Ukuguquka kwenhliziyo kungenzeka kusuka ku-GERD, okudinga ukuhlolwa okuhlelekile
Izimo oye wabhekana nokushaya kwenhliziyo ngesikhathi esithile empilweni yakho. Ezimweni eziningi, ukukhathazeka ozizwayo esifubeni sakho sekudlulele futhi kungase kuhambisane nokunambitheka kwe-asidi emlonyeni wakho, ukubhekwa ngokwemithi njengamanzi. Lezi zimpawu zingase zishiye zodwa noma zibe nemithi elula phezu kwe-counter.
Uma izimpawu zibe zihlala zingapheli noma zenzeke izikhathi ezimbili noma ngaphezulu ngesonto, noma kunjalo, ungase ube nesifo se-reflux ye-gastroesophageal (GERD) , okungadinga ukuhlolwa okungokomthetho okuphawulekayo kwezimpawu zomtholampilo, ukuhlolwa kwelebhu, nokucabanga.
Izimpawu zomtholampilo
Ukuxilongwa kwe-GERD kuvame ukusekelwe ezimpawu zomtholampilo. Ungamangali uma udokotela wakho ekucela ukuba uqedele uhlu lwemibuzo. I-GERD-Q i-Gastroesophageal Reflux Diaryase Questionnaire (GERD-Q) ukuhlolwa okuqinisekisiwe okuye kwaboniswa kwizifundo zokwelashwa ukuze kusize ukuxilongwa ngesilinganiso sokunemba samaphesenti angu-89.
I-GERD-Q ibuza imibuzo eyisithupha elula mayelana nemvamisa yezimpawu kanye nesidingo sakho sokwelashwa okungaphezu kwe-anti like antacids . Umbuzo ngamunye uthola ngezinsuku ezingu-0 (0 ngeviki) ukuya esikalini samaphuzu amathathu (izinsuku ezine kuya kweziyisikhombisa ngesonto). Izibalo ezingu-9 noma ngaphezulu zihambisana nokuxilongwa kwe-GERD.
Isivivinyo sokwelapha ukuxilongwa
Isinyathelo esilandelayo ekuhloleni kwakho ngokuvamile akusivivinyo nhlobo. Ngaphandle kokuba izimpawu zakho ziphakamisa ukukhathazeka ngesimo esibi nakakhulu, kungenzeka ukuthi udokotela wakho uzotusa isilingo sokwelapha.
Kulolu daba, udokotela wakho uzomisa i-proton pump inhibitor (PPI) ukuthi uthathe amasonto amane kuya kwangu-8.
Ama-PPI asebenza ngokunciphisa ukukhiqizwa kwe-asidi esiswini. Uma izimpawu zakho zithuthuka lapho amazinga e-asidi ehla, lokhu kuvame ukwanele ukuqinisekisa ukuxilongwa. Imithi kulesi sigaba ihlanganisa i- esomeprazole (Nexium) , i- omeprazole (Prilosec) , i-pantoprazole (i-Prevacid), noma i-rabeprazole (i-AcipHex). Eziningi zalezi mithi manje zitholakale ngaphezu kwekhawuntini.
Ama-Labs nezivivinyo
Ukungaqondakali okungajwayelekile ukuthi i- H. pylori , ibhaktheriya ehambisana nesifo sesilonda sesifo sofuba , nayo ibangela i-GERD. Ukucwaninga akubonanga ukuthi lokhu kuyiqiniso nokuhlola kungavunyelwanga. Ngokwenzayo, ukuphathwa kwe- H. pylori ukutheleleka akuncane ukwenza ngcono izimpawu ze-GERD.
Akusilo icala le-dyspepsia. Ngenkathi i-GERD ivame ukukhawulelwa ukugqunywa kwamanzi nokushaywa kwamanzi, i-dyspepsia iyisifo somtholampilo esibanzi. Kuhlanganisa nezinye izimpawu zamathumbu ezinjengezinhlungu eziphezulu zesisu, ukubhubhisa, ukucwenga, kanye nokudla okuncane, ngisho nokudla okuncane. Ukuhlolwa kweHl pylori kufanele kucatshangelwe kulezi zimo.
Ukuhlolwa kwe- H. pylori ukutheleleka kungenziwa ngenye yezindlela ezintathu.
- Ukuhlola ukuphefumula kwe-Urea: Isivivinyo sincike ekutheni i- H. pylori bacteria iphula urea ibe yi-carbon dioxide ne-ammonia. E-laboratory, uzofaka isampula ka-urea, njengokungathi uketshezi noma ithebhulethi, elandelele amanani we-carbon isotophi enomsakazo. Uzophefumula esitsheni lapho izinga lakho le-carbon dioxide lilinganiswa khona. Uma i- H. pylori ikhona, isotopu izotholakala kusampula.
- Gwema isilonda se-antigen: Uma unesifo se- H. pylori , amaprotheni avela kuma-bacteria azokwenziwa esitokisini sakho. I-enzyme immunoassays ingathola ukuthi ngabe ungenwe igciwane noma ngabe uhlola isampula sakho se-stool ne-antibodies ezibopha kulawo antigens.
- Ukuhlolwa kwe-Serology: Amasosha omzimba wakho enza ama-antibodies ngokumelene noHl pylori uma usulelekile. Ngeshwa, akulula ngaso sonke isikhathi ukuhumusha imiphumela ye-serology. Ama-antibodies e-IgM egazini angase akhombise ukutheleleka okusebenzayo kodwa ama-antibiotic a-IgG angabonisa ukuthi uyagula noma esekudala.
Ukuhlola ukuphefumula kwe-urea kanye nesilingo se-antigen yesilwane yizivivinyo ezithandwayo zokutheleleka okusebenzayo. Ngenxa yokuthi i-PPIs, i- bismuth subsalicylate (i- Pepto -Bismol) , kanye nama-antibiotics angaphazamisa ukunemba kwemiphumela, kutuswa ukuthi ungathathi lemithi okungenani amasonto amabili ngaphambi kokuhlolwa kwakho. Indawo yokubhubhisa izokunikeza imiyalelo yokuthi ungalungisa kanjani.
Ukucabanga
Uma uhlulekile ukuhlolwa kwesifo sokuhlonza, okusho ukuthi usenayo izimpawu, ungadinga ukuhlolwa okuqhubekayo. Kungenzeka ukuthi unesihluku esinamandla kakhulu se-GERD, izinkinga ezivela ku-GERD , noma esinye isizathu sezibonakaliso zakho zokushaya inhliziyo. Kuleli qophelo, udokotela wakho uzodinga ukuhlolisisa indlela osebenza ngayo futhi ukuthi isebenza kanjani kahle.
I-Endoscopy Ephezulu
Ucwaningo oluvame kakhulu lwe-imaging luyi- endoscopy engenhla , ebizwa nangokuthi i-esophagogroduodenoscopy (EGD). Ucwaningo lwenziwe ngaphansi kwesilwane.
Isimo esincane sokuguquguquka esinomthombo wekhamera nomthombo wokugcina ekugcineni kufakwa emlonyeni wakho futhi siqondiswe phansi kwesisu ngaphakathi esiswini nasengxenyeni engenhla ye duodenum, ingxenye yokuqala yamathumbu amancane. Lokhu kuvumela udokotela, ngokuvamile u-gastroenterologist, ukuba acabange ngokuqondile ngaphakathi kwalezi zitho futhi athathe i-biopsies noma enze izinqubo njengoba kudingekile ngokusekelwe ekutholeni kwakhe. Ama-sampuli we-tishu nawo angaqoqwa ukuhlolwa kwe-H. pylori .
Isivivinyo siwusizo kakhulu ekutholeni izinkinga ezivela ekungcoleni okukhulu kwe-asidi. Ukuxoshwa kwesisu (ukuvuvukala kwesisu) kanye nokuqina kwesigqila (ukunciphisa umzimba) kungathuthuka, okuholele ekubhebhekeni kwenhliziyo kanye nezinye izimpawu. Isifo sikaBarrett , isimo esibangela ingozi yakho yomdlavuza we- esophageal , enye, nakuba engavamile, ingcindezi.
Izinkinga ezivela endoscopy engenhla ngokwayo azivamile kodwa zenzeke. Siyabonga ukuthi lokhu kwenzeka kuphela ngo-0.15 wamaphesenti wesikhathi. Ukuhlukunyezwa okuvame ngokwengeziwe kungukukhala kwezinyembezi kodwa kungenzeka ukuba kwenzeke lapho kwenziwa inqubo, njengokuhlunga okuyi-esophageal . Ezinye izinkinga okumelwe zicatshangelwe yizifo ezivela endoscope noma ukuphuma kwegazi ezingase zenzeke ezindaweni ze-biopsy.
Ukuhlola ukuhlolwa kwe-pH Esophageal nokuHlola
Izinga legolide lokuhlola i-GERD liwukuqapha kokuqapha kwe-pH . Inkinga ingaba isikhathi esiningi futhi engathandeki. Akumangalisi ukuthi ayisetshenzisiwe njengethuluzi lokuqala lokuxilonga. Esikhundleni salokho, kwenziwa uma ezinye izifundo ezibalwe ngenhla zingalungile futhi udokotela kudingeka aqinisekise ukuthi kunenkinga ye-acid reflux ebangela izimpawu zakho.
Lesi sifundo senza ukuthi i-asidi ingena kanjani ku-esophagus. Ixhomeke ku-catheter encane ene-pH sensor ekupheleni kwesinye kanye nedivayisi yokurekhoda komunye. I-catheter ifakwa emphunjini futhi iqondiswe emgodini ukuze ihlale ngaphezu kwe-sphincter esezansi ephansi (LES) . Ngokwemvelo, i-LES ihlukanisa isisu kusukela esiswini.
I-catheter ishiywe endaweni yamahora angu-24. Ilinganisa izinga le-pH ngesikhathi se-LES. Ungakwazi futhi ukulinganisa inani lokudla nezinye izinto zesisu esisodwa esizikhohlisayo kulokho okubizwa ngokuthi ukuhlolwa kwe-impedance. Phakathi nalesi sikhathi, uceliwe ukuba ugcine idayari yezibonakaliso zakho nokudla kokudla. Uma isikhathi siphelile, idatha iqoqiwe kusuka enzwa futhi ihambisana nedayari yakho.
I-Acid ichazwa nge-pH ngaphansi kuka-7.0. Ngenhloso yokuxilonga, i-pH engaphansi kwamaphesenti angu-4 iqinisekisa ukuxilongwa kwe-GERD uma kwenzeka amaphesenti angu-4.3 noma ngaphezulu kwesikhathi. Lokhu okungenani, icala, uma ungathathi i-PPI. Uma uthatha i-PPI, ukuhlolwa kwakho kubhekwa njengokwejwayelekile uma i-pH yakho ikhona kulesi sikhawu esingu-1.3 amaphesenti wesikhathi.
Kukhona inguqulo ye-capsule yokuqapha kwe-pH, nakuba ukuhlolwa kwe-impedance akuyona inketho ngale ndlela. I-capsule ifakwe ku-esopha ngesikhathi se-endoscopy engenhla futhi idatha iqoqwe ngaphandle kwentambo. Amazinga we-Acid alinganiselwa emahoreni angu-48 kuya kwangu-96. Asikho isidingo sokuba enye i-endoscopy ukususa i-capsule. Ngakapheli isikhathi sesonto, idivayisi iwa isisindo futhi ixhunyiwe esitokisini. Ngenkathi ukuhlolwa kunembile kune-catheter yendabuko yokuhlola i-pH, kubuye kungene futhi kuyabiza kakhulu.
I-Manometry Esophageal
Udokotela wakho angase asole ukuthi isifo se-motility esophageal senza ukushaya kwenhliziyo yakho. Uma udla, ukudla kudlula emlonyeni wakho kuya esiswini sakho, kodwa kuphela ngemva kochungechunge oludidiyelwe lokunyakaza kwemisipha. Imisipha ehlanganisa i-esophagus isondeza ukudla phambili kwinqubo eyaziwa ngokuthi i- peristalsis .
Ama-sphincters angaphezulu futhi aphansi abuye avule futhi avalwe ngezikhathi ezifanele ukuhambisa ukudla phambili noma ngokunye ukuvimbela ukudla ekuhambeni kwesinye isiqondiso. Noma yikuphi ukungalungi kulezi zinyathelo kungaholela ekubuneni ukugwinya, ubuhlungu besifuba noma ukushaya inhliziyo.
I-Manometry ingumhlola ohlola umsebenzi we-motility. I-tube encane ifakwe emakhaleni akho futhi iqondiswa ngokusebenzisa isisu sakho nasesisu. Izinzwa eceleni kwebhulegi zibona ukuthi inkontileka yemisipha ikugwinya kangakanani uma ugwinya. Ngeke uphenduke ngesikhathi sokuhlolwa ngoba uzocelwa ukuba ugweme amanani amancane amanzi. Udokotela wakho uzolandela ukuhlanganiswa kanye namandla wezinyosi zokugaya izifo lapho ugwinya. Konke, ukuhlolwa kuvame ukugcina amaminithi angu-10 kuya kwangu-15 kuphela.
Ngenkathi i-manometry ingasiza ekuxilongweni kwe-GERD, kuyasiza kakhulu ukuxilonga ezinye izinkinga ze-motility ezifana ne- achalasia ne-spasm esophageal.
I-Barium Swallow
Ukugwinya kwe-barium kungase kungabi yilingo oluhle kakhulu lokuhlola i-GERD, kodwa lingabheka ukuqina kokungalingani, ukuxilongwa kwe-GERD. Ucwaningo lubuye luwusizo ekwakhekeni isifo sokubeletha esiyingozi noma sokukhubazeka kwe-motility disorder okungabangela izimpawu zokugubha.
Isivivinyo senziwa ngokuthatha uchungechunge lwe-x-ray ngenkathi uphuza udayi opaque okuthiwa i-barium. I-barium ibonakala imnyama nge-x ray ngaphezu kwamathambo akho kanye nezicubu, okwenza kube lula ngodokotela wakho ukulandela imisipha ukunyakaza ngokusebenzisa isisindo. Ukungafani kahle kwe-anatomic kulesi sigameko kungabonakala ngale ndlela.
Ukuhlonza okuhlukile
Ukuvuthwa kwenhliziyo kuvame kakhulu kodwa akusiyo njalo ku-GERD. Njengoba kuxoxwe, kungabuye kuhlotshaniswe no-dyspepsia, i- H. pylori ukutheleleka, kanye nesifo somzimba. Ezinye izimo okufanele zicatshangelwe zihlanganisa ukukhathazeka kwe-motility esophageal efana ne-achalasia ne-spasm esophageal.
Esimweni esibucayi nakancane, kungenzeka ukuthi umdlavuza we-esophageal uyasola. Ngenxa yalesi sizathu, kunconywa ukuthi ubone udokotela wakho uma unesifo sezinkinga zokushaya inhliziyo esiyingozi noma esenzeka ngaphezu kwezikhathi ezimbili ngesonto.
> Imithombo:
> Alzubaidi M, Gabbard S. UGERD: Ukuqaphela Nokuphatha Ukushisa. I-Cleve Clin J Med. 2015 Oct; 82 (10): 685-92. doi: 10.3949 / ccjm.82a.14138.
> Anderson WD 3rd, i-Strayer SM, i-Mull SR. Imibuzo evamile mayelana nokuPhathwa kwezifo ze-Reflux ze-Gastroesophageal. Am Fam Physician. 2015 Meyi 15; 91 (10): 692-7. https://www.ncbi.nlm.nih.gov/pubmed/25978198.
> Cohen J. Uhlolojikelele lwe-Endoscopy Yokugaya Emathunjini Ephezulu (Esophagogastroduodenoscopy). Ku: Grover S. UpToDate [Inthanethi] , Waltham, MA. Kubuyekezwe u-Agasti 4, 2015.
> I-Fass R. Indlela Yokubhekana Nezifo Ze-Reflux Yokugaya I-Gastroesophageal in Adult. Ku: Grover S. (ed), UpToDate [Inthanethi] , Waltham, MA. Kubuyekezwe ngomhla ka-6 Mashi, 2018.
> Jonasson C1, Wernersson B, Hoff DA, Hatlebakk JG. Ukuqinisekiswa kwe-Questionnaire ye-GerdQ yokuthola isifo se-Reflux ye-Gastro-Oesophageal. Ukudla Pharmacol Ther. 2013 Mar; 37 (5): 564-72. i-doi: 10.1111 / apt.12204.