Gastric esophageal reflux chirwere (GerD) chirwere chinowanzoitika mudhipatimendi rekugaya.Kuwanda kwayo uye kwakaoma kuratidzwa kwekiriniki kune kukanganisa kwakakomba pahupenyu hwevarwere.Uye kusingaperi kuzvimba kwesophagus kune njodzi yekukonzera gomarara resophageal.Maitiro ekunyatso ongorora uye kuenzanisa kurapwa ndiyo inotariswa yebasa rekiriniki.
02 GERD yekiriniki zviratidzo
GERD inogona kukamurwa kuita isiri-roded reflux (NERD), reflux esophagitis (RE) uye Barreta esophageal (BE) zvinoenderana neendoscopy.
NERD: Barrett esophagus uye yakajeka esophageal mucosa yakakuvadzwa mukutsanangurwa kweGerd asi endoscopy yakakuvadzwa.
Re: Endoscopy inogona kuona mudumbu-esophageal mucosa yakabatana nesophagus kana pamusoro.Iyo mucous membrane inokuvadzwa nepakati.
BE: The gastric-esophageal squamous epithelial chikamu chesophagus-like epithelium yesophagus connection pa endoscopy inotsiviwa ne cylindrical epithelium.
02 GERD yekiriniki zviratidzo
Pamusoro pekupisa kwemoyo uye reflux, zviratidzo zvakadai sekurwadziwa kwechipfuva, kurwadziwa kwepamusoro pedumbu, uye chishamiso chegurokuro, chikosoro, asima nezvimwe zviratidzo zvegurokuro zvinogona kuitika.
Izvo zvinofanirwa kucherechedzwa kuti varwere vane vakwegura GerD varwere vane yakaderera chiitiko chemoyo uye reflux.Chiitiko chezviratidzo muextractive tube chakakwira.Zviratidzo hazvisi zvakajairika, kana kunyange asymptomatic.Kuoma kwezviratidzo hakuenderane nekuoma kwechirwere.Fekitari Guiyu yakanga yakati sandara, uye paakanga ari chiremba, akakudziridzwa muGuangli.
03 Kuongororwa kweGERD
Mufananidzo.Zvakajairwa zviratidzo zveGerD uye atypical ekumusoro kugaya turakiti zviratidzo zvinotambura neGERD diagnostic flowchart Source: Chinese Medical Association
Diagnostic bvunzo yeasidhi suppression agent
Kune vanofungidzira gerd varwere (inowanzo shandiswa PPI), iyo yakajairika dosage ichagara kwemavhiki e2 (avo vane zviratidzo kunze kwechubhu vanoda kugara ≥4 mavhiki).Kana zviratidzo zvarerukirwa zvachose kana kuti chiratidzo chimwe chete chakapfava chinoratidzwa kuti chinoshanda.
2) Endoscopic
-Re -Los Angeles yakakamurwa kuita mamakisi (ona mufananidzo uri pazasi):
Kirasi A: 1 kana kupfuura esophageal mucosal kukuvadzwa, kureba kwekukuvadza ≤5 mm;
Giredhi B: 1 kana kupfuura esophageal mucosal kukuvara, kukuvara kureba> 5 mm, mucous membrane kukuvara uye hapana fusion;
Kirasi C: Inenge 2 esophageal mucosa yakakuvadzwa, uye mucous membrane yakakuvadzwa yakasanganiswa.
Kirasi D: Inoreva kukuvadzwa kwemucosa uye kubatanidzwa kweumwe neumwe, uye iyo fusion renji i75% yesophagus.
-IVA biopsy zano: Zvinokurudzirwa kuti kune akawanda uye mapfupi enguva biopsy, uye iyo biopsy inowanikwa ne 1cm interval kutenderedza chitofu.Saizi yemhando yakabatana nenjodzi yegomarara, uye njodzi yegomarara iri kuwedzera uye kuwedzera huwandu hwe3cm.
3) High-resolution esophageal measurement
Varwere vane GerD vanowanzo ratidza sesimba risingashande esophageal: chikamu che 70% kana peristalsis kukundikana reshiyo ye70% kana peristalsis ≥50%.
Anti-ikozvino monitoring
Ndiyo chiyero chekuongororwa kweCEDD.Ndiyo chiyero chegoridhe chekuongororwa kweGERD, kusanganisira kutariswa kwesophagus NH kukosha uye esophageal yang anti -NH kukosha kwekutarisa yesophagus pombi NH kukosha uye esophageal yang anti -NH kukosha kwekutarisa.The percentage of the pH <4 (acid exposure time, AET)> 4% mu24H, inofungidzirwa kuti pane pathological acid reflux.
04 GERD kurapwa
Mufananidzo .Gerd's treatment flowchart
Kunobva: Chinese Medical Association
Zvekungwaririra:
-PPI uye P-CAB ndiyo yekutanga sarudzo yekutanga kurapwa nekuchengetedza varwere vane Gard.Kurapa kwekutanga kwePPI mavhiki masere uye P-CAB kurapwa ndeye ≥4 mavhiki.
-Kune varwere vane kubudirira kweusiku (pakutora PPI, pH <4 nguva> 1H muusiku hweusiku), unogona kushandisa H2 receptor blockers usati waenda kunorara pamusana pePPI kurapwa, kana kushandura kuP-CAB uye refu.Half-life PPI kurapwa.
-Iyo anti-acid agent uye gastrointestinal active drugs zvinogona kushandiswa kwenguva pfupi-pfupi kukurumidza kuderedza zviratidzo zvekusagadzikana zvakadai sekupisa kwemoyo uye reflux.
-The endoscopic treatment indication: GERD kuongororwa kwakajeka, kurapa kweacidic hakubvumirwi, kusingadi kutora mishonga kwenguva yakareba, kana kukanganisa kwakashata kune chokuita nemishonga, uye haigoni kushivirira.
-Kuvhiya kuvhiyiwa kurapwa chiratidzo: pane zvakajairika GerD zviratidzo, PPI kurapwa haina basa;endoscopy inowana esophageal hernia, BE, RE, Los Angeles mamakisi kana pamusoro;X-ray ongororo yakaona kuti kune esophageal hole hernia.
Nguva yekutumira: Mar-21-2024