler SJ. Managing Barrett's oesophagus. BMJ 2003; 326: 892-4. British Medical Journal