Ukuguquka kwenkunzi kuvela kwi-GERD, efuna ukuhlolwa ngokusemthethweni
Izibakala sele uzibone ukukhwabanisa ngexesha elithile ebomini bakho. Kwiimeko ezininzi, ukungahambi kakuhle kwakho kwisifuba sakho siphezulu kwaye kunokuhamba kunye ne-asidi ukunambitha emlonyeni wakho, ngokubhekiselele kwizonyango ngokubhekiselele kumanzi. Ezi zimpawu zingase zihambe ngokwazo okanye ngeyeza ezilula kwi-anti-counter.
Nangona iimpawu zibe zihlala zingapheliyo okanye ziba zihlandlo ezimbini okanye ngaphezulu ngeveki, nangona kunjalo, unokuba nesifo se-reflux yesifo se-gastroesophageal (GERD) , esingafuna ukuvavanya ngokusemthethweni kweempawu zeklinikhi, iimvavanyo zelabhu kunye nokucinga.
Iimpawu zoKliniki
Ukuxilongwa kweGERD ngokuqhelekileyo kusekelwe kwiimpawu zeklinikhi. Ungamangaliswa ukuba ugqirha wakho ekucela ukuba uzalise le mibuzo. Umbuzo we-Gastroesophageal Reflux Disease Questionnaire (GERD-Q) luvavanyo oluqinisekisiweyo oluye lwaboniswa kwizifundo zekliniki ukukunceda ukuxilongwa ngezinga elichanekileyo lama-89 ekhulwini.
I-GERD-Q ibuza imibuzo emithandathu elula malunga neempawu zeempawu kunye nemfuno yakho yonyango olongezelelekileyo njengama- antacids . Umbuzo ngamnye ufunyenwe kwi-0 (0 iintsuku ngeveki) ukuya kwisikali sesithathu (kwiintsuku ezine ukuya kwezisixhenxe ngeveki). Izikolo ezithoba okanye ngaphezulu zihambelana nokuxilongwa kweGERD.
Uvavanyo lweNyango yokuThengisa
Isinyathelo esilandelayo ekuvavanyeni kwakho kaninzi aluvivinywa nonke. Ngaphandle kokuba iimpawu zakho ziphakamisa inkxalabo yimeko enzulu kakhulu, kunokwenzeka ukuba ugqirha wakho uya kuncomela ityala lonyango.
Kule meko, ugqirha wakho uya kumisela iproton pump inhibitor (PPI) ukuba uthathe iiveki ezine ukuya kweebhozo.
I-PPIs isebenza ngokukhupha i-acid production kwisisu. Ukuba iimpawu zakho ziphucula xa amanqanaba e-asidi eyancipha, oku kudla ngokwaneleyo ukuqinisekisa ukuxilongwa. Amachiza kule candelo abandakanya i- esomeprazole (Nexium) , omeprazole (Prilosec) , i-pantoprazole (Prevacid), okanye i-rabeprazole (AcipHex). Uninzi lwala mayeza luzafumaneka kwi-counter.
IiLabs kunye novavanyo
Ukungaqondi kakuhle oku kukuthi uHl pylori , ibhaktheriya ehambelana nesifo sesilonda esiswini , nayo ibangela i-GERD. Uphando alubonakalanga ukuba luyinyaniso kwaye ukuhlolwa ngokuqhelekileyo akukhuthazwa. Ngokwenza oko, unyango lwe- H. pylori sulelo alukwazi ukuphucula iimpawu ze-GERD.
Akusiyo imeko ye-dyspepsia. Nangona i-GERD ivame ukukhawulelwa ekuphefumuleni nasekuhambeni kwamanzi, i-dyspepsia yintsholongwane yeklinikhi ebanzi. Iquka ezinye iimpawu zesisu ezinjengentlungu ephezulu yamathumbu, ukubhubhisa, isicupunu, kunye nokusabalalisa kwangaphambili, kunye nexabiso elincinci lokutya. Uvavanyo lweHl pylori kufuneka luqwalaselwe ngala maxesha.
Uvavanyo lwe- H. pylori sulelo lungenziwa ngenye yeendlela ezintathu.
- Urea uvavanyo lokuphefumula: Uvavanyo luxhomekeke ekubeni i- H. pylori ibterteria iphula urea ukuya kwi-carbon dioxide kunye ne-ammonia. Kwisibonelelo sebhubhoratri, uya kudla isampula yerea, mhlawumbi njengelwelo okanye i-tablet, elandelelanisa inani le-isotopu e-radioactive ene-carbonate. Uya kuphefumula kwisitya apho iqondo lakho likarbon dioxide lilinganiswa khona. Ukuba uHl pylori ukhona, i-isotope iya kufunyanwa kwisampuli.
- Isilingo se-antigen yesitoreli: Ukuba unesifo sikaHl pylori , iiprotheyini ezivela kwibhaktheriya ziya kukhutshwa kwisigxina sakho. I-enzyme immunoassays iyakwazi ukubona ukuba ngaba unesifo se-sampuli yakho kunye ne-antibodies ezibophelele kwii-antigen.
- Ukuhlolwa kwe-Serology: I-immune system yenza i-antibodies malunga noHl pylori ukuba unesifo. Ngelishwa, akusoloko kulula ukutolika iziphumo ze-serology. Ama-antibodies e-IgM egazini angabonisa ukuba usulelo olukhuselekileyo kodwa i-IgG antibiotics inokumela ukutheleleka okanye ukusuleleka.
Uvavanyo lokuphefumula i-urea kunye nesilingo se-antigen test (test anti) Ngenxa yokuba i- PPIs , i- bismuth subsalicylate (i-Pepto-Bismol) , kunye ne-antibiotics inokuphazamisa ukuchaneka kweziphumo, kuyacetyiswa ukuba ungayithathi le miyeza ubuncinane kwiiveki ezimbini phambi kovavanyo lwakho. Iziko lebhubhoratri liya kukunika imiyalelo malunga nendlela yokulungiselela ngokufanelekileyo.
Ukucinga
Ukuba awuphumelelanga uvavanyo lwezonyango, oko kuthetha ukuba usenayo impawu, unokufuna iimvavanyo ezingaphezulu. Kungenzeka ukuba unesihluku esinamandla ngakumbi se-GERD, iingxaki ezivela kwi-GERD , okanye enye imbangela yezibonakaliso zakho zentlungu. Kule ngxaki, ugqirha wakho uya kufuna ukujonga ngokuthe xaxa kwi-esophagus yakho kunye nendlela esebenza ngayo.
Endoscopy ephezulu
Ucwaningo oluqhelekileyo lwe-imaging luyi- endoscopy ephezulu , ebizwa ngokuba yi-esophagogroduodenoscopy (EGD). Uphononongo lwenziwe phantsi kobude.
Ubume obuncinane obuguquguqukayo kunye nekhamera kunye nomthombo wokukhanya ekugqibeleni kufakwe emlonyeni wakho kwaye ukhokelwa phantsi kwesisu kwisisu nasekwinqweleni le-duodenum, inxalenye yokuqala yomathumbu amancinci. Oku kuvumela ugqirha, ngokuqhelekileyo isifo se-gastroenterologist, ukujonga ngokucacileyo ngaphakathi kwala malungu nokuthatha i-biopsies okanye ukwenza inkqubo njengoko kuyimfuneko ngokusekelwe kwiziphumo zakhe. Iisampuli zamathambo nazo ziyakuqokelelwa kuH. pylori .
Uvavanyo luncedo kakhulu ekufumaneni iingxaki ezivela kwi-acid exhaustation . I- esophagitis (ukuvuvukala kwe-esophagus) kunye nokuqhaqhazeka kwe- esophageal (ukunciphisa i-esophagus) kunokuphuhliswa, okukhokelela ekubanjeni kwentsholongwane kunye nezinye iimpawu. Isisindo seBarrett , imeko eyenza umngcipheko wakho ube ngumdlavuza wongxowankulu , enye enye, nakuba ingaqhelekanga, ingxaki.
Iingxaki ezivela kwi-endoscopy ephezulu ngokwazo aziqabile kodwa zenzeke. Ngombulelo, oku kwenzeka kuphela kwi-0.15 yeepesenti yexesha. Inkxalabo eqhelekileyo yinkxwaba kwi-oopopus kodwa kungenzeka ukuba yenzeke xa inkqubo, njengento yokuphucula i-esophageal , iyenziwa. Ezinye iingxaki ezifunekayo ukuba ziqwalaselwe zizifo ezivela kwi-endoscope okanye ukuphuma kwegazi ezinokuthi zenzeke kwiindawo ze-biopsy.
Ukuhlola i-Esophageal pH yokuHlola nokuPhelelwa kweNdleko
Umgangatho wegolide wokuxilonga i-GERD uhlola ukuhlolwa kwe-pH . Ingxaki yinto engadla ixesha kwaye ingonakalisi. Akumangalisi ukuba ayisetyenzisiwe njengethuluzi lokuqala lokuxilonga. Kunoko, kwenziwa xa ezinye izifundo ezikhankanywe ngasentla zingekho kwaye ugqirha kufuneka aqinisekise ukuba kukho ingxaki ye-acid reflux ebangela iimpawu zakho.
Olu pho nonongo lubonisa ukuba ingakanani i-asidi ingena kwi-esophagus. Ixhomekeka kwi-catheter encinci eneqondo le-pH ekupheleni kwesinye kunye nedivayisi yokurekhoda kwenye. I-catheter ifakwa kwimpumlo kwaye ikhokelwe kwisigxu ukuze ihlale phezu kwe- sphincter esezantsi (LES) . I-Anatomically, i-LES ihlukanisa isisu ukusuka esiswini.
I-catheter ishiywe endaweni yeeyure ezingama-24. Ilinganisa izinga le-pH kwixesha le-LES. Iyakwazi ukulinganisa inani lokutya kunye nezinye iziqulatho zesantya ezithintela kwi-esophagus kwizinto ezibizwa ngokuba yi-impedance test. Ngeli xesha, ucelwa ukuba ugcine idayari yeempawu zakho kunye nokutya kokutya. Emva kwexesha, idatha iqokelelwa kwi-sensor kwaye ihambelana nedayari yakho.
I-Acid ichazwa nge-pH ngaphantsi kwe-7.0. Ngeenjongo zokuxilonga, i-pH engaphantsi kwama-4 ekhulwini iqinisekisa ukuxilongwa kweGERD ukuba kwenzeka 4.3 ekhulwini okanye ngaphezulu kwexesha. Oku, ubuncinane, ityala xa ungathathi iPPI. Ukuba uthabatha i-PPI, uvavanyo lwakho lujongwa ngokungavamile xa i-pH yakho kule dilesi 1.3 iphesenti yexesha.
Kukho kwakhona i-capsule version ye-pH yokubeka iliso, nangona ukuhlolwa kwe-impedance ayikho inketho ngale ndlela. I-capsule ifakwe kwi-oopopus ngexesha lokugcina i-endoscopy kwaye idatha iqokelelwa ngaphandle. Amanqanaba e-Acid alinganiswa ngaphezu kwama-48 ukuya kuma-96 iiyure. Akukho sidingo sokuba enye i-endoscopy ukususa i-capsule. Ngethuba leveki, ifowuni iyawa kwi-esophagus kwaye igxothwe kwisigxina. Nangona uvavanyo luchanekile ngakumbi kunomthamo wendalo we-pH uvavanyo, luyavakala kakhulu kwaye lubiza kakhulu.
I-Manophyge yase-Esophageal
Ugqirha wakho usenokukrokrela ukuba i- disophogeal motility disorder idala ukutshiza kwakho. Xa udla, ukutya kudlula emlonyeni wakho kwisisu sakho, kodwa kuphela emva kwechungechunge lwee-muscle movements. Imisipha efaka i-esophagus isondeza ukutya phambili kwinkqubo ebizwa ngokuba yi- peristalsis .
I-sphincters esezantsi neyezantsi kufuneka ivule kwaye ivalwe ngamaxesha afanelekileyo ukuhambisa ukutya ngokubhekiselele okanye mhlawumbi ukukhusela ukutya ekuhambeni kwinqanaba elibuyela ngasemva. Nasiphi na ukungatyikiyo kwezi ntshukumo kunokukhokelela ekubeni kunzima ukugwinya, intlungu yesifuba, okanye intlungu.
I-Manometry ngumvavanyo ovavanya umsebenzi we-motility. Intshubhu encinci ifakwe kwisipumlo sakho kwaye ikhokelwe kwisifo sakho kunye nesisu. Iimvakalelo ezikwiphepha le-tube zibona ukuba izivumelwano zesikhumba zisebenza njani xa ugxina. Ngeke udideke ngexesha lovavanyo kuba uya kucelwa ukuba ugqibe amanani amancinci amanzi. Ugqirha wakho uza kulandelelanisa ukulungelelanisa kunye namandla okuqhaqhazeka kwemisipha njengoko uginya. Konke, uvavanyo luhlala luseminye imizuzu eyi-10 ukuya kwe-15 kuphela.
Nangona i-manometry ingakunceda ukuxilonga i-GERD, kunceda kakhulu ukuxilonga ezinye izifo zengqondo ezifana ne- achalasia kunye ne-esophageal spasm.
Barium Swallow
Ingxube ye-barium ingabi yinto efanelekileyo yokuvavanya ukujonga i-GERD, kodwa iyakwazi ukubheka izinto ezixhomekeke kuzo, ingxaki yeGERD. Uphononongo luye luncedo ekuboneni i- hernia yokuzala okanye i-esophageal distility disorder engabangela ukuba izibonakaliso zentlungu.
Uvavanyo luyenziwa ngokuthatha uluhlu lwe x-ray ngelixa usela idayi e-opaque ebizwa ngokuba yi-barium. I-barium ibonakala yinto emnyama kwi-x ray ngaphandle kwamathambo akho kunye nezicubu, okwenza kube lula ugqirha wakho ukulandela intshukumo ye-muscle ngokusebenzisa i-esophagus. Ukungaqhelekanga kwe-Anatomic kwipopu kuya kubonakala ngale ndlela.
Ukuxilongwa ngokungafani
Ukuguquka kwenkunzi kudla ngokuqhelekileyo kodwa akusoloko kubangelwa yiGERD. Njengoko kuxoxwa ngayo, kunokunxulumana nokudyspsia, ukukhulelwa kweH H. pylori , kunye ne-esophagitis. Ezinye iziganeko zokuqwalasela ziquka ukuphazamiseka kwemizimba yezilwanyana ezifana ne-achalasia kunye ne-spasm esophageal.
Kwiimeko ezinzima nakwimeko encinci, umhlaza wesifo sogqirha ungasimangalela. Ngenxa yoko, kucetyiswa ukuba ubone ugqirha wakho ukuba unempawu zokuqhaqhazela okanye ezinokuphindwe kabini ngeveki.
> Imithombo:
> Alzubaidi M, Gabbard S. UGERD: Ukuchonga nokuPhatha ukutsha. Cleve kliniki J Med. 2015 Oct; 82 (10): 685-92. i-doi: 10.3949 / ccjm.82a.14138.
> Anderson WD 3rd, Strayer SM, Mull SR. Imibuzo eqhelekileyo malunga nokuLawula i-Gastroesophageal Reflux Disease. I-Phys Physician. 2015 Meyi 15; 91 (10): 692-7. https://www.ncbi.nlm.nih.gov/pubmed/25978198.
> Cohen J. Ukwahlula kwe-Endoscopy ye-Gastrointestinal Endoscopy (Esophagogastroduodenoscopy). Ku: Grover S. UpToDate [Intanethi] , Waltham, MA. Ukuhlaziywa ngo-Agasti 4, 2015.
> I-Fass R. Indlela eya kwi-Refractory Gastroesophageal Reflux Izifo kwiBantu abadala. Ku: Grover S. (ed), UpToDate [Intanethi] , Waltham, MA. Ukuhlaziywa kweyoKwindla 6, 2018.
> Jonasson C1, Wernersson B, Hoff DA, Hatlebakk JG. Ukuqinisekiswa kwemibuzo yeGerdQ yokuHlola i-Gastro-Oesophageal Reflux. I-Pharmacy Ther. 2013 Mar; 37 (5): 564-72. i-doi: 10.1111 / apt.12204.