Isifo se-gastric esophageal reflux (GerD) sisifo esiqhelekileyo kwisebe lokwetyisa.Ukuxhaphaka kwayo kunye nokubonakaliswa kweklinikhi eyinkimbinkimbi kunempembelelo enkulu kumgangatho wobomi bezigulane.Kwaye ukudumba okungapheliyo kommizo kunomngcipheko wokubangela umhlaza wommizo.Indlela yokuxilonga ngokuchanekileyo kunye nokulinganisa unyango lugxininiso lomsebenzi wekliniki.
02 Ukubonakaliswa kweklinikhi ye-GERD
I-GERD inokohlulwa ibe yi-reflux engekho-roded (NERD), i-reflux esophagitis (RE) kunye ne-Barreta esophageal (BE) ngokwe-endoscopy.
I-NERD: I-Barrett esophagus kunye ne-esophageal mucosa ecacileyo yonakele kwinkcazo yeGerd kodwa i-endoscopy yonakalisiwe.
Impendulo: I-Endoscopy inokubona i-mucosa yesisu-esophageal edityaniswe nommizo okanye ngaphezulu.I-membrane ye-mucous yonakaliswa ngokukhawuleza.
I-BE: I-gastric-esophageal squamous epithelial ye-epithelium efana ne-epithelium yoqhagamshelwano lomqalazo kwi-endoscopy ithathelwa indawo yi-cylindrical epithelium.
02 Ukubonakaliswa kweklinikhi ye-GERD
Ukongeza kwintliziyo evuthayo kunye ne-reflux, iimpawu ezinjengeentlungu zesifuba, iintlungu zesisu esiphezulu, kunye ne-esophagus engummangaliso, ukukhohlela, i-asthma kunye nezinye iimpawu ze-esophageal zingenzeka.
Kufuneka kuqatshelwe ukuba izigulane ezinezigulane ezikhulileyo zeGerD zineziganeko eziphantsi zentliziyo kunye ne-reflux.Iziganeko zeempawu kwi-extractive tube ziphezulu.Iimpawu aziqhelekanga, okanye zingabonakali.Ubunzima beempawu abuhambelani nobunzima besifo.Umzi-mveliso uGuiyu wawuthe tyaba, yaye xa wayengugqirha, waphuhliswa eGuangli.
03 Ukuxilongwa kwe-GERD
Umzobo.Iimpawu eziqhelekileyo zeGerD kunye neempawu zephecana eliphezulu lokwetyisa linengxaki ye-GERD yokuxilonga itshati Umthombo: Umbutho wezoNyango waseTshayina
Uvavanyo lokuxilonga lwe-agent yokunciphisa i-asidi
Kwizigulane zegerd ezikrokrelayo (ezisetyenziswa ngokuqhelekileyo i-PPI), i-dosage esemgangathweni iya kuhlala kwiiveki ze-2 (ezo zineempawu ezingaphandle kwe-tube kufuneka zihlale ≥4 iiveki).Ukuba ngaba iimpawu ziphelile ngokupheleleyo okanye inye kuphela impawu ethambileyo engqiniweyo ukuba iyasebenza.
2) I-Endoscopic
-Re -Los Angeles yahlulwe ngokwamabanga (jonga umfanekiso ongezantsi):
Iklasi A: I-1 okanye ngaphezulu umonakalo we-esophageal mucosal, ubude bomonakalo ≤5 mm;
IBakala B: I-1 okanye ngaphezulu umonakalo we-esophageal mucosal, ubude bomonakalo> 5 mm, umonakalo we-mucous membrane kwaye akukho fusion;
Iklasi C: Ubuncinci i-2 esophageal mucosa yonakaliswe, kwaye i-membrane ye-mucous yonakaliswe idibaniswe kunye nomnye.
Iklasi D: Ibhekisela kumonakalo we-mucosa kunye nokuhlanganiswa komnye nomnye, kwaye uluhlu lwe-fusion luyi-75% ye-esophagus.
-BE isicwangciso se-biopsy: Kucetyiswa ukuba kubekho i-multiple kunye ne-interval biopsy, kwaye i-biopsy ifunyenwe nge-1cm interval malunga nesitovu.Ubungakanani boluhlu lunxulumene nomngcipheko womhlaza, kwaye umngcipheko womhlaza uyanda kwaye ukhulisa uluhlu lwe-3cm.
I-3)Umlinganiselo ophezulu we-esophageal
Izigulane ezineGerD zihlala zibonakala njengamandla angasebenziyo wommizo: umlinganiselo we-70% okanye ukusilela kwe-peristalsis kwe-70% okanye i-peristalsis yi-≥50%.
Ukujongwa okuchaseneyo
Ngumgangatho wokuxilongwa kwe-CEDD.Ngumgangatho wegolide wokuxilongwa kwe-GERD, kubandakanywa ukubeka iliso kwixabiso le-esophagus NH kunye ne-esophageal yang anti -NH ixabiso lokuhlola umbhobho wommizo we-NH ixabiso kunye ne-esophageal yang anti -NH ixabiso lokuhlola.Ipesenti ye-pH <4 (ixesha lokuvezwa kwe-asidi, i-AET)> 4% kwi-24H, kucatshangelwa ukuba kukho i-pathological acid reflux.
04 unyango lweGERD
Umfanekiso .Itshati yonyango lukaGerd
Umthombo: Umbutho wezoNyango waseTshayina
Ukulumkela:
-PPI kunye ne-P-CAB zikhetho lokuqala lonyango lokuqala kunye nokugcinwa kwezigulane ezine-Gard.Unyango lokuqala lonyango lwe-PPI ziiveki ezi-8 kwaye unyango lwe-P-CAB luyi-≥4 iiveki.
-Izigulane ezineempembelelo ebusuku (xa uthatha i-PPI, i-pH <4 ixesha> 1H ngobusuku bobusuku), ungasebenzisa i-H2 receptor blockers ngaphambi kokulala ngesiseko sonyango lwe-PPI, okanye utshintshe kwi-P-CAB kwaye ubude.Unyango lwe-PPI yesiqingatha sobomi.
-I-agent echasene ne-asidi kunye neziyobisi ezisebenzayo zesisu zingasetyenziselwa ukusetyenziswa kwexesha elifutshane lokunciphisa ngokukhawuleza iimpawu zokukhathazeka ezifana nokutshisa kwentliziyo kunye ne-reflux.
-Isibonakaliso sonyango lwe-endoscopic: Ukuxilongwa kwe-GERD kucacile, unyango lwe-acidic aluvumelekile, alufuni ukuthatha iyeza ixesha elide, okanye ukusabela okubi okunxulumene neziyobisi, kwaye ayikwazi ukunyamezela.
-Isalathisi sonyango lotyando: kukho iimpawu zeGerD eziqhelekileyo, unyango lwe-PPI aluvumelekanga;I-endoscopy ifumanisa i-esophageal hernia, i-BE, i-RE, amabakala aseLos Angeles okanye ngaphezulu;Uvavanyo lwe-X-reyi lufumanise ukuba kukho i-hernia yomngxuma wommizo.
Ixesha lokuposa: Mar-21-2024