Kushungurudza kunowanzobva kune GERD, inoda kuongorora
Mhedzisiro iwe wakambonzwa kuora mwoyo pane imwe nguva muhupenyu hwako. Muzviitiko zvakawanda, kushungurudzika kwako kunonzwa uri muchikwata chako chepamusoro kunopera uye kunogona kunge kuchiendeswa nevira yeAidhi mumuromo mako, zvinonzi mishonga inonzi mvura yakashata. Zviratidzo izvi zvinogona kubuda pachavo pachavo kana neine nyore pane-the-counter mishonga.
Kana zviratidzo zvikava zvisingagumi kana kuitika kaviri kana kupfuura pavhiki, zvisinei, iwe unogona kuva negastroesophageal reflux chirwere (GERD) , izvo zvingada kuongororwa zvakanyanya kwezviratidzo zvechipatara, miedzo yebazi, uye kufungidzira.
Clinical Symptoms
Kuongororwa kweGERD kunowanzochengetwa pamakiratidzo emakiriniki. Usashamiswa kana chiremba wako akukumbira kuti upedze bhuku remibvunzo. Gastroesophageal Reflux Disease Questionnaire (GERD-Q) chiratidzo chakagadziriswa chakaratidzwa mune zvidzidzo zvekliniki kubatsira kubatsira kuti chirwere chacho chive nehuwandu hweka 89%.
IGERD-Q inobvunza mibvunzo mitanhatu iri nyore pamusoro pehuwandu hwezviratidzo uye iwe unoda zvekare-the-counter treatments like antacids . Mubvunzo woga woga unowanikwa pane 0 (0 mazuva pavhiki) kusvika kuhutatu hutatu (mazuva mana kusvika manomwe pavhiki). Zvikamu zvipfumbamwe kana zvakakura zvinowirirana nekuongororwa kweGERD.
Kuongorora Kurapa Chiedzo
Nhanho inotevera mukuongorora kwako kazhinji haisi muedzo zvachose. Kunze kwekuti zviratidzo zvako zvinomutsa kufungisisa kwehutano hwakanyanya, zvinowanzoitika kuti chiremba wako anopa chirongwa chekurapa.
Munyaya iyi, chiremba wako achapa proton pump inhibitor (PPI) kuti utore mavhiki mana kusvika masere.
PPIs inoshanda kuburikidza nekuderedza asidi yekuita mukati mudumbu. Kana zviratidzo zvako zvichivandudzika apo asidi mazinga ari kuderera, izvi zvinowanzokwanira kusimbisa kuongororwa. Mishonga munyaya iyi inosanganisira esomeprazole (Nexium) , omeprazole (Prilosec) , pantoprazole (Prevacid), kana rabeprazole (AcipHex). Yakawanda yemishonga iyi ikozvino inowanikwa pamusoro pekambani.
Labs uye Miedzo
Izvo zvinowanzosaziva ndezvokuti H. pylori , bhakitiriya rinosangana nechirwere chechirwere chechirwere , rinokonzera GERD. Kutsvakurudza hakuna kuratidza kuti ichi ichokwadi uye kuongororwa hakuwanzokurudzirwa. Mukuita, kurapwa kweH. H. pylori chirwere hakuiti kuderedza zviratidzo zveGERD.
Icho hachisi icho che dyspepsia. Kunyange zvazvo GERD inowanzosvika pakutsvaira uye mvura inoputika, dyspepsia inowedzera makiriniki epirini. Inosanganisira dzimwe zviratidzo zvepamuviri sekumusoro kwepamuviri, kurwadziwa, kusuruvara, uye kusanganisa, kunyange nechingwa chiduku chezvokudya. Kuongorora kwaHh pylori kunofanira kutaridzirwa pamhosva idzi.
Kuedza kweHIV pylori kunogona kuitwa mune imwe yenzira zvitatu.
- Urea breath breath test: Muedzo unovimbiswa nekuti H. pylori bhakteria inoputsa urea kusvika mu carbon dioxide uye ammonia. Paimba yebazi, iwe unogona kuisa muenzaniso wewarea, zvichida semvura kana piritsi, iyo inofananidzira huwandu hwemhepo inokonzera carbon isotope yakaiswa pairi. Iwe uchazofema mumudziyo uko carbon yako dioxide yakaenzana. Kana H. pylori aripo, i isotopu ichaonekwa muzaniso.
- Simba antigen assay: Kana iwe uine utachiona naH H. pylori , mapuroteni anobva kubhakitiriya achabviswa muchitsiko chako. Enzyme immunoassays inogona kuona kana iwe usina kutapukirwa nekuedza shato yako nemasikirwo anosunga kune ma antigen.
- Kuongorora kwechiropolo : Mune masimba ako anogadzira zvirwere zvinopesana naHh pylori kana iwe uine utachiona. Zvinosuruvarisa, hazvisi nyore nguva dzose kududzira serology zvinoguma. Zvirwere zveAgM muropa zvinogona kuratidza hutachiwana hwehutachiona asi zvirwere zveGGG zvinogona kureva chirwere chinoshanda kana chekare.
Ireat breath breath test and the test antigen test is the tested test for active infection. Nokuti PPIs, bismuth subsalicylate (Pepto-Bismol) , uye mishonga inorwisa mabhakitiriya inogona kupindira nekururama kwemigumisiro, zvinokurudzirwa kuti usatora mishonga iyi kwevhiki mbiri mushure mekuedzwa kwako. Bhuku re laboratory richakupa mirayiridzo yekuti ungagadzirira sei.
Imaging
Kana iwe wakundikana chirwere chekuongororwa, zvinoreva kuti iwe uchiri nezviratidzo, unogona kuwedzera kuongorora. Zvinogona kunge iwe une dambudziko rinosuruvarisa reGERD, zvinetso kubva kuGERD , kana chimwe chikonzero chezviratidzo zvako zvekushaya mwoyo zvakakwana zvachose. Panguva ino, chiremba wako achada kutarisa zvakanyatsoonekwa nezvesimba rako uye kuti rinoshanda sei.
Pamusoro Endoscopy
Kunyanya kufungidzirwa kwekufungidzirwa kwekufungidzirwa kwepamusoro kune endoscopy yakakwirira , inonziwo isophagogastroduodenoscopy (EGD). Chidzidzo chinoitwa pasi pekudzivirira.
Chimwe chimiro chakakomberedzwa nekhamera uye chiedza chekupedzisira pamagumo chinowanikwa mumuromo mako uye chinotungamirirwa pasi pasi necheputi mudumbu uye kusvika kumucheto wepamusoro we duodenum, chikamu chekutanga chemukati mudumbu. Izvi zvinobvumira chiremba, kazhinji kacho gastroenterologist, kuti aone zvakajeka mukati mezvi nhengo idzi uye kutora biopsies kana kuita sarudzo sezvinodiwa kubva pane zvaakawana. Zvigunwe zvemasumbu zvinogonawo kuunganidzwa kune H. pylori kuongororwa.
Muedzo wacho unobatsira zvikuru pakuona zvinetso kubva kune yakawanda yakawanda yeAichagitis (kuvhiringidzwa kwesimba) uye kugadzirwa kwemasimba (kupera kwemasimba) kunogona kukura, zvichiita kuti kusagadzikana kwemoyo kunopfurikidza uye zvimwe zviratidzo. Bhorett's sopopus , mamiriro ezvinhu anowedzera dambudziko rako rekushaya chirwere chekushaya chirwere chepachirwere , mumwewo, zvisinei, zvisingaiti.
Matambudziko kubva kumucheto wokumusoro ekupedzisira pachawo haatomboitiki asi anoitika. Ndinofara, izvi zvinongoitika chete 0.15 muzana yenguva. Kunyanya kuwirirana kunowanzova kusvimha misodzi mukati memoyo asi zvinowanzoitika kana chirongwa, chakafanana nechinonzi esophageal dilation , chinoitwawo. Zvimwe zvinetso zvingafungidzirwa zvipembenene zvinobva kune endoscope kana kubuda ropa zvinogona kuitika panzvimbo dzebiopsy.
Esophageal pH Kuchengetedza uye Kupera Muchembera
Nzira yegoridhe yekuongororwa kweGERD inofungidzira pH kutarisa . Dambudziko nderokuva nguva inopedza uye isinganzwisisiki. Hazvishamisi kuti haisi kushandiswa seyero yekutsvaga yekuongorora. Pane kudaro, inoitwa apo zvimwe zvidzidzo zvataurwa pamusoro apa hazvina kunaka uye chiremba anoda kusimbisa kuti pane asidi reflux dambudziko rinokonzera zviratidzo zvako.
Ichi chidzidzo chinoderedza kuti yakawanda asidi inopinda sei. Inotenderera kune catheter shoma ine sensor pH pane imwe mugumo uye chigadzirwa chokurekora pane imwe. Iyo catheter inogadzirwa nemhino uye inotungamirirwa mukati megumbo kuitira kuti igare pamusoro pechepasi esophageal sphincter (LES) . Anatomically, iLES inoparadzanisa chirwere ichi kubva mudumbu.
Iyo catheter yasara munzvimbo panzvimbo maawa makumi maviri nemaviri. Inoyera pH level paLES munguva. Iyo inokwanisawo kuyera huwandu hwezvokudya uye zvimwe zvakagadzirwa mukati megastric izvo zvinoramba zvichinyanya kuitika mune izvo zvinonzi impedance kuedza. Munguva ino, unobvunzwa kuchengeta diary yezviratidzo zvako uye kudya kwekudya. Kana imwe nguva yasvika, deta inounganidzwa kubva mu sensor uye inobatanidzwa nedhiari yako.
Acid inotsanangurwa ne pH pasi pe7.0. Nokuda kwekuongororwa, pH pasi pe4 muzana inotsigira kuongororwa kweGERD kana ikaitika 4.3 muzana kana kupfuura nguva. Izvi, zvisinei, nyaya yacho kana iwe usingatori PPI. Kana uri kutora PPI, kuongorora kwako kunofungidzirwa kusina kujairika apo pH yako iri mumhara iyi 1.3 muzana yenguva.
Panewo shanduro yemapule yekuongorora kwepH, kunyange zvazvo kupedzisira kusati kwasarudzwa nenzira iyi. Iyo capsule yakabatanidzwa pane sopu panguva yakakwirira endoscopy uye data inounganidzwa pasina. Acid mazinga anotaridzirwa kupfuura maawa 48 kusvika 96. Icho hachisi chido chekuve neimwe endoscopy kubvisa capsule. Pasati nguva yevhiki, chigunha chinowira panoputika uye chinopfigirwa muchigaro. Kunyange zvazvo muedzo wacho wakarurama kwazvo kudarika chetsika catheter pH kuedza, inowedzerawo kuvhiringidza uye inodhura zvikuru.
Esophageal Manometry
Chiremba wako angafungira kuti chirwere chinonzi esophageal motility chinokonzera kuora mwoyo kwako. Kana iwe uchidya, zvokudya zvinobva mumuromo wako kusvika mudumbu rako, asi pashure pekuenzanisa mutsara wemasimba. Misumbu inoputira sopopus inokurudzira kudya mberi mune imwe nzira inonzi peristalsis .
Iko kumusoro nechepasi esophageal sphincters inofanirawo kuvhura nekuvhara panguva dzakakodzera kutamisa zvokudya mberi kana kuti zvimwe kudzivirira kudya kubva kune imwe nzira inodzokera kumashure. Chero kusagadzikana mune izvi kufamba kunogona kutungamirira kuoma kuvhara, kurwadziwa kwepfupa, kana kuora mwoyo.
Manometry isu test inotarisa motility basa. Bhuku duku rinosungirwa mumhino dzako uye rinotungamirirwa kuburikidza nehovha yako uye mudumbu. Sensor iri pedyo ne tube inoona kuti musimba unobvumirana sei kana iwe uchidya. Iwe hausi kuzotorwa panguva yekuedzwa nokuti iwe uchakumbirwa kuedza maduku maduku emvura. Chiremba wako achacherechedza kubatanidza uye simba rekugadzikana kwemaviri mushure mako iwe uchidya. Pose, muedzo unowanzopedza maminitsi gumi kusvika ku15 chete.
Kunyange zvazvo manometry inogona kubatsira kuongororwa GERD, inonyanya kubatsira kuongororwa zvimwe zvinetso zvekuita se- achalasia uye esophageal spasm.
Barium Swallow
Bhinzi iri ingangodaro isingave yakanakisisa muedzo wokutsvaga GERD, asi inogona kutarisa matanho ekugadzirisa, kusangana kweGERD. Kudzidza kunobatsirawo pakutsvaga hutano hwechibereko kana hutachiona hwemhepo hunoita kuti huve nehutachiona hwekuora mwoyo.
Chiyero chinoitwa nekutora mutsara we x-ray apo iwe unonwa dhaka rinenge rapaque rinonzi barium. Iyo bharum inosviba pane x-raya kupfuura mapfupa ako uye mishonga, zvichiita kuti zvive nyore kuti chiremba wako atevere muscle kufamba kuburikidza nesophagus. Anatomic kusakanganiswa muhangu inogonawo kuonekwa nenzira iyi.
Kusiyanisa Kuziva
Kushungurudza kunowanzoitika asi kwete nguva dzose kunokonzerwa neGERD. Sezvakakurukurwa, inogonawo kufananidzwa ne dyspepsia, HH pylori chirwere, uye kupera. Zvimwe mamiriro ekufungisisa zvinosanganisira zvirwere zvekusthageal motility zvakadai se achalasia uye esophageal spasm.
Mumamiriro ezvinhu akaipisisa uye zvingangodaro zvingangoitika, chirwere chepopugeal chinogona kupomera mhosva. Nokuda kwechikonzero ichi, zvinokurudzirwa kuona chiremba wako kana uine zviratidzo zvekurwadziwa kwepfungwa izvo zvakanyanya kana zvinowanikwa kanopfuura kaviri pavhiki.
> Sources:
> Alzubaidi M, Gabbard S. GERD: Kuongorora uye Kuchengeta Moto. Cleve Clinic J Med. 2015 Nha.; 82 (10): 685-92. doi: 10.3949 / ccjm.82a.14138.
> Anderson WD 3rd, Strayer SM, Mull SR. Mibvunzo Inowanzoenderana neHurumende yeGastroesophageal Reflux Disease. Ndiye Chiremba weNzara. 2015 May 15; 91 (10): 692-7. https://www.ncbi.nlm.nih.gov/pubmed/25978198.
> Cohen J. Kubatana kweMakumbo ekumusoro Endoscopy (Esophagogastroduodenoscopy). Mune: Grover S. UpToDate [Internet] , Waltham, MA. Yakapedzwa August 4, 2015.
> Fass R. Inosvika kuKuratidzira Gastroesophageal Reflux Disease muVakuru. Mu: Grover S. (ed), UpToDate [Internet] , Waltham, MA. Yakarongwa musi waMarch 6, 2018.
> Jonasson C1, Wernersson B, Hoff DA, Hatlebakk JG. Kuzadzikiswa kweMibvunzo yeGerdQ yeKutsvaga kweGastro-Oesophageal Reflux disease. Aliment Pharmacol Ther. 2013 Mar; 37 (5): 564-72. doi: 10.1111 / apt.12204.