Gastroesophageal reflux chirwere: zviratidzo, chirwere, uye kurapwa unhu

Chiremba German, chiremba uye musayendisiti Heinrich Quincke muna 1879 akarondedzera vasiri kwacho kuti rikaitika zvomudumbu mamiriro vanhu pashure pokutora chikafu, uye akamutumidza gastroesophageal reflux (zvakakumikidzwa zvinoderedza). Fanano ichi zvakaoma ataura izwi - gastroesophageal reflux. Shoko "reflux" ndiye rechiLatin "ichiyerera shure", uye ichi izwi inonzi mushonga kufamba negwara risiri kufananidzwa dzose mberi zviri chero kufamba negomba miviri. Kana ukaisa chirwere kwakadaro, hazvina zvakakodzera kuti rokurwadzisa, sezvo pachako zvakakumikidzwa chirwere haisi, uye haatarisiri kurapwa. Asi dzimwe nguva nzira yose vasiri urongwa vari kukundikana, zvokudya, kubva dumbu mukati yegurokuro, anotanga kudya kure panguva masero ayo epithelial, uye munhu ane ruzivo zvikuru hachifadzi. Muzviitiko izvi, nechirwere rinoratidza gastroesophageal reflux pamwe esophagitis - chirwere chakakomba zvakakwana zvingakonzera esophageal kenza.

The mashandiro pamusoro gastroesophageal reflux

Tinoziva kubva yakaitwa zvidzidzo vakadzvinyirirwa mumuromo apo pakuparadza zvokudya mumba yegurokuro, inova negomba chubhu. Basa rayo havabvumirwi kuti kutsanya chokuendesa bundu zvokudya mudumbu, apo hunotanga ozeyewa. Kureba yegurokuro mune vanhu vakawanda riri masendimita 30. The pasi tsandanyama fibers yamasvingo ayo akaronga kuti anoshanda vharuvhu chikamu (sphincter). Kana mukanyiwa zvokudya rwokufamba ivo faranuka kumurega mudumbu, uye ipapo compressed kutadzisa mbudo zvokudya kunyika yegurokuro. Kana ndima iri makavhara zvakakwana, dumbu zviri (zvokudya uye dumbu acid) aoma vakatamira kunyika yegurokuro, kuti, pane gastro-esophageal reflux. Zviratidzo uye vabatwe ichi zvinoenderana sei mupomerwi zvigadziriswe kushanda zvakanaka yegurokuro. Nokuti vanhu vakawanda, izvi haakonzeri chero risingafadzi kana kurwadza nezvekufadza, saka, regai zvinoda kurapwa. Zvisinei, vamwe kudzoka zvokudya kubva dumbu mukati yegurokuro pamwe kurwadza kana chete kusanzwa. Muzviitiko izvi vanofanira kutanga chiremba uye kurapwa.

Sezvo anodzivirira nzira basa

Nei dzimwe nguva hakukuvadzi gastrointestinal reflux zvokudya uye zvimwe ngozi? Chokwadi chokuti yegurokuro dzomunhu "chiite" pachisikirwo kuti kuonana chete chete alkaline unosvikirwa, unomedurirwa rikamunya muchindwi chikafu kuuya mumuromo make. Dumbu kwete anogamuchira zvokudya nemavhinga, rwunotanga kugaya, nokuti iro anogadzirwa gastric muto - imvura musanganiswa makemikari, madzihwa, uye mukuru zvinoriumba - hydrochloric acid. Kamwe muna yegurokuro, rwunotanga "kugaya" ari epithelial masero masvingo aro uyewo zvimedu zvokudya. Kana munhu ane kurwisa chisimba acidic unodzivirira zvenhengo reflux zvokudya hazvina vanotyisa. zvigadziriswe ava:

- mumwe panzvimbo yakakwirira mataurire sphincter pakati yegurokuro kuti kunotadzisa zvokudya vaende mhiri gastroesophageal mapazi;

- Good Clearance (nokukurumidza Clearance pakati yegurokuro kubva mudumbu zviri kuuya);

- epithelial mumasero yegurokuro kuramba hydrochloric asidhi;

- kudzora gastric acidity.

Zviratidzo Gerd, hachisi chirwere

Funga kana chiito anogona kunzi dzose dzevanhu physiology gastrointestinal reflux zvokudya. Zviratidzo zvakadaro chisingakuvadzi kwacho zvomudumbu ino ndeinotevera:

- munhu asingadi kunzwa chero kusagadzikana (ichi ndechimwe hukuru unhu);

- uzvirasire zvokudya mumba yegurokuro kubva mudumbu iri vakachengeta pakarepo chete pashure zvokudya;

- reflux rinovapo pfupi uye zvoitika vaviri nguva pazuva;

- panguva usiku hope reflux kunoitika.

Zvinofanira kucherechedzwa kuti vasiri reflux kwezvokudya kubva dumbu mukati yegurokuro rinowanikwa mune vanhu chero zera, kusanganisira vana.

Prevention chisingakuvadzi zvakakumikidzwa

Kunyange zviitiko apo gastro esophageal reflux haakonzeri matambudziko, unogona kutora nyore kuedza kubatsira miviri yavo kushanda nemudumbu. Kuderedza nechitarisiko reflux matanho ari nyore akadai:

- havaendi mubhedha zororo pakarepo pashure zvokudya;

- kwete kuti ndifambire mberi mumuviri basa, kunyanya zvine chokuita kunzvimbo yakatenuka, kwangopera apedza kudya;

- regai vachidyisa;

- kuderedza kunwa zvekudya (chocolate, doro, vamwe zvakananga sauces), vakazorora kuti sphincter pakati yegurokuro;

- kwete kutanga kudya kupinda zvakare zvakasimba nguvo, kuti sungisa bhandi;

- kuderedza uwandu huwandu uye uwandu kudya akawedzera.

Zviratidzo Gerd, inova zvokurwara

The chirwere anonzi gastroesophageal reflux pamwe esophagitis. It kunoitika apo kudzivirira zvigadziriswe pakati yegurokuro glitch uye haagoni kudzivirira ganda masero kubva ngura kuti hydrochloric acid. In chirwere ichi pane mhando mbiri zviratidzo.

1. Esophageal. Varwere dzinoshuma vakadaro kusagadzikana:

- chirungurira;

- anovava aftertaste mumuromo;

- belching (kunyanya acidic);

- dysphagia (vachidya zvichibvira kukachidzwa);

- bhokisi marwadzo (vanowanzotevedzera kuwedzera kana kukotama uye nzvimbo nhema, anogona kupararira maoko uye mutsipa).

2. Nepischevodnye. Varwere vanogona zvimwe kana zvose zvinotevera zviratidzo:

- matambudziko meno (caries, kuti enamel kuremara);

- sinusitis;

- laryngitis;

- pharyngitis;

- vangakosora;

- marwadzo mumoyo.

Nokuda kuratidzwa ava Gerd vanowanzotambura zvisiri chirwere uye aibata vanhu kuti havapo paurwere hwavo.

zvikonzero

Pathological gastroesophageal reflux anogona kuitika nokuda kwezvikonzero zvinotevera:

- kufutisa;

- doro, kusvuta;

- hiatal heniya;

- kudzikama kudya;

- mishonga kuti kuderedza mataurire sphincter;

- kunonyengedza kurutsa (dzimwe nguva muchetura);

- nechirwere chinonzi systemic scleroderma;

- nasogastric chubhu.

Gastroesophageal reflux mu vacheche

Mumazuva okutanga uye mwedzi woupenyu anenge 80% kwevacheche zvinochengetwa kurutsa pashure feedings. gastroesophageal reflux kakawanda vacheche haisi chirwere uye kunoitika nokuda nokusakwana kwake gastrointestinal hurongwa. Regurgitation zvakare anodzivirira mwana kubva nokudyisa uye mhepo muura hwake. Vabereki kunongova dzibate mafufu vertically anenge 10 maminitsi pashure zvokudya, kune regurgitation hazvina kuitika. On the zvinetso zvakakomba zvikuru pamwe dumbu uye yegurokuro runoratidzwa zviratidzo zvakadai:

- Kuramba achidanidzira mwana uye kufunganya;

- belching;

- kurutsa (kwete kuti kuvhiringidzwa regurgitation) pashure zvokudya;

- Kuramba kudya;

- hiccups;

- causeless chikosoro;

- mwana asingadi kurara zvakanaka uye kuwedzera uremu zvishoma.

By zvairatidza chiremba anogona mishonga mucheche wemisanganiswa pamwe thickeners uye Pharmaceuticals "Cisapride", "Domperidone", "Metoclopramide", "cimetidine". Kana reflux kunokonzerwa abnormalities ari nemamiriro nemudumbu, kuvhiya kupindira zvinokwanisika.

Gastroesophageal reflux muvana vakura pane rimwe gore

Vana Most 12-18 mwedzi kurutsa pashure feedings zvachose kunyangarika. Kids kukura vane utano uye hatiitirwi chero kusanzwa pashure kudya. Asi vamwe vana pane zvimwe zvichemo zvinoratidza matambudziko mudumbu kana yegurokuro:

- chirungurira (mwana anotsanangura chiratidzo ichi se "moto" kana "moto");

- regurgitation;

- kurwadziwa sternum;

- svoto;

- kunzwa zvizere mudumbu;

- regurgitation usiku hope (ichi chinogona kuoneka kutevera pamusoro pamutsago).

Kazhinji kunoratidza gastroesophageal reflux zviratidzo kuvana, hazvina chokuita zvomudumbu zvomukati:

- chikosoro;

- mumwe shoshoma izwi;

- bundu kana kwazvo huro;

- ifemereke;

- kupfupika mweya;

- dzikatadza pakuparadza;

- kakawanda nemabayo.

Kazhinji, kana zviratidzo izvi kutanga kurapa vanhuwo chando, asi Gerd kurapa kwakadaro rotsva.

Diagnostics

Kana murwere ane risingafadzi kana kurwadza zviratidzo gastroesophageal reflux chirwere, Dambudziko kuitwa nokushandiswa Murabhoritari ano uye richishanda nzira. Pakutanga Danho chiremba-gastroenterologist anounganidza kare, kusanganisira mashoko pamusoro zvirwere zvakadai muna hama murwere, nguva uye kusimba reflux zviratidzo. Danho rechipiri inoumbwa mukuita murabhoritari miedzo, yakadai se:

- bvunzo ropa (nemakemikari uye general);

- coprogram;

- urinalysis.

Wechitatu Danho kunosanganisira chirwere pakutsvakurudza:

- Esophageal manometry;

- EGD (esophagogastroduodenoscopy);

- mumwe tsamwisa nomuedzo;

- radiography kushandisa barium kuturika;

- Ultrasound.

mabatiro

Kana nechirwere pathological gastroesophageal reflux chirwere, kurapwa rinoitwa zvitatu kumativi:

1. Kushandisa-free. Rinosanganisira zvinhu zvinotevera:

- uremu kurangwa;

- Kudya (regai chocolate, doro, mafuta, Spicy, kofi, gariki, Citrus michero);

- arayira hwesimba;

- vabve wenguvo ose zvakasimba zvipfeko, zvakasimba mabhandi;

- kuwedzera musoro pamubhedha masendimita 20.

2. Mishonga:

inhibitor kuti hwepurotoni pombi (kwakaderedza excretion pamusoro hydrochloric asidhi mudumbu "Rapeprazol" "Omeprazole");

- antacids (zvinodhaka izvi neutralize mashoko hydrochloric asidhi "Fosfalyugel", "Almagel");

- prokinetics (kuti rikurumidze kufamba zvokudya kubva dumbu mukati ura "metoclopramide").

3. Surgery. Pachirehwa kana maviri marudzi yaivapo regai kupa kuvandudza anooneka.

Kana akasiya untreated, hydrochloric acid, kupinda yegurokuro, zvinogona kukonzera pitting masvingo perforation, ropa, rinonzi yegurokuro Barrett ndiko 10 nguva kunowedzera ngozi kutanga akaipa bundu.