Matenda a gastric esophageal reflux (GerD) ndi matenda omwe amapezeka m'madipatimenti am'mimba.Kuchuluka kwake ndi zovuta zowonongeka zachipatala zimakhudza kwambiri moyo wa odwala.Ndipo kutupa kosatha kwa mmero kumakhala ndi chiopsezo choyambitsa khansa yam'mero.Momwe mungadziwire molondola ndikuyimitsa chithandizo ndicho cholinga chachipatala.
02 Mawonetseredwe azachipatala a GERD
GERD ikhoza kugawidwa mu non-roded reflux (NERD), reflux esophagitis (RE) ndi Barreta esophageal (BE) malinga ndi endoscopy.
NERD: Barrett esophagus ndi mucosa momveka bwino wa esophageal zawonongeka pakutanthauzira kwa Gerd koma endoscopy yawonongeka.
Re: Endoscopy imatha kuwona mucosa yam'mimba-esophageal yomwe imalumikizidwa kukhosi kapena pamwamba.Nembanemba ya mucous imawonongeka pang'onopang'ono.
BE: Mbali ya m’mimba-m’mero ya m’mimba ya epithelium yofanana ndi yam’mero ya m’meroyo imalowetsedwa m’malo ndi cylindrical epithelium.
02 Mawonetseredwe azachipatala a GERD
Kuphatikiza pa kutentha kwa mtima ndi reflux, zizindikiro monga kupweteka pachifuwa, kupweteka kumtunda kwa m'mimba, ndi kukomoka mozizwitsa, chifuwa, mphumu ndi zizindikiro zina za m'mimba zimatha kuchitika.
Tikumbukenso kuti odwala okalamba GerD odwala ndi otsika zochitika za mtima ndi reflux.Kuchuluka kwazizindikiro mu chubu chowonjezera ndikwambiri.Zizindikiro sizowoneka, kapena ngakhale asymptomatic.Kuopsa kwa zizindikiro sikufanana ndi kuopsa kwa matendawa.Factory Guiyu inali yathyathyathya, ndipo pamene anali dokotala, anapangidwa ku Guangli.
03 Kuzindikira kwa GERD
Chithunzi.Zizindikiro zodziwika bwino za gerD komanso zizindikiro zam'mimba zam'mimba zam'mimba zimakhala ndi tchati chodziwira matenda a GERD Source: Chinese Medical Association
Mayeso a diagnostic a asidi kupondereza wothandizira
Kwa odwala okayikitsa a gerd (omwe amagwiritsidwa ntchito nthawi zambiri PPI), mlingo wokhazikika udzakhala kwa masabata a 2 (omwe ali ndi zizindikiro kunja kwa chubu ayenera kukhala ≥4 masabata).Ngati zizindikirozo zatha kwathunthu kapena chizindikiro chimodzi chokha chochepa chimatsimikiziridwa kukhala chothandiza.
2) Endoscopic
-Re -Los Angeles yagawidwa m'makalasi (onani chithunzi pansipa):
Kalasi A: 1 kapena kupitirira apo esophageal mucosal kuwonongeka, kuwonongeka kutalika ≤5 mm;
Kalasi B: 1 kapena kupitilira apo mucosal mucosal kuwonongeka, kuwonongeka kutalika> 5 mm, kuwonongeka kwa mucous membrane komanso kusaphatikizika;
Kalasi C: Osachepera 2 esophageal mucosa yawonongeka, ndipo nembanemba ya mucous imawonongeka ndikusakanikirana.
Kalasi D: Imatanthawuza kuwonongeka kwa mucosa ndi kuphatikizana wina ndi mzake, ndipo maphatikizidwe osiyanasiyana ndi 75% ya esophagus.
-Njira yopangira biopsy: Ndikofunikira kuti pakhale biopsy yapang'onopang'ono komanso yayifupi, ndipo biopsy imapezedwa ndi interval ya 1cm kuzungulira chitofu.Kukula kwamtunduwu kumakhudzana ndi chiopsezo cha khansa, ndipo chiopsezo cha khansa chikuwonjezeka ndikuwonjezera 3cm.
3) High-resolution esophageal muyeso
Odwala ndi GerD nthawi zambiri amaonekera ngati osagwira kum`mero mphamvu: gawo la 70% kapena peristalsis kulephera chiŵerengero cha 70% kapena peristalsis ndi ≥50%.
Anti-current monitoring
Ndiwo muyezo wozindikiritsa wa CEDD.Ndilo mulingo wagolide wa matenda a GERD, kuphatikiza kuwunika kwa esophagus NH kufunika ndi kuwunika kwa esophageal yang anti -NH kuwunika kwapaipi yakumaso NH mtengo komanso kuwunika kwamtengo wang anti -NH.Kuchuluka kwa pH <4 (nthawi yowonekera kwa asidi, AET)> 4% mu 24H, kumaganiziridwa kuti pali vuto la acid reflux.
04 Chithandizo cha GERD
Chithunzi .Gerd's treatment flow chart
Source: Chinese Medical Association
Kusamalitsa:
-PPI ndi P-CAB ndizo kusankha koyamba kwa chithandizo choyambirira ndi kukonza odwala omwe ali ndi Gard.Chithandizo choyambirira cha chithandizo cha PPI ndi masabata a 8 ndipo chithandizo cha P-CAB ndi ≥4 masabata.
-Kwa odwala omwe ali ndi zopambana usiku (pomwe amatenga PPI, pH <4 nthawi> 1H usiku wa usiku), mutha kugwiritsa ntchito ma H2 receptor blockers musanagone pamaziko a chithandizo cha PPI, kapena kusintha P-CAB ndi yaitali.Theka la moyo PPI chithandizo.
- Anti-acid wothandizira ndi m'mimba yogwira mankhwala angagwiritsidwe ntchito kwa kanthawi kochepa kuti athetse mwamsanga zizindikiro za kusapeza bwino monga kutentha kwa mtima ndi reflux.
- Chizindikiro cha chithandizo cha endoscopic: Kuzindikira kwa GERD kumamveka bwino, chithandizo cha acidic ndi chosavomerezeka, osafuna kumwa mankhwala kwa nthawi yayitali, kapena zotsatira zoyipa zokhudzana ndi mankhwala osokoneza bongo, ndipo sangathe kulekerera.
-Chizindikiro cha opaleshoni ya opaleshoni: pali zizindikiro za GerD, chithandizo cha PPI ndi chosavomerezeka;endoscopy amapeza chophukacho kummero, BE, RE, Los Angeles sukulu kapena pamwamba;X-ray kufufuza anapeza kuti pali kummero dzenje chophukacho.
Nthawi yotumiza: Mar-21-2024