Kutentha kwapakhosi kumawoneka kuchokera ku GERD, zomwe zimafuna kuunika
Zovuta mumakumanapo ndi kupweteka kwa nthawi pa moyo wanu. Nthaŵi zambiri, vuto lomwe mumamva mumtima mwanu ndilopitirira ndipo lingakhale limodzi ndi kukoma kwa m'kamwa mwako, mankhwala omwe amatchedwa madzi. Zizindikirozi zimatha paokha kapena ndi mankhwala ophweka pa-counter.
Pamene zizindikiro zimakhala zazikulu kapena zimachitika kawiri kapena kawiri pa sabata, komabe, mukhoza kukhala ndi matenda a reflux (GERD) a gastroesophageal (GERD) , omwe angafunikire kufufuza mozama za zizindikiro za kuchipatala, mayesero a ma laboni, ndi kujambula.
Zizindikiro zachipatala
Kupezeka kwa GERD nthawi zambiri kumadalira zizindikiro za kuchipatala. Musadabwe ngati dokotala akukupemphani kuti muzitsirize mafunso. Funso la Gastroesophageal Reflux Disease Questionnaire (GERD-Q) ndi yeseso yotsimikiziridwa yomwe yawonetsedwa m'maphunziro azachipatala kuti athandizidwe kuti athe kupeza matendawa molondola pa 89 peresenti.
GERD-Q ikufunsa mafunso asanu ndi awiri osavuta ponena za kuchuluka kwa zizindikiro ndi zosowa zanu za mankhwala owonjezera monga antiacids . Funso lirilonse likuwerengedwa pa 0 (0 masiku pa sabata) mpaka kufika pa mfundo zitatu (masiku anayi mpaka asanu ndi awiri pa sabata). Zaka zisanu ndi zinayi kapena zazikulu zimagwirizana ndi matenda a GERD.
Mayeso Ochizira Odwala
Khwerero lotsatira muyeso lanu nthawi zambiri siyeso ayi. Pokhapokha ngati zizindikiro zanu zikukukakamizani kuti mukhale ndi vuto lalikulu, ndiye kuti mwina dokotala wanu angakulimbikitseni kulandira mankhwala.
Pachifukwa ichi, dokotala wanu adzalamula proton pump inhibitor (PPI) kuti mutenge masabata anayi mpaka asanu ndi atatu.
Mapulogalamu a PPI amagwira ntchito poletsa kupangitsa asidi kupanga m'mimba. Ngati zizindikiro zanu zikupita patsogolo pamene asidi akuchepa, izi zimakhala zokwanira kutsimikizira kuti matendawa akupezeka. Mankhwala m'gulu ili ndi esomeprazole (Nexium) , omeprazole (Prilosec) , pantoprazole (Prevacid), kapena rabeprazole (AcipHex). Ambiri mwa mankhwalawa tsopano alipo pa pepala.
Mapulogalamu ndi Mayesero
Zomwe anthu ambiri amaganiza kuti H. H. pylori , mabakiteriya omwe amagwidwa ndi matenda a zilonda zam'mimba , amachititsanso kuti GERD. Kafukufuku asanasonyeze kuti izi ndi zoona ndi kufufuza sikukulimbikitsidwa. Mwachizolowezi, chithandizo cha H. pylori matenda sichikuthandizira kuti zizindikiro za GERD zitheke.
Izi sizili choncho kwa dyspepsia. Ngakhale kuti GERD nthawi zambiri imangokhalira kupweteketsa mtima ndi madzi, kupweteka ndi matenda aakulu. Zimaphatikizapo zizindikiro zina za m'mimba monga ululu wamimba, kupweteka, kusuta, komanso kusamba, ngakhale ndi chakudya chochepa. Kuwunika kwa H. pylori kuyenera kuganiziridwa pa milandu iyi.
Kuyesera kwa H. pylori matenda angathe kuchita chimodzi mwa njira zitatu.
- Kupima mpweya wa Urea: Mayesowa amadalira kuti H. pylori mabakiteriya amathyola urea mpaka carbon dioxide ndi ammonia. Kumalo osungirako ma laboratory, mudzadya zowonjezera za urea, mwina monga madzi kapena piritsi, zomwe zikuwonetsa kuchuluka kwake kwa mpweya wa carbonactive carbon isotope. Mukatero mudzapuma mu chidebe komwe muyezo wanu wa carbon dioxide umayesedwa. Ngati H. pylori alipo, isotope idzapezeka mu chitsanzo.
- Ikani antigen testay: Ngati muli ndi kachilombo ka H. pylori , mapuloteni ochokera ku mabakiteriya adzatulutsidwa mu mpando wanu. Enzyme immunoassays akhoza kudziwa ngati mulibe kachilombo ka HIV kapena ayi poyesera mankhwala anu omwe amamatira ma antigen.
- Kuyezetsa magazi: Zomwe thupi lanu limapanga zimapangitsa antibodies kumenyana ndi H. pylori ngati muli ndi kachirombo ka HIV. Mwatsoka, sikuli kosavuta kutanthauzira kumasulira kwa serology. Mankhwala a IgM m'magazi angasonyeze kuti ali ndi kachilombo koyambitsa matenda koma antibiotic ya IgG ingayimire matenda opatsirana kapena achikulire.
Urea mpweya kuyesera ndi stool antigen kuyesa ndi mayeso okondedwa kuti yogwira matenda. Chifukwa chakuti PPIs, bismuth subsalicylate (Pepto-Bismol) , ndi mankhwala opha tizilombo amatha kusokoneza molondola zotsatira zake, ndikulimbikitsidwa kuti musamamwe mankhwalawa kwa milungu ingapo musanayese. Malo opangira ma laboratory adzakupatsani malangizo a momwe mungakonzekere bwino.
Kujambula
Ngati mwalephera chiyeso cha chithandizo cha matenda, kutanthauza kuti mudakali ndi zizindikiro, mungafunikire kufufuza. Zingakhale kuti muli ndi vuto lalikulu la GERD, mavuto ochokera ku GERD , kapena chifukwa china cha zizindikiro zanu za kupweteka mtima. Panthawiyi, dokotala wanu akufuna kuyang'anitsitsa bwino momwe mukugwiritsira ntchito komanso mmene zimagwirira ntchito.
Kutsika Kwambiri Kwambiri
Phunziro lodziwika kwambiri la kujambula ndilokumapeto kwake kosatha , lomwe limatchedwanso esophagogastroduodenoscopy (EGD). Phunziroli likuchitidwa pansi.
Mapulogalamu ochepa omwe ali ndi kamera komanso magetsi pamapeto amalowa m'kamwa mwako ndipo amatsogoleredwa m'mimba ndikupita kumtunda kwa duodenum, gawo loyamba la m'mimba. Izi zimathandiza dokotala, nthawi zambiri gastroenterologist, kuti awonetsetse mkati mwa ziwalo izi ndi kutenga biopsies kapena kuchita momwe zingakhalire malinga ndi zomwe apeza. Zitsanzo za minofu zingathenso kusonkhanitsidwa kwa H. pylori kuyesa.
Mayesowa amathandiza kwambiri kupeza matenda omwe amapezeka chifukwa cha kuchuluka kwa asidi. Kuthamanga kwa magazi (kupweteka kwa mimba) ndi zovuta zowonongeka zimatha kukula, zomwe zimapangitsa kuti chifuwa cha mtima chikhalepo komanso zizindikiro zina. Matenda a Barrett , omwe amachititsa kuti chiopsezo cha khansa yapachilendo chiwonjezeke, ndi china, ngakhale chosazolowereka, chovuta.
Mavuto ochokera kumapeto apamwamba okha ndi osowa koma amapezeka. Mwamwayi, izi zimangokhala 0.15 peresenti ya nthawiyo. Khalidwe lodziwika kwambiri ndilokhalira m'mimba koma nthawi zambiri zimakhalapo pamene njira, monga kuchepa , imathandizanso. Zovuta zina zofunikira kuziganizira ndi matenda ochokera ku endoscope kapena kutuluka kwa magazi zomwe zingathe kuchitika pa malo osokoneza bongo.
Esophageal pH Kuyeza ndi Kugonjetsa Mimba
Ndondomeko ya golide yowunikira GERD ndiyo kuyang'anira pH kuchepa . Vuto ndilo lingakhale nthawi yambiri komanso yosasangalatsa. N'zosadabwitsa kuti siigwiritsidwe ntchito ngati chida choyambitsira chithandizo. Mmalo mwake, izo zimachitidwa pamene maphunziro ena omwe atchulidwa pamwambawa ndi olakwika ndipo adokotala akuyenera kutsimikizira kuti pali vuto la reflux acid limene limayambitsa zizindikiro zanu.
Phunziroli limapanga kuchuluka kwa asidi m'mimba. Zimadalira catheter yopyapyala yokhala ndi pH sensor kumapeto amodzi ndi chipangizo chojambula pamtundu wina. Catheter imayikidwa kupyolera m'mphuno ndipo imatsogoleredwa m'mimba ndipo imakhala pamwamba pa sophageal sphincter (LES) . Anatomically, a LES amalekanitsa mimba kuchokera mmimba.
Catheter yasiyidwa m'malo mwa maola 24. Zimayesa pH mlingo pa LES nthawi. Iyenso imayeza kuchuluka kwa chakudya ndi zina zamkati za m'mimba zomwe zimatsitsimulidwa mu chidziwitso chotchedwa impedance. Panthawiyi, mukufunsidwa kuti muzisunga zolemba zanu ndikudya. Nthawi ikadzatha, deta imasonkhanitsidwa kuchokera ku sensa ndipo ikugwirizana ndi diary yanu.
Acid imatanthauzidwa ndi pH zosakwana 7.0. Pofuna kupeza matenda, pH zosachepera 4 peresenti imatsimikizira kuti matenda a GERD akupezeka ngati akupezeka 4.3 peresenti kapena nthawi yambiri. Izi ndizoopsa ngati simutenga PPI. Ngati mukugwiritsa ntchito PPI, mayesero anu amaonedwa ngati achilendo pamene pH yanu ili pa 1.3 peresenti ya nthawiyi.
Palinso ndondomeko ya kapseni ya kuwunika kwa pH, ngakhale kuyesayesa kwapachilendo sikungatheke ndi njira iyi. Kapsule imagwirizanitsidwa ndi tsambalo pamapeto apamwamba kwambiri ndipo data imasonkhanitsidwa mosasunthika. Miyeso ya acid imayesedwa maola 48 mpaka 96. Palibe chifukwa chokhala ndi endoscopy ina kuchotsa capsule. Pasanathe sabata imodzi, chipangizocho chimagwera pamimba ndipo chimatulutsidwa mu mpando. Ngakhale kuti mayesowa ndi olondola kwambiri kusiyana ndi kachitidwe ka kathetti ka pH, kowonjezereka komanso kotsika mtengo kwambiri.
Esophageal Manometry
Dokotala wanu angaganize kuti vuto la motility losokoneza bongo likuyambitsa kupweteka kwanu. Mukamadya, chakudya chimachokera pakamwa panu kupita m'mimba mwako, koma pokhapokha mutatha kusinthana kwa minofu. Minofu yomwe imagwiritsa ntchito mitsempha imayendetsa chakudya patsogolo pa njira yomwe imatchedwa peristalsis .
Zapamwamba komanso zam'mimba zotsekula m'mimba zimatsegulira komanso kutseka nthawi yoyenera kutsogolera chakudya kapena kupewa chakudya cholowera kumbuyo. Zosayenerera zilizonsezi zingayambitse kumeza, kupweteka pachifuwa, kapena kupweteka kwa mtima.
Manometry ndi mayeso omwe amayesa ntchito ya motility. Kapepala kakang'ono kamaphatikizidwa m'mphuno mwako ndikuwatsogolera kudzera m'mimba ndi m'mimba. Zomwe zimagwiritsidwa ntchito pa chubu zimagwira bwino momwe thupi limagwirira ntchito pamene mukudya. Simudzakhalanso pansi pamayeso chifukwa mudzafunsidwa kuti muzitha madzi pang'ono. Dokotala wanu azitsatira njira yothandizira komanso mphamvu ya kupopera mitsempha ngati mukudya. Zonsezi, kawirikawiri mayesowa amatha mphindi 10 mpaka 15 zokha.
Ngakhale manometry ingathandize kuthandizira GERD, zimathandiza kwambiri kupeza matenda ena a motility monga achalasia ndi esophageal spasm.
Barium Swallow
Kugwilitsika kwa barium kungakhale kosayesa kuyesa GERD, koma ikhoza kuyang'ana zovuta zazing'ono, zovuta za GERD. Phunziroli likuthandizanso pozindikiritsa matenda ovuta omwe amatha kuchititsa zizindikiro za kupweteketsa mtima.
Mayesowa amachitidwa podutsa ma x-ray panthawi yomwe mumamwa tepi yofiira yotchedwa barium. The barium ikuwoneka mdima pa x-ray kusiyana ndi mafupa anu ndi minofu, zomwe zimapangitsa kuti dokotala wanu azitha kutsata minofu kudutsa m'mimba. Matenda osokoneza bongo amatha kuonanso motere.
Kusiyanitsa kusiyana
Kutsekemera kwafala kawirikawiri koma nthawizonse sikunayanjidwe ndi GERD. Monga tafotokozera, izi zikhonza kukhala zokhudzana ndi matenda a dyspepsia, H. pylori , ndi matenda opatsirana. Zina zomwe mungaganizire zikuphatikizapo matenda osokoneza bongo omwe amachititsa kuti achalasia ayambe kusokonezeka.
Pa zovuta kwambiri komanso zosavuta, khansara yotchedwa œophageal iyenera kukhala mlandu. Pachifukwa ichi, ndibwino kuti muwone dokotala ngati muli ndi zizindikiro za kupweteka kwa mtima zomwe ziri zoopsa kapena zomwe zimachitika kawiri pa sabata.
> Zotsatira:
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> Anderson WD 3rd, Strayer SM, Mull SR. Mafunso Okhudzana ndi Utsogoleri wa Matenda a Reflux a Gastroesophageal. Am Phys Physician. 2015 May 15; 91 (10): 692-7. https://www.ncbi.nlm.nih.gov/pubmed/25978198.
> Cohen J. Mndandanda wa Mimba Yam'mimba Endoscopy (Esophagogastroduodenoscopy). Mu: Grover S. UpToDate [Internet] , Waltham, MA. Idasinthidwa pa August 4, 2015.
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