Isifo se-gastric esophageal reflux sifo (Gerd) yisifo esivamile emnyangweni wokugaya ukudla. Ukwanda kwayo kanye nokubonakaliswa okuyinkimbinkimbi kwemitholampilo kuba nomthelela omkhulu kwikhwalithi yempilo yeziguli. Futhi ukuvuvukala okungapheli kwe-esophagus kunengozi yokubangela umdlavuza we-esophageal. Ungathola kanjani ngokunembile futhi ulinganise ukwelashwa kugxilwe emsebenzini wemitholampilo.
02 Ukubonakaliswa Kwemitholampilo Ka-Gerd
I-Gerd ingahlukaniswa ibe yi-noroded reflux (NDD), i-Reflux Esophagitis (Re) neBarreta Esophageal (be) ngokuya nge-endoscopy.
UNerd: UBarrett Esophagus kanye ne-Sucre Esophageal Mucosa ilinyazwe encazelweni ye-GERD kepha i-endoscopy yonakele.
Re: endoscopy angabona i-mucosa yesisu-esophageal exhunywe kwi-esophagus noma ngaphezulu. Ulwelwesi lwe-mucous lulimele ngezikhathi ezithile.
Yiba: Ingxenye ye-esophageal-esophageal squamous epithelial ye-esophagus-like epithelium ye-esophagus uxhumano e-endoscopy ithathelwa indawo yi-cylindrical epithelium.
02 Ukubonakaliswa Kwemitholampilo Ka-Gerd
Ngaphezu kwenhliziyo evuthayo kanye nokuphindaphinda, izimpawu ezifana nobuhlungu besifuba, ubuhlungu besisu obungenhla, kanye ne-esophagus eyisimangaliso, ukukhwehlela, i-asthma nezinye izimpawu ze-esophageal kungenzeka.
Kumele kwaziwe ukuthi iziguli ezineziguli ezindala ze-GERD zinesibalo esiphansi senhliziyo ne-Reflux. Izigameko zezimpawu eshubhu expression ziphezulu. Izimpawu azijwayelekile, noma i-asymptomatic. Ubulukhuni bezimpawu abufani nobulukhuni besifo. Ifektri Guiyu yayiyisicaba, kwathi lapho ingudokotela, yathuthukiswa eGuangli.
03 Ukuxilongwa kukaGerd
Umfanekiso. Izimpawu ezijwayelekile ze-Gerd kanye nezimpawu zokugaya ukudla okuphezulu kwe-atypical zihlushwa i-Gerd Diagnostic Flowchart Source: Chinese Medical Association
Ukuhlolwa kokuxilonga kwe-Agent Yokucindezela i-Acid
Ezigulini ezisolisayo ze-Gerd (i-PPI esetshenziswayo), umthamo ojwayelekile uzohlala amasonto ama-2 (lezo ezinezimpawu ezingaphandle kweshubhu kudingeka uqhubeke amasonto ama-≥4). Uma izimpawu zikhululeke ngokuphelele noma zine-munye kuphela izimpawu ezimnene kuphela kufakazelwa ukuthi zisebenza kahle.
2) endoscopic
-Re -los Angeles ihlukaniswe ngamamaki (bona isithombe esingezansi):
I-Class A: 1 noma ngaphezulu ukulimala kwe-mucosal umonakalo, ubude bomonakalo ≤5 mm;
Ibanga B: 1 noma ngaphezulu more esophageal mucosal umonakalo, ubude bomonakalo> 5 mm, umonakalo we-mucous membrane futhi akukho fusion;
I-Class C: Okungenani i-2 esophageal mucosa ilimele, futhi ulwelwesi lwe-mucous kulimele kuhlanganiswe.
I-Class D: isho ukulimala kwe-mucosa kanye nokuhlanganiswa komunye, futhi uhla lwe-Fusion lungama-75% we-esophagus.
Isu le-Biopsy: Kunconywa ukuthi kunesikhashana esiningi nesifushane se-biopsy, futhi i-biopsy itholakala ngokuphumula okungu-1cm esitofu. Ubukhulu bebanga buhlobene nengozi yomdlavuza, futhi ubungozi bomdlavuza bukhula futhi bandisa uhla lwe-3cm.
3) Ukulinganisa okuphezulu kwe-esophageal
Iziguli ezine-GERD zivame ukubonakala njengamandla we-esophageal engasebenzi: inani elingu-70% noma i-peristals ukwehluleka kwezilinganiso ezingama-70% noma i-peristalsis i-≥50%.
Ukuqapha oku-anti -curve
Kuyindinganiso yokuxilongwa kwe-CEDD. Kuyindinganiso yegolide yokuxilongwa kwe-GERD, kufaka phakathi ukuqapha kwenani le-esophagus NH kanye ne-Esophageal Yang anti -n-Value Monitoring ye-Esophagus Pipe Coundel ne-Esophageal Yang anti -nh Inani lokuhlola. Amaphesenti we-PH <4
04 Ukwelashwa kwe-Gerd
Umdwebo we-Flowchart we-Flowchart
Umthombo: Chinese Medical Association
Izinyathelo zokuzivikela:
-Ppi ne-P-cab ukukhetha kokuqala kokwelashwa kokuqala nokulungiswa kweziguli ngeGard. Ukwelashwa kokuqala kokwelashwa kwe-PPI kumaviki ayi-8 kanti ukwelashwa kwe-P-Cab kungamaviki angu-≥.
-Ngokugula ngeziguli ezinempumelelo ebusuku (lapho uthatha i-PPI, isikhathi se-PH <1 Ukwelashwa kwe-Half -life PPI.
-I-Anti -ASID Agent kanye nezidakamizwa ezisebenzayo zesisu zingasetshenziselwa uhlelo lokusebenza olufushane ukunciphisa ngokushesha izimpawu zokungakhululeki okufana nenhliziyo evuthayo ne-Reflux.
-Inkomba yokwelashwa e-endoscopic: Ukuxilongwa kwe-Gerd kucacile, ukwelashwa kwe-acid kuvumelekile, akuthandi ukuphuza umuthi isikhathi eside, noma ukusabela okuphikisayo okuhlobene nezidakamizwa, futhi akunakubekezelela.
Inkomba yokuhlinza yokuhlinza - -Surgical: Kunezimpawu ezijwayelekile ze-Gerd, ukwelashwa kwe-PPI akuvumelekile; I-Endoscopy ithola i-esophageal hernia, yiba, re, amabanga e-los angeles noma ngaphezulu; Uhlolo lwe-X -rray luthola ukuthi kukhona i-esophageal hole hernia.
Isikhathi Sokuthumela: Mar-21-2024