Isifo se-gastric esophageal reflux disease (GerD) sisifo esiqhelekileyo kwicandelo lokugaya ukutya. Ukuxhaphaka kwaso kunye neempawu zaso ezintsonkothileyo zeklinikhi zinempembelelo enkulu kumgangatho wobomi bezigulane. Kwaye ukudumba okungapheliyo kwe-esophagus kunomngcipheko wokubangela umhlaza we-esophagus. Indlela yokuxilonga ngokuchanekileyo kunye nokulungelelanisa unyango yeyona nto iphambili kumsebenzi weklinikhi.
02 Iimpawu zeklinikhi zeGERD
I-GERD inokwahlulwa ibe yi-non-eroded reflux (NERD), i-reflux esophagitis (RE) kunye ne-Barreta esophageal (BE) ngokwe-endoscopy.
I-NERD: I-Barrett esophagus kunye ne-clear esophageal mucosa zonakele kwinkcazo ye-Gerd kodwa i-endoscopy yonakele.
Re: I-Endoscopy ingabona i-mucosa yesisu-yomsoco edibene ne-esophagus okanye ngaphezulu. I-mucous membrane yonakala ngamaxesha athile.
BE: Inxalenye ye-epithelial yesisu-esophageal ye-epithelium efana ne-esophagus yoqhagamshelwano lwe-esophagus kwi-endoscopy ithathelwa indawo yi-epithelium ye-cylindrical.
02 Iimpawu zeklinikhi zeGERD
Ukongeza ekutshiseni kwentliziyo kunye nokurhawuzelelwa kwesisu, iimpawu ezifana neentlungu zesifuba, iintlungu zesisu esingentla, kunye nokuphefumla okumangalisayo, ukukhwehlela, i-asthma kunye nezinye iimpawu zokuphefumla zinokwenzeka.
Kufuneka kuqatshelwe ukuba izigulana ezinezigulane zeGerD ezindala zinesifo sentliziyo esincinci kunye ne-reflux. Ubuninzi beempawu kwityhubhu yokukhupha buphezulu. Iimpawu aziqhelekanga, okanye azibonakali. Ubunzima beempawu abufani nobunzima besifo. IFactory Guiyu yayithe tyaba, kwaye xa wayengugqirha, wakhulela eGuangli.
03 Ukuxilongwa kwe-GERD
Umfanekiso. Iimpawu eziqhelekileyo ze-GerD kunye neempawu ezingaqhelekanga zendlela yokugaya engentla zichaphazeleka yitshati yokujonga i-GERD Umthombo: Umbutho Wezonyango waseTshayina
Uvavanyo lokuxilonga lwearhente yokucinezela i-asidi
Kwizigulane ezirhanelekayo (ezisetyenziswa rhoqo yi-PPI), idosi eqhelekileyo iya kuhlala iiveki ezi-2 (abo baneempawu ezingaphandle kombhobho kufuneka bahlale iiveki ezi-≥4). Ukuba iimpawu ziphelile ngokupheleleyo okanye kukho uphawu olunye oluncinci olufunyenwe lusebenza.
2) I-Endoskopu
-Re -ILos Angeles yahlulwe ngokwamanqanaba (jonga umfanekiso ongezantsi):
Udidi A: Umonakalo we-mucosal yomqala o-1 okanye ngaphezulu, ubude bomonakalo ≤5 mm;
Udidi B: Umonakalo omnye okanye ngaphezulu kwi-esophagus mucosal, ubude bomonakalo obungaphezulu kwe-5 mm, umonakalo kwi-mucous membrane kunye nokungabikho kokudibana;
Udidi C: Ubuncinane i-mucosa ezimbini zomqala zonakele, kwaye i-mucous membrane yonakele ixutywe.
Udidi D: Lubhekisa kumonakalo we-mucosa kunye nokudibana komnye nomnye, kwaye uluhlu lokudibana luyi-75% yomqala.
Icebo le-biopsy ye-BE: Kucetyiswa ukuba kubekho i-biopsy yexeshana eliphindaphindiweyo nelifutshane, kwaye i-biopsy ifunyanwa ngesithuba se-1cm esijikeleze isitovu. Ubungakanani boluhlu bunxulumene nomngcipheko womhlaza, kwaye umngcipheko womhlaza uyanda kwaye unyusa uluhlu lwe-3cm.
3) Umlinganiselo womqala ophezulu
Izigulane ezine-GerD zihlala zibonakala ngamandla angasebenziyo e-esophageal: umlinganiselo we-70% okanye umlinganiselo wokusilela kwe-peristalsis we-70% okanye i-peristalsis yi-≥50%.
Ukubeka esweni okuchasene nombane
Ngumgangatho oqhelekileyo wokuxilongwa kwe-CEDD. Ngumgangatho oqhelekileyo wokuxilongwa kwe-GERD, kubandakanya ukubekwa esweni kwexabiso le-NH ye-esophagus kunye nokubekwa esweni kwexabiso le-NH ye-esophagus pipe ye-NH kunye nokubekwa esweni kwexabiso le-NH ye-esophagus. Ipesenti ye-pH <4 (ixesha lokuvezwa yi-asidi, i-AET)> 4% kwi-24H, kucingelwa ukuba kukho i-pathological acid reflux.
04 Unyango lwe-GERD
Umfanekiso .Itshathi yohambo lonyango lukaGerd
Umthombo: Umbutho Wezonyango waseTshayina
Ukulumkela:
-PPI kunye ne-P-CAB zezona zikhetho zokuqala zonyango lokuqala kunye nokugcinwa kwezigulane ezine-Gard. Unyango lokuqala lonyango lwe-PPI luthatha iiveki ezi-8 kwaye unyango lwe-P-CAB luthatha iiveki ezi-≥4.
-Kwizigulane ezineengxaki zomphumo ebusuku (xa uthatha i-PPI, i-pH <4 time> 1H ebusuku), ungasebenzisa ii-H2 receptor blockers ngaphambi kokulala ngokusekelwe kunyango lwe-PPI, okanye utshintshele kwi-P-CAB kunye nonyango lwe-PPI oluhlala ixesha elide.
-I-arhente yokulwa ne-asidi kunye namayeza asebenzayo esisu angasetyenziselwa ukusetyenziswa okwethutyana ukunciphisa ngokukhawuleza iimpawu zokungakhululeki ezifana nokutshisa kwentliziyo kunye nokubuyela umva kwesisu.
-Isalathisi sonyango lwe-endoscopic: Ukuxilongwa kwe-GERD kucacile, unyango lwe-asidi alusebenzi, alufuni ukuthatha amayeza ixesha elide, okanye iimpendulo ezimbi ezinxulumene namayeza, kwaye alukwazi ukunyamezela.
-Isalathisi sonyango lotyando: kukho iimpawu eziqhelekileyo zeGerD, unyango lwe-PPI alusebenzi; i-endoscopy ifumana i-esophageal hernia, i-BE, i-RE, amanqanaba aseLos Angeles okanye ngaphezulu; Uvavanyo lwe-X-ray lufumanise ukuba kukho i-esophageal hole hernia.
Ixesha leposi: Matshi-21-2024