Gastroesophageal reflux kab mob: mob, mob, thiab kev kho mob yam ntxwv

German tus kws kho mob, kws phais neeg thiab paub txog Heinrich Quincke nyob rau hauv xyoo 1879, piav ib tug physiological txheej txheem uas tshwm sim nyob rau hauv lub digestive system ntawm tib neeg tom qab noj cov zaub mov, thiab hu ua nws Gastroesophageal reflux (GER yuav txo tau nyob rau hauv). Yaj no tsis yooj yim hais lub sij hawm - Gastroesophageal reflux. Lo lus "reflux" yog Latin rau "ntws rov qab", thiab qhov no lub sij hawm yog hu ua cov tshuaj muaj zog nyob hauv kev coj rov qab piv rau lub cev kev kawm ntawm tus txheem ntawm tej zog ntawm tus hollow lub cev. Yog hais tias koj muab tso rau xws mob, nws tsis yog tsim nyog yuav tsum tau chim siab, vim nyob rau hauv nws tus kheej GER kab mob no yog tsis yog, thiab tsis yuav tsum tau kev kho mob. Tab sis tej zaum cov mechanisms ntawm muaj sia dab yog tsis, khoom noj khoom haus, rov qab los ntawm lub plab rau hauv cov hlab pas, pib noj tam sim ntawd ntawm nws epithelial hlwb, thiab tus neeg nrog cov kev heev tsis kaj siab. Nyob rau hauv cov neeg mob, tus mob ntawd hais Gastroesophageal reflux nrog esophagitis - ib tug kab mob loj txaus uas yuav ua tau kom esophageal mob cancer.

Lub mechanism ntawm Gastroesophageal reflux

Peb paub los ntawm lub cev zaj lus qhia kom crushed nyob rau hauv lub qhov ncauj thaum nqos khoom noj khoom haus mus rau hauv cov hlab pas, uas yog ib tug hollow raj. Nws zog yog tas rau lub ceev ceev tus me nyuam ntawm ib tug pob ntawm cov khoom noj nyob rau hauv lub plab, qhov twg nws pib yuav tsum tau nqis. Qhov ntev ntawm cov hlab pas nyob rau hauv feem ntau cov neeg yog 30 cm. Cov hauv qab ntawm cov nqaij fibers ntawm nws cov phab ntsa li cov txheej txheem ntawm uas khiav lag luam cov valve ib feem (sphincter). Thaum lub pob ntawm cov khoom noj zog lawv so kom txaus qhia rau nws nyob rau hauv lub plab, thiab ces compressed, tiv thaiv qhov tawm ntawm cov zaub mov rov qab mus rau hauv cov hlab pas. Yog hais tias cov zaj yog sim txaus, mob plab txheem (khoom noj khoom haus thiab lub plab acid) cov tsiv rov qab mus rau hauv cov hlab pas, uas yog, muaj yog gastro-esophageal reflux. Cov tsos mob thiab kev kho mob ntawm tus mob no yog nyob ntawm seb tus tiv thaiv mechanisms ua hauj lwm zoo nyob rau hauv cov hlab pas. Rau ntau tus neeg, txoj kev no tsis ua kom muaj tsis kaj siab los yog mob ncus, yog li ntawd, tsis txhob yuav tsum tau kev kho mob. Txawm li cas los, ib co ntawm cov rov qab los ntawm khoom noj khoom haus rov qab los ntawm lub plab rau hauv cov hlab pas nrog mob los yog cia li tsis xis nyob. Nyob rau hauv cov neeg mob yuav tsum tau nrog ib tug kws kho mob thiab kev kho mob.

Raws li kev tiv thaiv mechanisms ua hauj lwm

Yog vim li cas nyob rau hauv tej rooj plaub ua mob ab tsi hnyuv reflux ntawm cov zaub mov thiab lwm yam? Lub fact tias ib tug neeg lub txoj hlab nqos mov "programmed" los ntawm qhov ua kev sib cuag xwb nrog ib tug alkaline nruab nrab, uas yog rau chewed zaub mov los nyob rau hauv nws lub qhov ncauj. Plab tsis tsuas tau txais zaub mov nais, nws pib mus zom, rau cov uas nws yog ua pais plab kua txiv - ib tug kua sib tov ntawm enzymes, hnoos qeev, thiab lub ntsiab tivthaiv - hydrochloric acid. Ib zaug nyob rau cov hlab pas, nws pib mus rau "zom" lub epithelial hlwb ntawm nws cov phab ntsa raws li zoo raws li tawg tsam ntawm khoom noj khoom haus. Yog hais tias ib tug neeg muaj tiv thaiv lub txhoj puab heev acidic tiv thaiv mechanisms, reflux ntawm khoom noj khoom haus nws yog tsis txaus ntshai. Cov mechanisms yog:

- ib tug es siab suab nrov ntawm lub sphincter ntawm cov hlab pas uas txwv tsis pub khoom noj khoom haus mus tshaj lub Gastroesophageal tsam;

- Zoo clearance (sai clearance ntawm cov hlab pas ntawm lub plab txheem ntawm khoom);

- epithelial hlwb ntawm cov hlab pas kuj mus hydrochloric acid;

- tswj ntawm pais plab acidity.

Cov tsos mob ntawm GERD, tsis yog ib tug kab mob

Xav txog thaum lub cai yuav muab suav hais tias ib txwm tib neeg physiology hnyuv reflux zaub mov. Cov tsos mob ntawm xws li ib tug txawm txheej txheem nyob rau hauv lub digestive system yog raws li nram no:

- tus neeg tsis xav tias tej yam tsis xis (qhov no yog ib tug ntawm cov hom sijhawm);

- muab khoom noj khoom haus mus rau hauv cov hlab pas ntawm lub plab yog cai xwb tam sim ntawd tom qab ib tug noj mov;

- reflux kav luv luv-lived thiab nws tshwm sim ib ob peb lub sij hawm ib hnub twg;

- thaum lub sij hawm ib hmo pw tsaug zog reflux tshwm sim.

Nws yuav tsum tau muab sau tseg tias physiological reflux ntawm khoom noj khoom haus los ntawm lub plab rau hauv cov hlab pas tshwm sim nyob rau hauv cov neeg uas muaj hnub nyoog, nrog rau cov me nyuam.

Kev tiv thaiv txawm GER

Txawm nyob rau hauv tus neeg mob qhov twg gastro esophageal reflux tsis ua teeb meem, koj yuav tau siv ib co yooj yim dag zog los pab lawv lub cev ua hauj lwm cov hnyuv ib ntsuj av. Txo cov tsos ntawm reflux yog xws yooj yim cov kauj ruam:

- tsis txhob mus pw mus so tam sim ntawd tom qab ib tug noj mov;

- tsis mus nrog lub cev ua hauj lwm, tshwj xeeb tshaj yog hais txog tus nqes hav, NW nyuam qhuav tiav noj;

- tsis txhob overeat;

- txo tau ntawm cov khoom noj (chocolate, haus dej cawv, tej yam kev cov kua ntsw), relaxing cov sphincter ntawm cov hlab pas;

- tsis tau pib noj mus rau hauv ib yam nkaus thiab kaw ntom nti ua khaub ncaws, mus ceev txoj siv tawv;

- txo tus nqi ntawm cov servings thiab tus naj npawb ntawm cov zaub mov muaj zog.

Cov tsos mob ntawm GERD, uas yog ib tug pathology

Tus kab mob yog suav tias yog Gastroesophageal reflux nrog esophagitis. Nws tshwm sim thaum tus tiv thaiv mechanisms ntawm cov hlab pas glitch thiab yuav tsis tiv thaiv cov tawv nqaij hlwb los ntawm lub xeb hydrochloric acid. Nyob rau hauv no kab mob muaj ob hom ntawm cov tsos mob.

1. esophageal. Cov neeg mob qhia xws tsis xis nyob:

- kub siab;

- qaub aftertaste nyob rau hauv lub qhov ncauj;

- belching (mas acidic);

- dysphagia (noj tau txhaws qa);

- mob hauv siab (yuav ua ntu thaum stooping thiab dag txoj hauj lwm, tej zaum yuav kis tau rau hauv tej caj npab thiab lub caj dab).

2. Nepischevodnye. Cov neeg mob tej zaum yuav muaj ib txhia los yog tag nrho cov nram qab no cov tsos mob:

- teeb meem nrog cov hniav (caries, tus txha hniav laus tsis xws luag);

- sinusitis;

- laryngitis;

- pharyngitis;

- hnoos;

- mob nyob rau hauv lub plawv.

Vim hais tias ntawm cov kev muaj GERD yog feem ntau incorrectly kuaj thiab kho tau los ntawm cov neeg uas tsis muaj nyob rau hauv lawv cov kab mob.

yog vim li cas

Pathological Gastroesophageal reflux yuav tshwm sim rau cov nram qab yog vim li cas:

- rog;

- cawv, haus luam yeeb;

- hiatal hernia;

- kauj noj cov zaub mov;

- cov tshuaj uas txo lub suab nrov ntawm lub sphincter;

- profuse ntuav (tej zaum nrog lom);

- mauj scleroderma;

- nasogastric raj.

Gastroesophageal reflux nyob rau hauv cov me nyuam mos

Nyob rau hauv thawj hnub thiab lub hlis ntawm lub neej nyob rau hauv kwv yees li 80% ntawm cov me nyuam mos yog cai ntuav tom qab pub mov noj. Gastroesophageal reflux ntau ntau nyob rau hauv cov me nyuam mos tsis yog ib tug kab mob thiab tshwm sim vim cov neeg txhaum ntawm nws hnyuv system. Regurgitation kuj tiv thaiv tus me nyuam los ntawm overeating thiab cua mus rau hauv nws cov hnyuv. Cov niam txiv tsuas yog los tuav lub crumbs mas txog 10 feeb tom qab pub mis, mus regurgitation tsis tshwm sim. Nyob rau hauv ntau teeb meem loj rau hauv lub plab thiab cov hlab pas yog rawsli los ntawm xws li tej yam tshwm sim:

- pheej quaj tus me nyuam thiab ntxhov siab vim;

- belching;

- ntuav (tsis yuav tsis meej pem nrog regurgitation) tom qab pub;

- tsis kam mus noj;

- nros;

- causeless hnoos;

- tus me nyuam pw tsis tsaug zog zoo thiab nkag mus rau hauv hnyav me ntsis.

Los ntawm indications tus kws kho mob yuav muab tshuaj rau ib tug me nyuam mos liab mixtures nrog thickeners thiab pharmaceuticals "Cisapride", "Domperidone", "Metoclopramide", "cimetidine". Yog hais tias reflux yog tshwm sim los ntawm kev txawv txav nyob rau hauv cov qauv ntawm cov mob huam, phais kev pab puas yuav tau.

Gastroesophageal reflux nyob rau hauv cov me nyuam laus tshaj ib xyoo

Feem ntau cov me nyuam 12-18 lub hlis mus rau ntuav tom qab pub mov noj kiag li ploj. Cov me nyuam loj hlob li noj qab nyob zoo thiab tsis muaj kev tsis xis nyob tom qab noj mov. Tab sis ib co me nyuam muaj lwm yam kev tsis txaus siab uas yuav kis tau teeb meem rau hauv lub plab los yog txoj hlab nqos mov:

- kub siab (tus me nyuam qhia txog qhov no cov tsos mob raws li "hluav taws" los yog "hluav taws");

- regurgitation;

- mob nyob rau hauv lub kaus siab;

- xeev siab;

- ib tug kev xav ntawm fullness nyob rau hauv lub plab mog;

- regurgitation thaum hmo ntuj thaum lub sij hawm pw tsaug zog (qhov no yuav pom nyob rau txoj kev nyob rau hauv lub tog hauv ncoo).

Feem ntau qhia Gastroesophageal reflux cov tsos mob nyob rau hauv cov me nyuam, nws tsis yog hais txog mus rau lub digestive kabmob:

- hnoos;

- ib tug hoarse lub suab;

- ib tug pob los yog mob qa;

- ceg ris;

- ua tsis taus pa;

- teeb meem nyob rau hauv nqos;

- heev mob ntsws dej.

Feem ntau, thaum cov tsos mob pib los kho tus mob khaub thuas, tab sis GERD xws txoj kev kho tsis.

diagnostics

Yog hais tias tus neeg mob muaj tsis kaj siab los yog mob cov tsos mob ntawm Gastroesophageal reflux kab mob, mob yuav tsum tau ua nrog rau cov kev siv uas niaj hnub kuaj thiab instrumental txoj kev. Thaum tus thawj theem tus kws kho mob-gastroenterologist sau keeb kwm, nrog rau cov lus qhia txog tej kab mob nyob rau hauv cov txheeb ze ntawm tus neeg mob, lub caij thiab cov kev siv ntawm reflux cov tsos mob. Qhov thib ob theem muaj nyob rau hauv nqa tawm laboratory kev ntsuam xyuas, xws li:

- ntshav kuaj (biochemical thiab general);

- coprogram;

- urinalysis.

Qhov thib peb theem yuav diagnostic kev tshawb fawb cov cuab yeej:

- esophageal manometry;

- EGD (esophagogastroduodenoscopy);

- ib tug provocative mus sib hais;

- radiography siv barium ncua kev kawm ntawv;

- ultrasound.

kev kho mob

Yog hais tias mob pathological Gastroesophageal reflux kab mob, kev kho mob yog nqa tawm nyob rau hauv peb cov kev qhia:

1. Tshuaj-free. Nws muaj xws li cov nram qab no cov khoom:

- ceeb thawj kho;

- Noj cov zaub mov (ua tsis chocolate, haus dej cawv, fatty, ntsim, kas fes, cov qij, citrus txiv hmab txiv ntoo);

- ordering ntawm lub hwj chim;

- cais tawm los ntawm lub wardrobe ntawm kaw ntom nti ua khaub ncaws, ceev koj cov menyuam;

- tus sawv ntawm lub taub hau ntawm lub txaj los ntawm 20 cm.

2. Tshuaj:

inhibitor ntawm proton twj tso kua mis (txo feem ntawm hydrochloric acid nyob rau hauv lub plab "Rapeprazol" "Omeprazole");

- antacids (cov tshuaj neutralize lub hydrochloric acid "Fosfalyugel", "Almagel");

- prokinetics (kom ceev li lub zog ntawm cov zaub mov los ntawm lub plab rau hauv cov hnyuv "metoclopramide").

3. phais. Nws siv yog hais tias tus ob yav dhau los hom tsis muab pom kev txhim kho.

Yog hais tias tsis kho, hydrochloric acid, mus rau hauv cov hlab pas, nws yuav ua rau pitting phab ntsa ntawm perforation, los ntshav, hu ua Barrett tus txoj hlab nqos mov, uas yog 10 lub sij hawm tsub kom qhov uas yuav pib ib tug kab mob qog hlav.