Peptic Ulcer Disease

Nhoroondo yePeptic Ulcer Disease

Peptic ulcer chirwere chirwere chinowanzogadzirisa chirwere chisingaiti chete chinogona kuita kuti upenyu husanyanya kunetseka, asi hunogonawo kuva nemigumisiro yakaoma. Zvakaitika munguva pfupi yapfuura-kunyanya ruzivo rutsva pamusoro pezvikonzero zvaro uye kurapwa-zvakashandura kutarisira kwepectic ulcer. Kana iwe kana munhu waunoda ane chirwere chechirwere chechirwere, iwe unofanirwa kuve nechokwadi chokuti unoziva nezvekupedzisira kwemashoko pamusoro pezvinetso izvi zvinowanzoitika.

Chii Chinonzi Ulter Peptic?

Chirwere cheputi chinokonzera kubatana kwemuviri kana duodenum (chikamu chokutanga chemukati mudumbu). Izvi zvinonzi "peptic" ulcers nokuti dzakabatana nebasa reAic acid uye pepsin (inokosha yakakosha enzyme) pamasero anokonzera mudumbu uye duodenum.

Chirwere chinenge chiri mudumbu chinonzi gastric ulcer. Kana iri mu duodenum inonzi daodenal ulcer.

• Zvokudya Zvakanaka Nezvakaipa zvePeptic Ulcers

• Uri Kuzvimirira Kuti Uve Nechirwere Here?

Zviratidzo zvingasiyana zvakasiyana pakati pemhando mbiri idzi dzechirwere uye chiremba wako anogona kuvabata zvishoma zvakasiyana. Vanachiremba vanoona vanhu vane zviputi zveplatin kakawanda. Penguva ipi zvayo, kusvika kune imwechete yezana yevanhu munyika yose ichava nechirwere cheputi.

Zviratidzo zvehuputi chinogona kuora mwoyo. Zvakaipisisa, izvi zvipembenene zvinogona kutungamirira kune zvakakosha, zvichida migumisiro inotyisa. Nenzira yakanaka, kuvanhu vazhinji vanogona kuporeswa uye zvinetso zvakakomba zvinogona kudziviswa nerapa rerapi yakakodzera uye nezviyero zvekudzivirira zvipembenene zvekare.

Zviratidzo

Chiratidzo chikuru chechiptic cheponda chirwere chepamuviri .

Vanhu vakawanda vachatsanangura kugunun'una kana kupisa kunopisa kunowanikwa mukati megomba remukati kana pasi pezasi nenyundo kune imwe kurudyi kana kuruboshwe.

Muenzaniso wemarwadzo emuviri inogona kuvimba nenzvimbo yechironda. Ne gastric ulcers, kurwadziwa kunowanzoitwa kwakaipisisa nekudya uye, pane dzimwe nguva, munhu ane gastric ulcer angangodaro (zvichida asinganzwisisiki) akacheka kudya uye kunyange kurashikirwa nehumwe uremu.

Kusiyana neizvi, zvipembenene zvedodenal zvinowanzokonzera marwadzo mukati mekudya apo dumbu risina chinhu-marwadzo anowanzobviswa nekudya chimwe chinhu. Vanhu vane chironda che duodenal havawanzoregi kuwanda uye vanogona kuwedzera kuwanda.

Kana chironda chinenge chakakura chikava chakakura zvakakwana, chinogona kukanganisa mumudziyo weropa uye kubudisa ropa. Vanachiremba vanoshevedza iyi i " gI yepamusoro inopa ropa " sezvo nzvimbo yekubuda ropa iri mumucheto wepamusoro wematumbo. Zviratidzo zvepamusoro peGI rinopa ropa rinogona kunge rakajeka uye risingagoni kuregererwa, zvakadai sekurasira ropa rakatsvuka.

Kune rumwe rutivi, kana kubuda ropa kunonoka , zviratidzo zvinogona kunge zvisinganyatsooneki uye zvinogona kusanganisira kupera zvishoma nezvishoma kweutera (kubva pane chirwere chemahyamu ), chizivi , chirwere (kubva mukukurumidza kwemwoyo), kubatwa kwepamuviri (kunokonzerwa neropa richifamba, uye inogumbura, utumbo), uye melena kana tarry stool (inokonzerwa nekugadzira chirwere chinoshanda muropa mumatumbo emukati).

Chirwere cheputi chinowanikwa pamakakatanwa emudumbu uye duodenum (nzvimbo inonzi pyloric channel) inogona kukonzera kuvhara mukati mudumbu rekudzivirira kuti zvive nekudzivirira zvishoma. Kana zvakadaro, zviratidzo zvingasanganisira kubhururuka, kusuruvara kwakanyanya, kushungurudza, kusutsa, uye kuora kurasikirwa. Vanhu vane zvipembenene zvekare vanewo mukana wakakura wekuwedzera gastroesophageal reflux chirwere (GERD) uye zviratidzo zvinosangana nayo, kunyanya kupisa .

Kunyange zvazvo chirwere cheputi chinoratidza pachena kuti chinokonzera zviratidzo zvakasiyana-siyana, chikamu chinoshamisa chevanhu vane zvipembenene zvinokonzera (zvichida kusvika makumi mashanu kubva muzana) hazvioni chero zviratidzo. Zvinosuruvarisa, kunyange zvipembenene zvinenge zvisingaiti zvakananga zviratidzo zvingaguma zvichikonzera matambudziko makuru.

Verenga zvakawanda pamusoro pezviratidzo zvepeptic ulcers.

Matambudziko

Kana chinhu choga chepptic maronda chaakaita chaiva kukonzera marwadzo emimba, vangave vasina kuonekwa sechinetso chakadai. Asi, sezvatakamboona, vanogona kuita zvakawanda kupfuura izvozvo!

Matambudziko makuru epeptic chirwere chepachivi Anosanganisira:

• Bleeding. Ichi ndicho chinetso chakajairika chepptic ulcer chirwere. Kubuda ropa kunogona kunonoka uye pane kunyengera kana kunogona kuva kukuru uye pakarepo kutyisa upenyu. Zvinonzwisisika, chirwere chinononoka kubuda zvishoma chingangodaro chisingaonekwi chinogona kuve chichirwere chakanyanya kukurumidza-kana chichiwedzera muropa remudziyo.
• Gastric outlet kudzivirira. Ichi chiitiko-kuvhara pamakona emudumbu uye duodenum-kunogona kukonzerwa nehutachiona hweplatin ulcer kana nekupererwa kwenguva refu nekuda kwechirwere chepakutanga. Kana kuvhara kwakanyanya, kana kuti kusagadzikana kunonzwisisika hakugadziriswi mushure menguva yakakodzera yerapi yezvechiremba, chirwere chinopikisa chinogona kudiwa.
• Perforation. Kana chironda cheputi chinopera zvachose kuburikidza nemadziro emudumbu kana duodenum, zvinogona kukonzera kupera. A perforation inogona kubvumira mudumbu weAidhiya kuti idzike mukati mechipfuva chemuviri, zvichikonzera kurwadziwa kwepamuviri zvakanyanya uye dzimwe nguva kunetseka . Kupera kwemavara echptic ulcer chirwere chinotyisa. Kurapa kunoda kurapa kurapa.

• Zviratidzo zvePeptic Ulcers

• Ndeapi Marudzi Okuvhiya kwePeptic Ulcers?

• Fistula. Chirwere chinogona kuvharidzirwa muchechi chiri pedo uye chigadzira fistula (kureva, kubatana) pakati pemudumbu kana duodenum uye sangano rakapoteredza. Fistulas inogona kuumba nekoloni, muti webiariary, pancreas, kana ropa guru mudziyo. Zvichienderana nechikamu chechikamu chinosanganiswa, zviratidzo zvinogona kusiyana nekurutsira zvinhu zvakashata zvakanyanya, zvakanyanya, kana kuti zvinouraya zvirwere. Saizvozvowo kunonoka, chirwere chinopikisa chinoda kurapwa.

Verenga zvakawanda pamusoro pezvinetso zveplatin ulcers.

Zvinokonzera

Muchikamu chikuru chezviitiko, zviputi zveputi zvinokonzerwa nechimwe chezvinhu zviviri:

1. Utachiona ane bhakitiriya rinonzi Helicobacter pylori (H. pylori)
2. Kushandiswa kusingaperi kwemaitiro asina-steroidal anti-inflammatory drugs (NSAIDS)

Kuziva kuti H. pylori zvirwere zvinokonzera zvakawanda kana zvisingaiti zvepachirwere chironda chimwe chekukura kwechiremba kwemazana mashoma emakore apfuura. Utachiona husingaperi neHh pylori hunowanzozara. Inofungidzira ndeyokuti inenge 50 muzana yevanhu vose vane H. pylori mumatakiti avo ekumusoro. Uye zvinotendwa kuti izvi ndizvo zvave zviri munhoroondo yevanhu.

Kutsvakurudza kunoratidza kuti H. pylori anogona kutora vanhu kuti vape zvironda zvakasiyana-siyana, kusanganisira:

• Kuwedzerwa kuchengetedzwa kwemuviri acid
• Zvinokonzera kupisa
• Kuwedzeredza nzira dzekudzivirira dzedumbu
• Zvinokonzera gastric cells (iyo secrete acid uye pepsin) kukura mumucheka we duodenum

Chirwere cheAn H. pylori chinowanzoitika kune vanhu vane chironda chechirwere chechirwere. Inenge 75 kubva muzana yezvipembenene zveputi muUnited States zvinosangana nehutachiona huno-uye chiyero chakakwirira munyika isina kusimba. Kurambidza H. pylori chinhu chinokosha cherapi yehutachiona chechirwere.

Kushandiswa kusingaperi kweNSAIDs, kusanganisira aspirin, kunowedzera mukana wezvipembenene zvepasta nemakumi maviri. Vashandi veNSAID vanewo H. pylori (boka iro, zvakare, rinosanganisira zvinodarika hafu yevanhu vose) rinowedzera makumi matanhatu muhutachiona hwechirwere.

NSAID dzinofungidzirwa kuti dziwedzere ngozi yezvironda zvepaspin nekudzivisa COX-1 receptor mudenga repamusoro. Kuvhiringidzika kwe COX-1 kunoderedza kushandiswa kwemhando dzakasiyana-siyana dze prostaglandin dzinoshandiswa kuchengetedza ganda remuviri uye duodenum. (NSAIDs dzisingabvumi COX-1 receptor dzakagadzirwa, asi idzi dzakagamuchira mukurumbira wakaipa nekuda kwekuwedzera kuwedzera mumatambudziko emwoyo.)

Verenga zvakawanda pamusoro peNSAID uye mwoyo .

Vanhu vasina H. pylori vanogona kukura maronda epptic, kunyanya kana vakashandisa NSAIDs. Vanhu vasingashandisi NSAIDs vanogona kukura maronda epptic, kunyanya kana vane H. pylori. Asi vanhu vane zvinhu zviviri izvi zvinokonzerwa nehuwandu hwehutachiona hwehutachiona.

Kunyange zvazvo H. pylori uye NSAIDs nhoroondo yezvipembenene zvakanyanya zvechirwere, pane zvimwe zvakawanda zvinokonzera zvinokonzerawo. Izvi zvinosanganisira:

• Mamwe madhiragi (kunyanya steroids, clopidogrel , spironolactone , SSRIs, crack cocaine, methamphetamine, uye kunyange acetaminophen )
• Chemotherapy uye therapy rayation
• Zvirwere zvakasiyana-siyana zvinosanganisira Zollinger-Ellison syndrome uye carcinoid syndrome
• Zvimwe zvirwere, kusanganisira herpes simplex uye cytomegalovirus
• Chirwere chinopisa simba sarcoidosis uye Crohn's disease
• Doro rinoshandisa
• Kusvuta
• Chirwere chetachiona chirwere chinokonzera mishonga inopa dumbu kana duodenum
• Mamiriro ekusava neutano hwakanaka

Pasinei nezvamungave wakanzwa hupenyu hwako hwose, hakuna humwe uchapupu hwokuti kudya chero rudzi rwezvokudya zvakasiyana, zvakadai sezvokudya zvinonaka, zvinokonzera peptic ulcer chirwere. Iwe unogona kuwana kuti, iwe pachako, kudya zvimwe zvokudya zvinogona kuunza kuora mwoyo, indigestion, kana zvimwe zviratidzo zvepamuviri-uye kana zvakadaro, unofanira kuzvidzivirira. Asi iwe uri kuvadzivisa kuitira kuti uchinzwe zviri nani, kwete kudzivirira peptic ulcer chirwere.

Saizvozvowo, nyanzvi zvino dzinoderedza pfungwa yokuti zvipembenene zvinokonzerwa nehupenzi kana kusingaperi kushungurudzika mupfungwa, kufanana nekubata benzi anotsamwisa, kunze kwekuti kushungurudzika kuchikutungamirira iwe kusvuta, kunwa, kana kuisa mazano akawanda Advil.

Verenga zvakawanda pamusoro pezvinokonzera peptic ulcers.

Kuziva

Kuongororwa kuongororwa kwepectic ulcer chirwere kune zvinangwa zviviri zvakasiyana:

1. Kugadzira kuvapo kana kusavapo kwechirwere chinonzi cheptic ulcer
2. Kuongorora chikonzero chechirwere, kana chiripo

Kana zviratidzo zvako zviri zvinyoro, chiremba wako angangokuisa pane imwe nzira yekurapa kuti uvhare musimba acid. Kana zviratidzo zvako zvichienda uye usadzoka mushure mokunge chiyero chakareruka, izvo zvingava zvose zviripo kune iyo. Zvisinei, kana zviratidzo zvako zvisinganyanyi kuoma, kana kana zviratidzo zvako zvinodzoka mushure mokurapa kwenguva pfupi, kazhinji kacho pfungwa yakanaka yekuita tsanangudzo yekujekesa. Nhasi, izvi zvinoitwa zvakanyatsonaka uye zvakajeka nechinangwa chekupedzisira .

Ne endoscopy, iyo inogadziriswa yakazara ine fiberoptic system inopedzisira ichiputika uye ichipinda mudumbu-uye chidimbu chemuviri uye duodenum chinonyatsoratidzwa. Endoscopy inokurumidza uye yakarurama. Uyezve, kana chirwere chikavapo, kusuruvara kwayo kunogona kuongororwa uye kunogona kuongororwa chero zviratidzo zvekushaya mutezo-iyo inenge iine biopsy inogona kutorwa. Bhiopsy inobatsira zvikuru pakuona kana H. pylori aripo.

Dzidzo yepamusoro yeGI x-ray , achishandisa swallowed barium kugadzira kusiyana, inogonawo kushandiswa kuongororwa mavara epptic. Zvisinei, iyi miedzo haina kunyatsokwana kudarika endoscopy, inotora nguva yakareba, uye haipei mukana wei biopsies kuti uongorore kudarika kunogona kuitika kana H. pylori. Inosanganisirawo kupisa kwemavara. Nokuda kwezvikonzero izvi, x-rays haisisashandiswi kakawanda kuti iongorore chirwere chekuonda.

Kana chirwere chinonzi cheptic chiri kuonekwa, zvinokosha kuongorora kana chirwere cheH. H. pylori chiripo uye kuti NSAID inogona kuva chinhu. Idzi ruzivo rwakakosha pakusarudza pakurapa kwakakodzera.

Nzira yakanakisisa yekuona H. pylori ine bhaopsy yakawanikwa munguva yekupedzisira. Zvimwewo, urea breath breath ingashandiswa. H. pylori anovanza enzyme urease inokonzera urea yakawandisa-iyo inogona kuonekwa mumhepo. Kuongororwa ropa nekugadzika kwechigaro kunogona kushandiswawo kuona H. pylori.

Nemhaka yokuti NSAIDs (uye dzimwe nguva mimwe mishonga) inowanzoita basa rakakosha pakugadzirwa kwezvironda zveputi, zvakakosha kupa chiremba wako nhoroondo yakazara yemishonga yaunenge uchishandisa, mishonga yepamutemo kana kupfuura-the-counter.

Kana uine peptic ulcer uye usina hutachiona hweH H. pylori kana kushandiswa kweNSAID, chiremba wako angave achida kuita mamwe mazano ezvokurapa, achitarisa zvimwe zvinokonzera zvinokonzera. Muchizhinji chevanhu vane chirwere chechirwere chechirwere, zvisinei, izvi hazvidiwi.

Verenga zvakawanda pamusoro pekuongororwa peptic ulcers.

Kurapa

Mune zviitiko zvakawanda, zviputi zveputi zvinogona kubudirira kurapwa nemishonga inorapa. Nenzira yakawanda, kurapwa kwechiremba kune zvinhu zvitatu:

1. Kubvisa H. pylori
2. Kupa nzira yeproton pump inhibitor (PPI) therapy
3. Kubvisa zvinhu zvinoita kuti zviputi zvive

Kana kuongororwa kwakanaka kune H. pylori, kiyi yekubudirira kuporesa peptic ulonda chirwere ndechokubvisa utachiona nekambo remishonga inorwisa mabhakitiriya. Kazhinji, maviri anonzi antibiotic anoshandiswa kwemazuva manomwe kusvika ku14-kazhinji kacho clarithromycin, metronidazole, uye / kana amoxicillin.

Zvakakosha kudzokorora kuongororwa kwaH H. pylori mushure mokunge maitiro emishonga inorwisa mabhakitiriya kuratidza kuti chirwere chacho chaenda. Kana isiri iyo, imwe nzira yekurapa, kushandisa madhijirisi akasiyana kana madheji akasiyana, ichadiwa. Kukundikana kuporesa chironda, uye zvipembenene zvinowanzoitika, zvinowanzoitika kune vanhu vane H. pylori zvirwere hazvina kukodzera kurapwa.

Chirwere chinoporesa chinogonawo kukurudzirwa nekudzivisa kuchengetedza kwemuviri acid. Kana chironda chiripo chiripo, izvi zvinopedzerwa kuburikidza nekushandisa PPI, yakadai esomeprazole (Nexium) , pantoprazole (Prevacid), omeprazole (Prilosec) , kana rabeprazole (AcipHex). Kuderedza asidi mumudumbu hakusi kungobatsira chirwere kuporesa asiwo kunoita kuti mishonga inorwisa mabhakitiriya iwedzere kupikisa H. pylori. PPI kurapwa kazhinji inopfuurira kwevhiki masere kusvika ku12 kune vanhu vane chirwere chechirwere chechirwere.

Mukuwedzera pakunzvenga zvose zveNSAID, ani naani ane cheptic ulcer anofanirwa kumira kusvuta uye kuderedza doro kusingapfuuri kunwa kamwechete pazuva (kana izvozvo).

Pashure pemishonga inorwisa mabhakitiriya yakatorwa, H. H. pylori akaparadza, masvondo masere kusvika kune gumi nemaviri ekurapa kwePPI, uye kubvisa maitiro anokanganisa seASAIDs, mikana yekuporesa zvachose cheptic ulcer yakanakisisa-kazhinji inopfuura 90-95 muzana. Uyezve, njodzi yechirwere chekare inenge yakadzika.

Zvisinei, kana H. pylori isingagumi-kana kana ukaenderera mberi (kana kutanga) uchishandisa NSAIDS, kusvuta, kana kudya zvinodhaka zvakanyanya doro-kune mukana wakanaka kwazvo wekuonda achakundikana kuporesa kana kudzoka.

Nyanzvi nyanzvi dzinokurudzira kudzokorora endoscopy mushure mekurapa gondric ulcer kuvimbisa kuti kuporesa kwapera. Gastric ulcers dzimwe nguva inoumba panzvimbo yekenza yemukati- uye zvinogona kukosha kufungidzira nzvimbo iyo mushure mekurapa kuti ave nechokwadi chokuti nzvimbo yakaporesa inowanzoitika. Kazhinji hazvifaniri kukodzokorora endoscopy mushure mekurapwa kwechidheal ulcer.

Chirwere chisina kupora mushure memasvondo gumi nemaviri echirongwa chePPI chinonzi "refractory" ulcer. Kana iwe uine chirwere chechirwere chepamusoro pane imwe yechidzidzo chemavhiki gumi nemaviri ekupirisa kwePPI:

• Iwe unogona kunge uine imwe endoscopy ine biopsies yakawanda, uchitsvaga hutachiona hweH H. pylori, uye kuva nechokwadi kuti hapana chiratidzo chekuvhiringidza.
• Iwe unogona kunge uchinge uchitarisa zvakanyanya kurapwa kwekurapa kutsvaga zvisiri izvo zvinokonzera zvinokonzera peptic ulcer chirwere.
• Iwe unofanirwa kutarisira chiremba wako kuti aongorore kubvunzurudzwa kwakanyanya kwemaitiro ako pamusoro pekushandisa kweNSAID, kusvuta, kunwa, uye chero kumwe kumwe kushandiswa kwemishonga.

Zvose izvi zvinodiwa. Kutsvaga nzira yekurapa chironda chekudzivirira chinonyanya kukosha, sezvo vanhu vane zvipembenene zvisingatauri zviri nyore kukura imwe yezvinetso zvakashata zveplatin ulcer chirwere.

Ini ndakanga ndapfuura, kurapa kurapwa kwechirwere chechirwere chakanga chakajairika. Zvisinei, sezvo H. pylori yakawanikwa kuti inokosha uye inowanzokonzera chikonzero-uye sezvo simba remishonga yePPI rakagadzirwa-kuvhiyiwa kwave kusingowanzodikanwa.

Kuvhiya iko zvino kunonyanya kukosha kune zvipembenene zvinoratidza kuti hazvina kukodzera kurapwa, vanofungidzirwa kuti vane hutachiona, kana kuti kurapwa kwezvinetso zvechirwere chechirwere, kufanana nekubuda ropa, kudzivirira, kupera, kana fistula.

Verenga zvakawanda pamusoro pekurapa peptic ulcers.

Shoko Rinobva

Kunyange zvazvo chirwere chinonzi cheptic chirwere chikuru chinogona kuve nemigumisiro yakaipa, kufambira mberi mukurapa kwemakore mashoma mashoma apfuura zvakashandura zvakajeka kurapwa kwechiitiko ichi uye kufanirwa kwevanhu vane.

Kana iwe uine hutachiona hwechirwere chechirwere, chero bedzi iwe uchishanda nachiremba wako kuti ugadzirise chikonzero chinokonzera, chengetedza kutevera mwedzi miviri kusvika kumwedzi mitatu yemishonga inodhaka iyo inogona kunge yakatemwa, uye usapindwa mushonga-uye tsika-iwe uri Unofanirwa kudzivisa, pane mukana wakanaka kwazvo wekuti chionda chako chichaporesa zvachose uye hachizombodzoki.

> Sources:

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> Leodolter A, Kulig M, Brasch H, et al. Meta-kuenzanisa Kuenzanisa Kurasikirwa, Kuporeswa uye Kudzoka Mishonga muvarwere neHelicobacter pylori-inobatanidza Gastric kana Duodenal ulcer. Aliment Pharmacol Ther 2001; 15: 1949.

> Li LF, Chan RL, Lu L, et al. Kusvuta Kusvuta uye Utachiona Hwezvirwere: iC Causal Relationship uye Inowanikwa Maitiro Ema Molecular (Kudzokorora). Int J Mol Med 2014; 34: 372.

> Malfertheiner P, Megraud F, O'Morain CA, et al. Kutungamirirwa kweHelicobacter Pylori Infection - iyo Maastricht IV / Florence Consensus Report. Gut 2012; 61: 646.