NHG-Richtlijnen
NHG-Standaard
M36
5.2
Onlangs herzien
maart 2021
april 2025
D. Spijsverteringsorganen

Richtlijnen spoed

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Spoedeisende klachten en symptomen

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Lichamelijk onderzoek bij spoedeisende klachten en symptomen

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Beleid bij spoedeisende klachten en symptomen

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Richtlijnen diagnostiek

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Laboratoriumonderzoek

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Test op Helicobacter pylori

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Gastroduodenoscopie

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Evaluatie

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Richtlijnen beleid

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Beleid bij maagklachten bij NSAID-gebruik

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Beleid bij een eerste episode van maagklachten

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Voorlichting en niet-medicamenteuze behandeling

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Medicamenteus beleid eerste episode

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Beleid bij persisterende of recidiverende klachten

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Beleid na positieve H. pylori-test

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Beleid na gastroduodenoscopie

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Oesofagitis

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Ulcus duodeni

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Ulcus ventriculi

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Erosieve gastritis of bulbitis

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Geen verklarende bevindingen én refluxklachten

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Geen verklarende bevindingen én andere maagklachten dan refluxklachten

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Consultatie en verwijzing

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Stoppen of minderen van chronisch gebruik van zuurproductieremmers bij maagklachten

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Vooraf

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Voorlichting

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Afbouwschema

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Belangrijkste wijzigingen

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Kernboodschappen

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Inleiding

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Scope

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Buiten de scope

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Achtergronden

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Begrippen

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Maagklachten

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Maagcomplicaties

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Maagbescherming

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Geneesmiddelen bij maagklachten

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Epidemiologie

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Etiologie/pathofysiologie

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Maagzuur

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Reboundeffect na staken zuurproductieremmers

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Dieetfactoren, genotmiddelen en psychische factoren

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Reflux

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Ulcera

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Geneesmiddelen met maagbijwerkingen

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NSAID’s
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Bisfosfonaten en kaliumchloride
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Corticosteroïden
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Helicobacter pylori

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Maag- en slokdarmcarcinoom

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Overige risicofactoren
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Familiair maagcarcinoom
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PPI-gebruik en maagcarcinoom
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Beloop van maagklachten

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Richtlijnen spoed

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Spoedeisende klachten en symptomen

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Lichamelijk onderzoek bij spoedeisende klachten en symptomen

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Beleid bij spoedeisende klachten en symptomen

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Richtlijnen diagnostiek

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Laboratoriumonderzoek

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H. pylori-test

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Indicaties
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Keuze H. pylori-test
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Uitvoering H. pylori-test
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Controle na eradicatiebehandeling
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Gastroduodenoscopie

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Absolute indicatie
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Relatieve indicaties
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Risicoschatting
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Voorbereiding
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Evaluatie

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Onderscheid van maagklachten voor het te voeren beleid

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Differentiaaldiagnostische overwegingen

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Richtlijnen beleid

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Beleid bij maagklachten met alarmsymptomen voor maligniteit

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Beleid bij maagklachten bij NSAID-gebruik

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Maagklachten bij NSAID-gebruik algemeen

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Beleid bij maagklachten bij noodzakelijk NSAID-gebruik

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Beleid bij een eerste episode van maagklachten

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Algemeen

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Voorlichting en niet-medicamenteuze behandeling

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Thuisarts
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Medicamenteus beleid algemeen

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Medicamenteus beleid eerste episode

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Farmacogenetisch onderzoek
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Beleid bij persisterende of recidiverende klachten

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Beleid na positieve H. pylori-test

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Algemeen

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Voorlichting

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H. pylori-eradicatie: medicatie en controletest

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Beleid na gastroduodenoscopie

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Oesofagitis

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Ulcus duodeni

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Ulcus ventriculi

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Erosieve gastritis of bulbitis

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Geen verklarende bevindingen én refluxklachten

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Geen verklarende bevindingen én andere maagklachten dan refluxklachten

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Overwegingen
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Niet-medicamenteus beleid bij andere klachten dan refluxklachten
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Medicamenteus beleid bij andere klachten dan refluxklachten
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Antidepressiva bij functionele maagklachten
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Prokinetica bij functionele maagklachten
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Consultatie en verwijzing

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Beleid bij chronisch gebruik van zuurproductieremmers

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Achtergronden

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Aandachtspunten om onnodig chronisch gebruik te voorkomen

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Indicaties voor chronisch PPI-gebruik

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Beleid bij indicatie voor chronisch PPI-gebruik

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Oorzaken van maagklachten na stoppen met een PPI

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Bijwerkingen bij chronisch gebruik van PPI’s en H2-antagonisten

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Laboratoriumcontroles bij chronisch PPI-gebruik

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Stoppen of minderen van chronisch gebruik van zuurproductieremmers bij maagklachten

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Vooraf

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Voorlichting

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Afbouwschema

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Referenties

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Hooymans CD, Numans ME, Quartero AO, Smeink P, Van den Berg L, Van den Donk M, Van der Weele GM
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