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Magesår forårsaket av NSAIDs: Forebygging

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Pasienter som skal bruke NSAIDs, blir advart mot at slike medisiner kan forårsake mageplager. Det er derfor fornuftig å ta disse tablettene i forbindelse med måltid. Da vil de i mindre grad kunne skade slimhinnen. Du vil også få beskjed om å stanse behandlingen og ta kontakt med lege dersom du får plagsomme magesmerter. Vanligvis er risikoen for å få magesår liten ved kortvarige kurer på 1-2 uker. Jo lengre kuren varer og jo høyere dose, jo større er risikoen for magesår.

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Revmatikere vil kunne være avhengige av å ta NSAIDs fast for å kontrollere den revmatiske sykdommen. Dersom en slik pasient har fått magesår, må vedkommende få beskyttende medisin hvis behandlingen med NSAID skal fortsette. Det finnes ulike alternativer, men hyppigst brukes magesårsmedisiner - dobbel dose H2-blokker eller protonpumpehemmer.

Husk at kombinasjonen av et NSAID og et SSRI-middel (antidepressivum) er ekstra belastende på slimhinnen i magesekken og kan forårsake blødende magesår.

Vil du vite mer

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

  1. Fashner J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection. Am Fam Physician 2015; 91(4): 236-242. www.aafp.org
  2. Lanas A, Chand FKL. Peptic ulcer disease. Lancet 2017; 390: 613–24. doi:10.1016/ S0140-6736(16)32404-7
  3. Aro P, Storskrubb T, Ronkainen J, et al. Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study. Am J Epidemiol 2006; 163: 1025-34. American Journal of Epidemiology
  4. 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
  5. Lee Lynch K. Peptic ulcer disease. BMJ Best Practice, last updated 10 Sep 2020. bestpractice.bmj.com
  6. Vakil NB. Epidemiology and etiology of peptic ulcer disease. UpToDate, last updated Sep 19, 2017. UpToDate
  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. 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
  10. Nasjonale retningslinjer: Antibiotika i sykehus. Ulcussykdom. Helsedirektoratet. Sist faglig oppdatert 08. januar 2018. www.helsedirektoratet.no
  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. 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
  13. 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. New England Journal of Medicine
  14. Anand BS. Peptic ulcer disease. Medscape, last updated Oct 03, 2018. emedicine.medscape.com
  15. Martinez JP, Mattu A. Abdominal pain in the elderly. Emerg Med Clin North Am 2006; 24: 371-88. PubMed
  16. Hirschl AM, Makristathis A. Methods to detect Helicobacter pylori: From culture to molecular biology. Helicobacter 2007; 12(Suppl. 2): 6-11.
  17. Megraud F, Lehours P. Helicobacter pylori detection and antimicrobial susceptibility testing. Clin Microbiol Rev 2007; 20: 280-322. PubMed
  18. Calvet X, Ramirez-Lázaro MJ, Montserrat A, et al. Comparative accuracy of 3 monoclonal stool tests for diagnosis of Helicobacter pylori infection among patients with dyspepsia. Clin Infect Dis 2010; 50: 323-8. PubMed
  19. Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112:212-239. PubMed
  20. Lassen AT, Hallas J, Schaffalitzky de Muckadell OB. Helicobacter pylori test and eradicate versus prompt endoscopy for management of dyspeptic patients: 6.7 year follow-up of a randomsed trial. Gut 2004; 53: 1758-63. Gut
  21. Jarbol DE, Kragstrup J, Stovring H, Havelund T, Schaffalitzky de Muckadell OB. Proton pump inhibitor or testing for Helicobacter pylori as the first step for patients presenting with dyspepsia? A cluster randomized trial. Am J Gastroenterol 2006; 101: 1200-8. PubMed
  22. Ford AC, Gurusamy KS, Delaney B, et al. Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive people. Cochrane Database Syst Rev. 2016;(4):CD003840. Cochrane (DOI)
  23. Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F. Meta-analysis: Duration of first-line proton-pump inhibitor-based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007; 147: 553-62. Annals of Internal Medicine
  24. 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. Cochrane (DOI)
  25. Larsen AL, Ragnhildstveit E, et al. Resistance rates of metronidazole and other antibacterials in Helicobacter pylori from previously untreated patients in Norway. APMIS 2013; 121(4): 353-8 PubMed
  26. 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
  27. 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.
  28. Chan FKL, Ching JYL, Hung LCT. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005; 352: 238-44. PubMed
  29. Sanabria A, Villegas MI, Morales Uribe CH. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD004778. DOI: 10.1002/14651858.CD004778.pub3 DOI
  30. Zeng M, Mao X-H, Li J-X, et al. Efficacy, safety, and immunogenicity of an oral recombinant Helicobacter pylori vaccine in children in China: A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015. doi: 10.1016/S0140-6736(15)60579-7 DOI
  31. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152: 101-13. PubMed
  32. Würtz M, Grove EL, Kristensen SD, Hvas A-M. The antiplatelet effect of aspirin is reduced by proton pump inhibitors in patients with coronary artery disease. Heart 2009; e-pub: PMID:19910291. PubMed
  33. Niv Y. H pylori recurrence after successful eradication. World J Gastroenterol. 2008 Mar 14;14(10):1477-8. PMID: 18330934. PubMed
  34. Lau JY, Sung J, Hill C, et al. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion 2011; 84:102. PubMed
  35. Forsmo HM, Vandvik PO, Glomsaker T. Ulcus perforatum - et 12-årsmateriale. Tidsskr Nor Lægeforen 2005; 125: 1822-4. Tidsskrift for Den norske legeforening
  36. Thorat MA, Cuzick J. Prophylactic use of aspirin: systematic review of harms and approaches to mitigation in the general population. Eur J Epidemiol 2015; 30:5. PubMed
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