Isifo se-gastric esophageal reflux (GerD) yisifo esivamile emnyangweni wokugaya ukudla. Ukusabalala kwaso kanye nokubonakaliswa kwaso okuyinkimbinkimbi kwezokwelapha kunomthelela omkhulu ezingeni lempilo yeziguli. Futhi ukuvuvukala okungapheli komphimbo kunengozi yokubangela umdlavuza womphimbo. Indlela yokuxilonga kahle nokwenza ukwelashwa kube ngokwejwayelekile yiyona nto egxile emsebenzini wezokwelapha.
02 Izimpawu zemitholampilo ze-GERD
I-GERD ingahlukaniswa ibe yi-non-eroded reflux (NERD), i-reflux esophagitis (RE) kanye ne-Barreta esophageal (BE) ngokwe-endoscopy.
I-NERD: I-Barrett esophagus kanye ne-clear esophageal mucosa zonakele encazelweni ye-Gerd kodwa i-endoscopy yonakele.
Re: I-Endoscopy ingabona i-mucosa yesisu-yomsoco exhunywe ku-esophagus noma ngaphezulu. I-mucous membrane yonakala ngezikhathi ezithile.
BE: Ingxenye ye-epithelial yesisu ne-esophagus ye-epithelium efana ne-esophagus yokuxhumana kwe-esophagus ku-endoscopy ithathelwa indawo yi-epithelium esilinda.
02 Izimpawu zemitholampilo ze-GERD
Ngaphezu kokushisa kwenhliziyo kanye nokuhlanza, izimpawu ezifana nobuhlungu besifuba, ubuhlungu besisu esingaphezulu, kanye nomphimbo omangalisayo, ukukhwehlela, i-asthma kanye nezinye izimpawu zomphimbo zingase zibe khona.
Kufanele kuqashelwe ukuthi iziguli ezineziguli ze-GerD ezindala zinezinga eliphansi lesifo senhliziyo kanye ne-reflux. Izinga lezimpawu emgudwini wokukhipha liphezulu. Izimpawu azivamile, noma azibonakali ngisho nakancane. Ubunzima bezimpawu abufani nobunzima besifo. I-Factory Guiyu yayiyisicaba, futhi ngesikhathi esengudokotela, yakhulela eGuangli.
03 Ukuxilongwa kwe-GERD
Isibalo. Izimpawu ezijwayelekile ze-GerD kanye nezimpawu ezingavamile zomgudu wokugaya ukudla ongaphezulu zihlushwa ishadi lokugeleza kokuxilonga i-GERD Umthombo: I-Chinese Medical Association
Ukuhlolwa kokuxilonga kwe-ejenti yokucindezela i-asidi
Ezigulini ezisolisayo (i-PPI esetshenziswa njalo), umthamo ojwayelekile uzohlala amasonto ama-2 (labo abanezimpawu ezingaphandle kwepayipi kudingeka bahlale amasonto angu-≥4). Uma izimpawu ziphela ngokuphelele noma kutholakale ukuthi izimpawu ezincane ziyasebenza.
2) I-Endoscopic
-Re -ILos Angeles ihlukaniswe ngamamaki (bheka isithombe esingezansi):
Isigaba A: Umonakalo we-mucosal womqala ongu-1 noma ngaphezulu, ubude bomonakalo obungu-≤5 mm;
Ibanga B: Umonakalo owodwa noma ngaphezulu wolwelwesi lomphimbo, ubude bomonakalo obungaphezu kuka-5 mm, umonakalo wolwelwesi lomuthi kanye nokungabikho kokuhlangana;
Isigaba C: Okungenani ama-mucosa amabili omphimbo onakele, kanti ulwelwesi lwama-mucous lonakele luhlanganiswe ndawonye.
Isigaba D: Sibhekisela ekulimaleni kwe-mucosa kanye nokuhlanganiswa komunye nomunye, futhi ububanzi bokuhlangana buyi-75% yomphimbo.
Isu le-biopsy le-BE: Kunconywa ukuthi kube ne-biopsy yezikhawu eziningi nezifushane, futhi i-biopsy itholakala ngesikhawu esingu-1cm nxazonke kwesitofu. Ubukhulu bebanga buhlobene nengozi yomdlavuza, futhi ingozi yomdlavuza iyanda futhi ikhulisa ububanzi obungu-3cm.
3) Ukulinganisa umphimbo okunesisombululo esiphezulu
Iziguli ezine-GerD zivame ukubonakala njengokungasebenzi kahle kwamandla omphimbo: isilinganiso se-70% noma isilinganiso sokuhluleka kwe-peristalsis esingu-70% noma i-peristalsis singu-≥50%.
Ukuqapha okulwa nogesi
Yindinganiso yokuxilonga i-CEDD. Yindinganiso yegolide yokuxilonga i-GERD, okuhlanganisa ukuqapha inani le-NH ye-esophagus kanye nokuqapha inani le-NH le-esophagus pipe ye-NH kanye nokuqapha inani le-NH le-esophagus yang. Iphesenti le-pH <4 (isikhathi sokuchayeka kwe-asidi, i-AET)> 4% ku-24H, kubhekwa ukuthi kukhona i-pathological acid reflux.
04 Ukwelashwa kwe-GERD
Umfanekiso .Ishadi lokugeleza kokwelashwa kukaGerd
Umthombo: Inhlangano Yezokwelapha YaseShayina
Izinyathelo zokuzivikela:
I-PPI kanye ne-P-CAB yizona ezikhethwa kuqala ekwelashweni nasekunakekelweni kokuqala kweziguli ezine-Gard. Ukwelashwa kokuqala kokwelashwa kwe-PPI kungamasonto ayi-8 kanti ukwelashwa kwe-P-CAB kungamasonto angu-≥4.
-Kubantu abanezinkinga ebusuku (lapho uthatha i-PPI, i-pH <4 time> 1H ebusuku), ungasebenzisa ama-H2 receptor blockers ngaphambi kokulala ngokusekelwe ekwelashweni kwe-PPI, noma ushintshele ku-P-CAB kanye nokwelashwa kwe-PPI okuhlala isikhathi eside.
-I-anti-acid agent kanye nemithi esebenzayo yokugaya ukudla ingasetshenziswa ukusetshenziswa kwesikhashana ukuze kuncishiswe ngokushesha izimpawu zokungakhululeki njengokushisa kwenhliziyo kanye nokubuyela emuva kwesisu.
-Isibonakaliso sokwelashwa nge-endoscopic: Ukuxilongwa kwe-GERD kucacile, ukwelashwa okune-asidi akuvumelekile, ukungathandi ukuthatha imithi isikhathi eside, noma ukusabela okubi okuhlobene nemithi, futhi akukwazi ukubekezelela.
-Isibonakaliso sokwelashwa ngokuhlinzwa: kunezimpawu ezijwayelekile ze-GerD, ukwelashwa kwe-PPI akuvumelekile; i-endoscopy ithola i-hernia yomphimbo, i-BE, i-RE, amamaki aseLos Angeles noma ngaphezulu; Ukuhlolwa kwe-X-ray kuthole ukuthi kukhona i-hernia yomphimbo.
Isikhathi sokuthunyelwe: Mashi-21-2024