He maʻi maʻamau ka maʻi reflux esophageal gastric (GerD) i ka ʻoihana ʻai. ʻO kona laha a me nā hōʻike paʻakikī o ke olakino he hopena koʻikoʻi ia i ka maikaʻi o ke ola o nā maʻi. A ʻo ka mumū mau o ka esophagus he pilikia ia e hoʻoulu ai i ka maʻi ʻaʻai esophageal. ʻO ke ʻano o ka ʻike pololei ʻana a me ke ʻano maʻamau o ka lāʻau lapaʻau ke kikowaena o ka hana lapaʻau.
02 Nā hōʻike lapaʻau o GERD
Wahi a ke ʻano o ka endoscopy, hiki ke hoʻokaʻawale ʻia ʻo GERD i nā ʻano ʻelua: reflux esophagitis (RE), reflux esophagitis (RE) a me Barreta esophageal (BE).
NERD: Ua hōʻino ʻia ka esophagus Barrett a me ka mucosa esophageal maopopo i ka wehewehe ʻana o Gerd akā ua hōʻino ʻia ka endoscopy.
Re: Hiki i ka Endoscopy ke ʻike i ka mucosa ʻōpū-esophageal i pili i ka esophagus a i ʻole ma luna. Ua hōʻino ʻia ka membrane mucous i kēlā me kēia manawa.
BE: Ua pani ʻia ka ʻāpana epithelial squamous gastric-esophageal o ka epithelium e like me ka esophagus o ka pilina esophagus ma ka endoscopy e ka epithelium cylindrical.
02 Nā hōʻike lapaʻau o GERD
Ma waho aʻe o ka puʻuwai e puhi ana a me ka reflux, hiki ke loaʻa nā hōʻailona e like me ka ʻeha o ka umauma, ka ʻeha o ka ʻōpū o luna, a me ka esophagus kupanaha, ka maʻi ʻū, ka hānō a me nā hōʻailona esophageal ʻē aʻe.
Pono e hoʻomaopopo ʻia he haʻahaʻa ka nui o ka puʻuwai a me ka reflux i nā poʻe maʻi me nā poʻe maʻi GerD ʻelemakule. Kiʻekiʻe ka nui o nā hōʻailona i loko o ka ʻōmole extractive. ʻAʻole maʻamau nā hōʻailona, a ʻaʻole hoʻi asymptomatic. ʻAʻole like ka nui o nā hōʻailona me ke koʻikoʻi o ka maʻi. He pālahalaha ʻo Factory Guiyu, a i kona wā he kauka, ua hoʻomohala ʻia ʻo ia ma Guangli.
03 Ka hōʻailona o GERD
Kiʻi. ʻO nā hōʻailona maʻamau o GerD a me nā hōʻailona atypical o ke ala ʻai luna e loaʻa i ka GERD diagnostic flowchart Puna: Chinese Medical Association
Hoʻāʻo diagnostics o ka mea hoʻopau waikawa
No nā poʻe maʻi gerd kānalua (PPI i hoʻohana pinepine ʻia), e mau ka mahele maʻamau no 2 mau pule (ʻo ka poʻe me nā hōʻailona ma waho o ka ʻōmole e pono e mau i ≥4 mau pule). Inā ua hōʻoluʻolu loa ʻia nā hōʻailona a i ʻole hoʻokahi wale nō hōʻailona liʻiliʻi i hōʻoia ʻia he pono.
2) Endoscopic
-Re -Ua māhele ʻia ʻo Los Angeles i nā papa (e nānā i ke kiʻi ma lalo):
Papa A: 1 a ʻoi aku paha ka hōʻino ʻana o ka mucosal esophageal, ʻo ka lōʻihi o ka hōʻino he ≤5 mm;
Papa B: 1 a ʻoi aku paha ka hōʻino ʻana o ka mucosal esophageal, ka lōʻihi o ka hōʻino> 5 mm, hōʻino ʻia ka membrane mucous a ʻaʻohe fusion;
Papa C: Ma ka liʻiliʻi he 2 mau mucosa esophageal i hōʻino ʻia, a ua hōʻino ʻia ka membrane mucous i hui pū ʻia me kekahi.
Papa D: Pili i ka hōʻino ʻana o ka mucosa a me ka hoʻohui ʻana o kekahi i kekahi, a ʻo ka pae fusion he 75% o ka esophagus.
-Hoʻolālā biopsy BE: Manaʻo ʻia he mau biopsy manawa pōkole a me nā manawa he nui, a loaʻa ka biopsy ma kahi o 1cm a puni ke kapuahi. Pili ka nui o ka pae i ka pilikia o ka maʻi kanesa, a ke piʻi nei ka pilikia o ka maʻi kanesa a ke hoʻonui nei i ka pae o 3cm.
3) Ke ana ʻana o ka esophageal kiʻekiʻe
ʻO nā maʻi me GerD e hōʻike pinepine ʻia me ka mana esophageal maikaʻi ʻole: ʻo ka hapa o 70% a i ʻole ka lakio peristalsis failure o 70% a i ʻole peristalsis he ≥50%.
Ka nānā ʻana i ke au kū'ē
ʻO ia ke kūlana maʻamau no ka ʻike ʻana i ka CEDD. ʻO ia ke kūlana gula o ka ʻike ʻana i ka GERD, me ka nānā ʻana i ka waiwai NH o ka esophagus a me ka nānā ʻana i ka waiwai anti-NH o ka esophagus o ka waiwai NH o ka paipu esophagus a me ka nānā ʻana i ka waiwai anti-NH o ka esophagus. ʻO ka pakeneka o ka pH <4 (manawa hōʻike waikawa, AET)> 4% i loko o 24H, ua manaʻo ʻia he reflux waikawa pathological.
04 Lapaʻau GERD
Kiʻi. Ka papa hana lapaʻau ʻo Gerd
Puna: Hui Lapaʻau Kina
Nā Mālama:
-ʻO PPI a me P-CAB ke koho mua no ka mālama mua ʻana a me ka mālama ʻana i nā maʻi me Gard. ʻO ka mālama mua ʻana o ka mālama ʻana o ka PPI he 8 mau pule a ʻo ka mālama ʻana o ka P-CAB he ≥4 mau pule.
-No nā poʻe maʻi me nā breakthroughs i ka pō (i ka wā e lawe ai i ka PPI, ʻo ka pH <4 manawa> 1H i ka pō o ka pō), hiki iā ʻoe ke hoʻohana i nā mea pale H2 receptor ma mua o ka hiamoe ʻana ma ke kumu o ka mālama ʻana i ka PPI, a i ʻole e hoʻololi i ka P-CAB a me ka lōʻihi. Lapaʻau PPI hapalua ola.
-Hiki ke hoʻohana ʻia ka mea anti-acid a me nā lāʻau lapaʻau gastrointestinal no ka noi pōkole e hōʻoluʻolu koke i nā hōʻailona o ka ʻoluʻolu ʻole e like me ka puʻuwai ʻā a me ka reflux.
-ʻO ka hōʻailona lapaʻau endoscopic: Ua maopopo ka hōʻailona GERD, ʻaʻole pono ka lāʻau ʻakika, makemake ʻole e lawe i ka lāʻau lapaʻau no ka manawa lōʻihi, a i ʻole nā hopena maikaʻi ʻole e pili ana i nā lāʻau lapaʻau, a ʻaʻole hiki ke ʻae.
-Hōʻailona lapaʻau ʻoki kino: aia nā hōʻailona GerD maʻamau, ʻaʻole pono ka lāʻau PPI; ʻike ka endoscopy i ka hernia esophageal, BE, RE, Los Angeles mau māka a i ʻole ma luna; Ua ʻike ka hoʻokolokolo X-ray aia he hernia lua esophageal.
Ka manawa hoʻouna: Malaki-21-2024