Gastric esophageal reflux disease (GerD) yog ib yam kab mob uas tshwm sim hauv lub plab zom mov.Nws qhov kev nthuav dav thiab kev kho mob nyuaj ua rau muaj kev cuam tshuam loj rau lub neej zoo ntawm cov neeg mob.Thiab qhov mob ntev ntawm txoj hlab pas muaj kev pheej hmoo ua rau mob qog noj ntshav esophageal.Yuav ua li cas thiaj kuaj tau thiab kho tus qauv kom raug yog lub hom phiaj ntawm kev ua haujlwm kho mob.
02 GERD's Clinical Manifestations
GERD tuaj yeem muab faib ua non-eroded reflux (NERD), reflux esophagitis (RE) thiab Barreta esophageal (BE) raws li endoscopy.
NERD: Barrett esophagus thiab ntshiab esophageal mucosa puas nyob rau hauv lub ntsiab lus ntawm Gerd tab sis endoscopy puas lawm.
Re: Endoscopy tuaj yeem pom lub plab-esophageal mucosa uas txuas nrog rau txoj hlab pas lossis saum toj no.Lub mucous membrane yog puas intermittently.
BE: Lub plab-esophageal squamous epithelial ib feem ntawm txoj hlab pas zoo li epithelium ntawm txoj hlab pas txuas ntawm qhov endoscopy yog hloov los ntawm cylindrical epithelium.
02 GERD's Clinical Manifestations
Ntxiv nrog rau qhov kub hnyiab ntawm lub plawv thiab reflux, cov tsos mob xws li mob hauv siab, mob plab, thiab cov hlab pas zoo nkauj, hnoos, hawb pob thiab lwm yam tsos mob ntawm txoj hlab pas tuaj yeem tshwm sim.
Nws yuav tsum raug sau tseg tias cov neeg mob uas muaj cov neeg laus GerD muaj qhov tshwm sim tsawg ntawm lub plawv thiab reflux.Qhov tshwm sim ntawm cov tsos mob nyob rau hauv extractive raj yog siab.Cov tsos mob tsis raug, lossis txawm tias asymptomatic.Qhov hnyav ntawm cov tsos mob tsis yog sib npaug rau qhov hnyav ntawm tus kab mob.Lub Hoobkas Guiyu yog tiaj tus, thiab thaum nws yog kws kho mob, nws tau tsim nyob rau hauv Guangli.
03 GERD's Diagnosis
Daim duab.Cov tsos mob ntawm tus kab mob GerD thiab cov tsos mob atypical plab hnyuv siab raum raug kev txom nyem los ntawm GERD diagnostic flowchart Source: Suav Medical Association
Diagnostic test ntawm acid suppression agent
Rau cov neeg mob gerd uas tsis txaus ntseeg (feem ntau siv PPI), cov koob tshuaj yuav kav ntev li 2 lub lis piam (cov uas muaj cov tsos mob sab nraum lub raj yuav tsum tau ≥4 lub lis piam).Yog tias cov tsos mob tau zoo tag nrho los yog tsuas yog ib qho kev mob me me xwb tau ua pov thawj tias muaj txiaj ntsig zoo.
2) Endoscopic
-Re -Los Angeles muab faib ua qib (saib daim duab hauv qab no):
Chav Kawm A: 1 lossis ntau dua esophageal mucosal puas, qhov kev puas tsuaj ntev ≤5 hli;
Qib B: 1 lossis ntau dua esophageal mucosal puas, kev puas tsuaj ntev> 5 mm, mucous membrane puas thiab tsis muaj fusion;
Chav Kawm C: Yam tsawg kawg yog 2 esophageal mucosa puas lawm, thiab cov mucous membrane puas sib xyaw ua ke.
Chav Kawm D: Hais txog kev puas tsuaj ntawm mucosa thiab kev sib koom ua ke ntawm ib leeg, thiab qhov sib xyaw ua ke yog 75% ntawm txoj hlab pas.
-BE biopsy lub tswv yim: Nws raug pom zoo tias muaj ntau yam thiab luv luv biopsy, thiab qhov kev kuaj ntshav tau txais los ntawm 1cm ntu ib ncig ntawm lub qhov cub.Qhov loj ntawm qhov ntau yog cuam tshuam nrog kev pheej hmoo ntawm kev mob qog noj ntshav, thiab kev pheej hmoo ntawm mob qog noj ntshav nce ntxiv thiab nce qhov ntau ntawm 3cm.
3) High-resolution esophageal ntsuas
Cov neeg mob uas muaj GerD feem ntau pom tias tsis muaj zog ntawm txoj hlab pas: qhov feem ntawm 70% lossis peristalsis tsis ua haujlwm ntawm 70% lossis peristalsis yog ≥50%.
Kev saib xyuas tam sim no
Nws yog tus qauv rau kev kuaj mob ntawm CEDD.Nws yog tus txheej txheem kub ntawm kev kuaj mob GERD, suav nrog kev saib xyuas ntawm txoj hlab pas NH tus nqi thiab esophageal yang anti -NH tus nqi saib xyuas ntawm txoj hlab pas NH tus nqi thiab esophageal yang anti -NH tus nqi saib xyuas.Qhov feem pua ntawm pH <4 (acid exposure time, AET)> 4% hauv 24H, nws tau txiav txim siab tias muaj cov kab mob acid reflux.
04 Kev kho GERD
Daim duab .Gerd txoj kev kho mob flowchart
Source: Suav Medical Association
Cov kev ceev faj:
-PPI thiab P-CAB yog thawj qhov kev xaiv rau thawj zaug kev kho mob thiab kho cov neeg mob Gard.Kev kho thawj zaug ntawm PPI kev kho mob yog 8 lub lis piam thiab kev kho P-CAB yog ≥4 lub lis piam.
-Rau cov neeg mob uas muaj kev tawg thaum hmo ntuj (thaum noj PPI, pH <4 lub sijhawm> 1H hmo ntuj), koj tuaj yeem siv H2 receptor blockers ua ntej mus pw raws li kev kho mob PPI, lossis hloov mus rau P-CAB. thiab ntev.Ib nrab-lub neej PPI kev kho mob.
-Cov tshuaj tiv thaiv-acid thiab cov tshuaj ua rau lub plab zom mov tuaj yeem siv rau lub sijhawm luv luv kom txo tau cov tsos mob ntawm qhov tsis xis nyob xws li mob plawv thiab reflux.
-Qhov qhia txog kev kho mob endoscopic: Kev kuaj mob GERD yog qhov tseeb, kev kho mob acidic tsis siv, tsis kam noj tshuaj ntev, lossis muaj kev cuam tshuam tsis zoo rau cov tshuaj, thiab tsis tuaj yeem zam.
-Kev kho mob phais kev phais: muaj cov tsos mob ntawm GerD, PPI kev kho mob tsis raug;endoscopy pom cov esophageal hernia, BE, RE, Los Angeles qib lossis siab dua;X-ray kuaj pom tias muaj qhov esophageal qhov hernia.
Post lub sij hawm: Mar-21-2024