Isifo se-gastric esophageal reflux (GerD) yisifo esivamile emnyangweni wokugaya ukudla.Ukusabalala kwayo kanye nokubonakaliswa komtholampilo okuyinkimbinkimbi kunomthelela omkhulu eqophelweni lempilo yeziguli.Futhi ukuvuvukala okungapheli kommizo kunengozi yokubangela umdlavuza womminzo.Ukuxilonga ngendlela efanele kanye nokumisa ukwelashwa kugxile emsebenzini womtholampilo.
02 Ukubonakaliswa komtholampilo kwe-GERD
I-GERD ingahlukaniswa ibe i-reflux engagugi (NERD), i-reflux esophagitis (RE) ne-Barreta esophageal (BE) ngokuya nge-endoscopy.
I-NERD: I-Barrett esophagus kanye ne-clean esophageal mucosa konakele encazelweni ye-Gerd kodwa i-endoscopy yonakalisiwe.
I-Re: I-Endoscopy ingabona ulwelwesi lwesisu oluxhunywe kumminzo noma ngaphezulu.Ulwelwesi lwamafinyila lulimala ngezikhathi ezithile.
I-BE: Ingxenye ye-gastric-esophageal squamous epithelial ye-epithelium enjenge-esophagus yokuxhumana komminzo ku-endoscopy ithathelwa indawo yi-cylindrical epithelium.
02 Ukubonakaliswa komtholampilo kwe-GERD
Ngaphandle kokushisa kwenhliziyo kanye ne-reflux, izimpawu ezifana nobuhlungu besifuba, ubuhlungu besisu esingaphezulu, kanye ne-esophagus eyisimangaliso, ukukhwehlela, isifuba somoya kanye nezinye izimpawu zomphimbo zingase zenzeke.
Kufanele kuqashelwe ukuthi iziguli ezineGerD asebekhulile zinezigameko eziphansi zenhliziyo kanye ne-reflux.Izigameko zezimpawu ku-extractive tube ziphezulu.Izimpawu azijwayelekile, noma azibonakali.Ukuqina kwezimpawu akuhambisani nobukhulu besifo.I-Factory Guiyu yayiyisicaba, futhi lapho esengudokotela, yathuthukiswa eGuangli.
03 Ukuxilongwa kwe-GERD
Umfanekiso.Izimpawu ezijwayelekile ze-GerD kanye nezimpawu zepheshana eliphezulu lokugaya ukudla okungavamile zihlushwa ishadi lokuxilonga le-GERD Umthombo: I-Chinese Medical Association
Ukuhlolwa kokuxilonga kwe-ejenti yokucindezela i-asidi
Ezigulini ezisolisayo ze-gerd (i-PPI evame ukusetshenziswa), umthamo ojwayelekile uzohlala amaviki angu-2 (lezo ezinezimpawu ezingaphandle kweshubhu zidinga ukuhlala ≥4 amaviki).Uma izimpawu zehle ngokuphelele noma uphawu olulodwa kuphela oluthambile olubonakala lusebenza kahle.
2) Endoscopic
-Re -Los Angeles ihlukaniswe ngamamaki (bona isithombe esingezansi):
Ikilasi A: Ukulimala kwe-mucosal engu-1 noma ngaphezulu, ubude bokulimala ≤5 mm;
IBanga B: Ukulimala kwe-mucosal engu-1 noma ngaphezulu, ubude bokulimala> 5 mm, ukulimala kolwelwesi lwamafinyila futhi akukho ukuhlangana;
Isigaba C: Okungenani i-2 esophageal mucosa yonakalisiwe, futhi ulwelwesi lwamafinyila lonakele luhlanganiswe nomunye.
I-Class D: Ibhekisela emonakalweni we-mucosa nokuhlanganiswa komunye nomunye, futhi uhla lokuhlanganisa luyi-75% yomminzo.
-Isu le-biopsy: Kunconywa ukuthi kube ne-biopsy yesikhawu esiningi nesifushane, futhi i-biopsy itholwa ngesikhawu esingu-1cm eduze kwesitofu.Ubukhulu bebanga buhlobene nengozi yomdlavuza, futhi ingozi yomdlavuza iyanda futhi ikhulisa ububanzi obuyi-3cm.
I-3)Isilinganiso esiphezulu sommizo
Iziguli ezine-GerD zivame ukubonakala njengamandla omphimbo angasebenzi: ingxenye engu-70% noma isilinganiso sokuhluleka kwe-peristalsis esingu-70% noma i-peristalsis ingu-≥50%.
Ukuqapha okuphambene namanje
Kuyindinganiso yokuxilongwa kwe-CEDD.Kuyindinganiso yegolide yokuxilonga i-GERD, okuhlanganisa ukugadwa kwevelu ye-NH yomphimbo kanye nokuqapha ukubaluleka kwepayipi lomminzo le-NH kanye nokuqapha ukubaluleka kwe-yang anti -NH.Iphesenti le-pH <4 (isikhathi sokuchayeka kwe-asidi, AET)> 4% ku-24H, kubhekwa ukuthi kune-pathological acid reflux.
04 Ukwelashwa kwe-GERD
Umfanekiso .Ishadi eligeleza lokwelashwa likaGerd
Umthombo: Inhlangano Yezokwelapha YaseShayina
Izinyathelo zokuzivikela:
-I-PPI kanye ne-P-CAB yisinqumo sokuqala sokwelashwa kokuqala nokugcinwa kweziguli ezine-Gard.Ukwelashwa kokuqala kokwelashwa kwe-PPI amaviki angu-8 kanti ukwelashwa kwe-P-CAB kungamasonto angu-≥4.
-Ezigulini eziphumelele ebusuku (lapho uthatha i-PPI, i-pH <4 isikhathi> 1H ngobusuku bobusuku), ungasebenzisa i-H2 receptor blockers ngaphambi kokulala ngesisekelo sokwelashwa kwe-PPI, noma ushintshele ku-P-CAB futhi eside.Ukwelashwa kwe-PPI yesigamu sempilo.
-I-anti-acid ejenti kanye nezidakamizwa ezisebenza emathunjini zingasetshenziselwa ukusetshenziswa kwesikhashana ukuze kudambise ngokushesha izimpawu zokungaphatheki kahle njengokushisa kwenhliziyo kanye ne-reflux.
-Isibonakaliso sokwelashwa kwe-endoscopic: Ukuxilongwa kwe-GERD kucacile, ukwelashwa kwe-acidic akuvumelekile, ukungafuni ukuthatha imithi isikhathi eside, noma ukusabela okubi okuhlobene nezidakamizwa, futhi akukwazi ukubekezelela.
-Inkomba yokwelashwa kokuhlinzwa kokuhlinzwa: kunezimpawu ezijwayelekile ze-GerD, ukwelashwa kwe-PPI akuvumelekile;i-endoscopy ithola i-hernia yommizo, i-BE, i-RE, amamaki e-Los Angeles noma ngaphezulu;Ukuhlolwa kwe-X-ray kwathola ukuthi kune-hernia yembobo yommizo.
Isikhathi sokuthumela: Mar-21-2024