Chirwere chinowanzodiwa uye kupfuura-the-counter painkillers chinogona kutungamirira kuvhuta.
Chirwere chepisti ndiro izwi rinoshandiswa kune chironda chinowanikwa mumucheche mucosal yemudumbu, chirwere chiduku, kana sophagus. Apo chironda chiri mudumbu chinogonawo kunzi gastric ulcer. Zvironda mumucheto wokutanga wemukumbo muduku (duodenum) inogona kunzi "duodenal ulcer". Chikonzero chinowanzoitika chepptic ulcer rudzi rwebhakitiriya rinonzi Helicobacter pylori (H pylori) .
Chechipiri, isingazivikanwi, asi ichiwedzera kuwedzerwa kukosha, chikonzero chezviputi zvinoshandiswa kushandiswa kwemishonga isina-steroidal anti-inflammatory (NSAIDs) .
Kushandisa-over-the-counter NSAIDs, dzakadai sa aspirin kana ibuprofen nekuda kwepfungwa dzinenge dzisina musoro kana kuti dzakadzoka hazvizokonzeri peptic ulcer. Pane kudaro, chirwere chinonzi cheptic chironda chimwe chinhu chinogona kuitika nepamusoro yeiyo NSAIDs inoshandiswa kwenguva yakareba, yakadai sekurwadziwa kusingaperi kunosanganiswa neArthritis kana zvimwe zvinopesana nemamiriro ezvinhu. Vanhu vane zvinetso pamusoro pekushandiswa kweNSAID uye kuti chirwere chekudya chinokanganiswa sei chinofanira kutaura nechiremba.
Nei NSAID Dzinokonzera Ulcers
NSAID dzakadai sa aspirin, ibuprofen, uye naproxen , zvinogona kukonzera ulcers nekuvhiringidza simba remuviri kuzvidzivirira kubva kune gastric acids. Kunyange zvazvo chirwere chemuviri chiri chakakosha pakugadzira chirwere, zvinogona kukonzera kukanganisa kana zvipingamupinyi zvinodzivirira zvemuviri zvinokanganisa.
Kazhinji, mudumbu ine zviratidzo zvitatu zvekuchengetedza gastric acid:
- Mucus yakabudiswa nemasero e-foveolar anowedzera mudumbu
- Bicarbonate yakabudiswa nemasero e-foveolar anobatsira kusagadzirisa musimba asidi
- Kupararira kweropa kunobatsira mukugadzirisa nekuvandudzwa kwemasero mumudumbu mucosal layer
NSAIDs dzinopedza kubudiswa kwemukoko wekudzivirira uye kuchinja sarudzo.
Kirasi yemapidhi yakagadzirwa nemuviri anonzi prostaglandin ane zvinorwadza zvinogamuchira marwadzo. NSAIDs dzinoshanda kuderedza marwadzo kuburikidza nekuvhara ma enzymes anowanikwa mukugadzirwa kwemamwe prostaglandin. Prostaglandins inodzivirirawo mumcosal yakasara yemudumbu, uye kana yapera, zvinogona kunge zvakasara mukati. Kubviswa kwemuviri wezvidziviriro zvemuviri kurwisa gastric acids kunogona kutungamirira mukuputika mudumbu. Nokufamba kwenguva, izvi zvinogona kukonzera kuputika kwemudziyo weropa, zvichiita kuti kubuda ropa uye kukura kwevhu rakavhurika, ronda rekuonda mumucheka mucosal.
Zviratidzo zvePeptic Ulcer
Chirwere chinogona kuita kuti zviratidzo zvirambe zviri mumutsara asi vamwe vanhu havana zviratidzo zvachose. Chiratidzo chinowanzovhiringidza kurwadziwa kwepamuviri (apo mudumbu riripo) iyo inogona kunzwa inotyisa kana ichipisa. Zvinorwadza zvinowedzera zvakanyanya, nevamwe vachiona kusuruvara uye vamwe vane kurwadziwa kukuru. Kazhinji nguva iyo kurwadziwa kuchaitika mushure mekudya asi kune vamwe vanhu zvinogonawo kuitika usiku. Inogona kuenderera kune imwe nzvimbo kubva pamaminitsi mashomanana kusvika kumaawa mashoma.
Zvimwe zviratidzo hazvizivikanwi asi zvinogona kusanganisira gesi, kushungurudza, kusuruvara, kurasikirwa kwechido, kuora kurasikirwa, uye kunzwa uzere pashure pekudya kuduku.
Muzviitiko zvisingawanzoitiki, vanhu vane zvipembenene zvepaste vanogona kuona ropa muzvigaro zvavo kana kuti zvigaro zvakasviba nokuti zvine ropa. Ropa rinobva kune rimwe kana kupfuura peptic ulcers rinogona kuonekwawo mumarutsi.
Kuongororwa Peptic Ulcers
Kana zviratidzo zvechirwere chinenge chiripo, chiremba anogona kurayira miedzo yakawanda kuti aone chinokonzera uye anotsigira kuongororwa. Kune vanhu vari kugamuchira NSAID nokuda kwekutambudzika kusingaperi, chiremba angave atova nekutya kukuru kuti ichi ndicho chikonzero che, kana kuti chiri kuwedzera, chirwere chechirwere chechirwere. Nokuti iyo ndiyo inonyanya kukonzera zvipembenene zveputi, utachiona hwaH. H. pylori hunowanzotongwa kuburikidza nekushandiswa kwefemu yekuongorora kana chigamba chekuongorora.
An upper GI series kana kuti endoscopy yepamusoro inogona kushandiswa kutarisa mukati memugwagwa wepamusoro wekudya uye kutarisa masonda. MuGI yepamusoro, varwere vanonwa chinhu chinonzi barium uye mutsara we x-rays anotorwa. Iyo barium inobatsira nhengo dzomukati dzichiratidza pane x-ray. Munguva ye endoscopy yepamusoro iyo tube inogadziriswa nekamera inoshandiswa kutarisa mukati mehutu, dumbu, uye duodenum. Varwere vanongororwa panguva iyi uye zvidimbu zviduku ( biopsy ) zvinogona kutorwa kubva kumigero yegumbo rekudya kuti iwedzere kuedzwa.
Risk Factors
Zvose zvinokonzerwa neNSAID zvinogona kukonzera kushaya hupombwe, chironda chekubuda ropa, uye zvironda. Zvisinei, vamwe vanhu vanowanzokwanisa kukura chirwere chepachirwere kupfuura vamwe. Semuenzaniso, apo zvidzidzo zvinoratidza kuti makumi maviri nezana kubva muzana kubva muzana kubva muzana yevanhu vanowana dhigirii yepamusoro yeNSAID ichaita chirwere, asi chidiki chezana chevaya vanozoenderera mberi kukudziridza matambudziko makuru.
Zvinetso zvakakomba kubva kunezviputi zvepptic zvinokonzerwa neNSAID zvinowanzoitika kuvanhu vano:
- Vakuru kupfuura 65
- Uyewo tora corticosteroids
- Wakashandisa NSAIDs pasi pemwedzi
- Iva nenhoroondo yezvironda
- Tora nhamba yakakura NSAIDs
- Iva nehutachiona na H. pylori
- Shandisa aspirin zuva rega rega (kusanganisira pasi-dose aspirin nokuda kwechirwere chemoyo)
- Uyewo tora ropa shoma
Kuchengetedza Peptic Ulcers
Iko zvino yava kuzivikanwa kuti zvokudya zvinonaka uye kushungurudzika hazvisi kukonzera ulcers. Zvisinei, kune dzimwe nzira dzekuchinja mararamiro dzinogona kukurudzirwa kuitira kuti ubatsire kuporesa maronda . Chiremba angakurudzira kuti murwere ane chironda chechirwere chechirwere chinomira kusvuta, kurega doro, kudzivisa caffeine, kurega NSAID, uye usadzivisa chero mimwe mhando yezvokudya izvo zvinowedzera zviratidzo.
Mune zvimwe zviitiko mishonga inogona kutarisirwa kune varwere vanotora NSAID kuitira kuti vadzivirire zvipembenene zvirege kuitika panzvimbo yekutanga. Zvironda zveNSAID zvinowanzopora kamwe chete kurapwa neNSAID yakamira. Kukurudzira mushonga wekuporesa, chiremba anokwanisa kukurudzira kutora zvimwe zvepamusoro pemishonga yemishonga. Chirwere chinoputika, icho chinogona kuwanikwa musina chiremba, chingave chakanyorerwa nokuti chinobatsira kukonzera mutezo yemudumbu. Mune zvimwe zviitiko bismuth subsalicylate (yakadai sePepto-Bismol kana Kaopectate ) inogona kushandiswa zvakare.
Mishonga yemishonga inogona kukurudzirwa inosanganisira H2-blocker (histamine receptor blocker), iyo inodzivisa kugadzirwa kwemudumbu weAIDS kuburikidza nekuvhara histamine, uye / kana proton pump inhibitor (PPI) , iyo inoderedza kuwanda kwemashizha mudumbu. Mucosal protective agent (MPAs) imwe yekirasi yemishonga inoshandiswa mishonga inogona kushandiswa, uye iyi mishonga inoshanda kuchengetedza muviri kubudisa mucosal inobatsira mukati mudumbu ..
Dambudziko guru revanhu vane chirwere chechirwere chechirwere chechirwere chinokonzerwa nechirwere cheNSAID ndechekugadzirisa marwadzo apo mishonga yacho inorega. Panyaya yekurwadziwa kusingaperi, izvi zvingada rubatsiro rweboka revanyanzvi, kusanganisira chiremba wekurwadziwa. Kirasi yemishonga inonzi COX-inhibitors (cyclooxygenase inhibitors) inogona kushandiswa kudzora marwadzo kune vamwe vanhu. COX-inhibitor yakaratidzwa kuti inoshanda kusunungura marwadzo uye inobatanidza nehuwandu hwemigumisiro yechipfuva kupfuura dzimwe mhando dzeNSAIDs. Iyi mishonga yakaratidzwa kuva nemigumisiro yemwoyo, zvisinei, saka kazhinji inokurudzirwa kuti inoshandiswa pamushandi wakadzika kwazvo.
Zvizhinji zvechirwere zvinoporesa kamwechete apo NSAID dzinomiswa asi pane dzimwe nguva kuvhiyiwa kunogona kudiwa. Izvi zvinowanzowanzoitika kana pane zvinetso semugumisiro weshure, zvakadai sekubuda ropa, kukonzera (gomba mukati mudumbu kana musikana muduku), kana kuvhara (kuvharwa kwemuviri).
Shoko Rinobva
Vanhu vakawanda vanotora NSAID havazovi nehutachiona hwechirwere. Zvisinei, vanhu vane marwadzo asingagumi uye avo vari kugamuchira mishonga yakakura yemishonga iyi vanofanira kunge vachiziva nezvekugona kwechirwere. Mune zvimwe zviitiko, zvingave zvakafanira kubvunza chiremba kana kune nzira dzekudzivirira zvironda uye kana zviyero izvi zvichifanira kuiswa pachinenge chichikwanisa kuwedzerwa maNSAID. Nemhaka yekuti maronda asina kubatwa anogona kutungamirira kumatambudziko, zvakakosha kuwana chirwere chekuona uye kugamuchira kurapwa pakarepo kana chironda ichifungidzirwa. Muzviitiko zvakawanda maziso anoporesa nekumira NSAID uye zviratidzo zvinogona kutarisirwa nehupenyu hwekuchinja, asi kupfuura-the-counter uye mishonga yemishonga inogona kushandiswa kuti ikurumidze kushanda. Kana kurwadziwa kusingaperi kunoramba kuine nyaya uye kune ngozi yekutengesa chironda cheNSAID-chakabatana, kugadzirisa nechinokonzera marwadzo uye kushanda nehutano hwehutano hwekurwa kuti uwane dzimwe nzira dzekununura marwadzo inogona kuva yakanakisisa.
> Kwakabva:
> Lanza, F, Chan F, Quigley E, et al. "Mirayiridzo yekudzivirira zvinetso zveNSAID zvine chokuita nesonda." Amer J Gastroenterol. 2009; 104: 728-38. DOI: 10.1038 / ajg.2009.115.
> Larkai EN, Smith JL, Lidsky MD uye al. Gastroduodenal mucosa uye dyspeptic zviratidzo mune arthritic varwere panguva isingashandisi kushandiswa kwezvinodhaka zvinodhaka. Am J Gastroenterol .1987; 82: 1153-1158.
> National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Zviratidzo Nezvikonzero zvePeptic Ulcers (Dumbu Dzakare)" National Institutes of Health Nov, 2014.