Indwara ya Gastric esophageal reflux (GerD) ni indwara ikunze kugaragara mu ishami ryigifu.Kuba ikwirakwizwa ryayo hamwe n’ubuvuzi bugaragara bigira ingaruka zikomeye ku mibereho y’abarwayi.Kandi umuriro udakira wa esofagusi ufite ibyago byo gutera kanseri yo mu nda.Nigute ushobora gusuzuma neza no gutunganya ubuvuzi nibyo byibandwaho mubikorwa byubuvuzi.
02 Kugaragara kwa GERD
GERD irashobora kugabanywamo ibice bidasubirwaho (NERD), reflux esophagitis (RE) na Barreta esophageal (BE) ukurikije endoskopi.
NERD: Barrett esophagus na mucosa esofageal mucosa yangiritse mubisobanuro bya Gerd ariko endoskopi yangiritse.
Re: Endoscopi irashobora kubona igifu-esophageal mucosa ihujwe na esofagusi cyangwa hejuru.Ururenda rwangiritse rimwe na rimwe.
BE: Gastric-esophageal squamous epithelial igice cya esofagus imeze nka epitelium ya esofagus ihuza esofagus kuri endoskopi isimburwa na epitelium ya silindrike.
02 Kugaragara kwa GERD
Usibye gutwika umutima no guhinduka, ibimenyetso nko kubabara mu gatuza, kubabara mu nda, hamwe na esofagusi y'igitangaza, inkorora, asima n'ibindi bimenyetso bya Esophageal.
Twabibutsa ko abarwayi bafite abarwayi ba GerD bageze mu zabukuru bafite ibibazo bike byumutima no kugaruka.Umubare wibimenyetso mu miyoboro ikuramo ni mwinshi.Ibimenyetso ntabwo bisanzwe, cyangwa nibimenyetso.Uburemere bwibimenyetso ntaho bihuriye nuburemere bwindwara.Uruganda Guiyu rwarimeze neza, kandi igihe yari umuganga, yateje imbere i Guangli.
Isuzuma rya GERD
Igishushanyo.Ibimenyetso bisanzwe bya GerD nibimenyetso bidasanzwe byo mu gifu byindwara zifata indwara ya GERD yo kwisuzumisha Source: Association Medical Medical Association
Ikizamini cyo gusuzuma imiti igabanya aside
Ku barwayi ba gerd bakekwa (bakunze gukoresha PPI), dosiye isanzwe izamara ibyumweru 2 (abafite ibimenyetso hanze yigituba bakeneye kumara ibyumweru 4).Niba ibimenyetso byoroheje burundu cyangwa ibimenyetso byoroheje gusa byagaragaye ko ari byiza.
2) Endoskopi
-Re -Los Angeles igabanijwemo amanota (reba ishusho hepfo):
Icyiciro A: 1 cyangwa byinshi byangiza ururenda rwangirika, ibyangiritse uburebure bwa mm 5;
Icyiciro B: 1 cyangwa byinshi byangiza Esophageal mucosal yangiritse, kwangirika kwuburebure> mm 5, kwangirika kwijimye kandi nta fusion;
Icyiciro C: Nibura mucosa 2 esophageal mucosa yangiritse, kandi ururenda rwangiritse ruvanze hamwe.
Icyiciro D: Yerekeza ku kwangirika kwa mucosa no kwishyira hamwe, kandi intera yo guhuza ni 75% ya esofagus.
-BE ingamba za biopsy: Birasabwa ko habaho biopsy intera nini kandi ngufi, kandi biopsy iboneka na 1cm intera ikikije amashyiga.Ingano yurwego ifitanye isano na kanseri, kandi ibyago bya kanseri biriyongera kandi byongera intera ya 3cm.
3) Igipimo kinini -gupima esophageal gupima
Abarwayi bafite GerD bakunze kwigaragaza nkimbaraga zidafite imbaraga: igipimo cya 70% cyangwa igipimo cyo kunanirwa kwa peristalisike 70% cyangwa peristalisite ni ≥50%.
Gukurikirana ibirwanya
Nibisanzwe byo gusuzuma CEDD.Nibipimo bya zahabu mugupima GERD, harimo kugenzura agaciro ka esophagus NH na esophageal yang anti -NH kugenzura agaciro ka esofagus umuyoboro wa NH agaciro na esophageal yang anti -NH kugenzura agaciro.Ijanisha rya pH <4 (igihe cyo guhura na aside, AET)> 4% muri 24H, bifatwa ko hariho aside irike.
04 Kuvura GERD
Igishushanyo .Igitabo cyo kuvura
Inkomoko: Ishyirahamwe ryubuvuzi ryabashinwa
Icyitonderwa:
-PPI na P-CAB nuburyo bwambere bwo kuvura no gufata neza abarwayi bafite Gard.Ubuvuzi bwambere bwo kuvura PPI ni ibyumweru 8 naho kuvura P-CAB ni ibyumweru 4.
-Ku barwayi bafite intambwe nijoro (mugihe ufata PPI, pH <4 time> 1H mwijoro ryijoro), urashobora gukoresha ibyuma byakira H2 mbere yo kuryama ukurikije imiti ya PPI, cyangwa ugahindura P-CAB na birebire.Kimwe cya kabiri cyubuzima bwa PPI.
-Imiti igabanya ubukana hamwe na gastrointestinal imiti ikora irashobora gukoreshwa mugukoresha igihe gito kugirango igabanye vuba ibimenyetso byuburangare nko gutwika umutima no kugaruka.
-Icyerekezo cyo kuvura endoskopique: Gusuzuma GERD birasobanutse, kuvura aside nta gaciro bifite, kudashaka gufata imiti igihe kirekire, cyangwa ingaruka mbi zijyanye nibiyobyabwenge, kandi ntibishobora kwihanganira.
-Igipimo cyo kuvura indwara zo kubaga: hari ibimenyetso bisanzwe bya GerD, kuvura PPI bitemewe;endoskopi isanga hernia esophageal, BE, RE, amanota ya Los Angeles cyangwa hejuru;Isuzuma rya X-ryerekanye ko hari umwobo wa esophageal hernia.
Igihe cyo kohereza: Werurwe-21-2024