Ciwon ciki na esophageal reflux cuta (GerD) cuta ce ta gama gari a cikin sashin narkewar abinci.Yaduwarta da hadaddun bayyanar cututtuka na asibiti suna da tasiri mai tsanani akan rayuwar marasa lafiya.Kuma kumburin hanji na yau da kullun yana da haɗarin haifar da ciwon daji na esophageal.Yadda za a tantance daidai da daidaitattun jiyya shine mayar da hankali ga aikin asibiti.
02 Bayyanar cututtuka na GERD
Ana iya raba GERD zuwa reflux mara-eroded (NERD), reflux esophagitis (RE) da Barreta esophageal (BE) bisa ga endoscopy.
NERD: Barrett esophagus da bayyanannen mucosa na esophageal sun lalace a ma'anar Gerd amma endoscopy ya lalace.
Sake: Endoscopy na iya ganin mucosa na ciki-esophageal wanda ke da alaƙa da esophagus ko sama.Mucosa yana lalacewa ta lokaci-lokaci.
BE: Ƙwararren ƙwayar ciki-esophageal squamous epithelial part na esophagus-kamar epithelium na esophagus dangane a endoscopy an maye gurbinsu da cylindrical epithelium.
02 Bayyanar cututtuka na GERD
Bugu da ƙari ga ƙonewar zuciya da reflux, alamu kamar ciwon ƙirji, ciwon ciki na sama, da mu'ujiza mai banmamaki, tari, asma da sauran alamun hanji na iya faruwa.
Ya kamata a lura cewa marasa lafiya tare da tsofaffi marasa lafiya na GerD suna da ƙananan ƙwayar zuciya da reflux.Yawan bayyanar cututtuka a cikin bututu mai cirewa yana da yawa.Alamun ba na al'ada ba ne, ko ma asymptomatic.Girman alamun ba daidai ba ne da tsananin cutar.Factory Guiyu yana da lebur, kuma lokacin da yake likita, an haɓaka shi a Guangli.
03 Binciken GERD
Hoto.Alamomin GerD na yau da kullun da alamomin narkar da abinci na sama suna fama da taswirar bincike na GERD Source: Associationungiyar Likitocin China
Gwajin bincike na wakili na hana acid
Ga marasa lafiya gerd (wanda aka fi amfani da PPI), daidaitaccen adadin zai wuce makonni 2 (waɗanda ke da alamun bayyanar da ke waje da bututu suna buƙatar ɗaukar makonni ≥4).Idan bayyanar cututtuka sun sami sauƙi gaba ɗaya ko kuma kawai bayyanar cututtuka guda ɗaya kawai aka tabbatar da tasiri.
2) Endoscopic
-Re-Los Angeles an raba shi zuwa maki (duba hoton da ke ƙasa):
Class A: 1 ko fiye da lalacewar mucosal na esophageal, lalata tsawon ≤5 mm;
Matsayin B: 1 ko fiye da lalacewar mucosal na esophageal, lalata tsawon> 5 mm, lalacewar mucous membrane kuma babu haɗuwa;
Class C: Akalla mucosa na esophageal guda 2 ya lalace, kuma mucosa ya lalace tare da juna.
Class D: Yana nufin lalacewar mucosa da haɗin kai na juna, kuma kewayon fusion shine 75% na esophagus.
-BE dabarar biopsy: Ana ba da shawarar cewa akwai biopsy da yawa da gajere, kuma ana samun biopsy ta tazara 1cm a kusa da murhu.Girman kewayon yana da alaƙa da haɗarin ciwon daji, kuma haɗarin ciwon daji yana ƙaruwa kuma yana haɓaka kewayon 3cm.
3) Ma'auni mai mahimmanci na esophageal
Marasa lafiya tare da GerD sau da yawa suna bayyana a matsayin ikon esophageal mara amfani: rabon 70% ko raunin peristalsis na 70% ko peristalsis shine ≥50%.
Anti-current monitoring
Ma'auni ne don gano cutar CEDD.Matsakaicin zinare ne na ganewar asali, gami da saka idanu na esophagus ƙi idan aka kulla saka idanu na esopnh ƙimar kulawa.Adadin pH <4 (lokacin bayyanar acid, AET)> 4% a cikin 24H, ana la'akari da cewa akwai kumburin acid.
04 Maganin GERD
Hoto .Taswirar hanyoyin jiyya na Gerd
Source: kungiyar likitocin kasar Sin
Matakan kariya:
-PPI da P-CAB sune zabi na farko don maganin farko da kula da marasa lafiya tare da Gard.Maganin farko na maganin PPI shine makonni 8 kuma maganin P-CAB shine ≥4 makonni.
-Ga marasa lafiya tare da ci gaba da dare (lokacin shan PPI, pH <4 lokaci> 1H a cikin dare na dare), zaka iya amfani da masu hana masu karɓar H2 kafin ka kwanta a kan tushen PPI, ko canza zuwa P-CAB. da tsawo.Rabin-rai magani PPI.
Ana iya amfani da wakili na anti-acid da magungunan gastrointestinal aiki don ɗan gajeren lokaci aikace-aikace don gaggauta rage alamun rashin jin daɗi kamar ciwon zuciya da reflux.
Alamar maganin endoscopic: ganewar asali na GERD a bayyane yake, maganin acidic ba shi da inganci, rashin son shan magani na dogon lokaci, ko halayen da suka shafi kwayoyi, kuma ba zai iya jurewa ba.
- Alamar maganin tiyata ta tiyata: akwai alamun alamun GerD na yau da kullun, maganin PPI ba shi da inganci;endoscopy yana gano hernia na esophageal, BE, RE, Los Angeles maki ko sama;Binciken X-ray ya gano cewa akwai hernia rami na esophageal.
Lokacin aikawa: Maris 21-2024