Tō Mate Whakaheke Kai (Gerd)

Ko te reflux o te waikawa ka puta mai ina ngāwari te uaua sphincter kei te pito raro o te esophagus i te wā he, ā, ka tukua te waikawa o te kopu kia hoki ki runga ki te esophagus. Ka taea e tēnei te whakaeke i te mamae o te ngakau me ētahi atu tohu. Ka taea e te reflux auau, e te pumau rānei te arahi ki te GERD.

Ko te mate reflux gastroesophageal he āhuatanga e rere ana te waikawa o te kopu kia hoki anō ki runga ki te pūkaha e hono ana i te waha me te kopu, e kiia nei ko te esophagus. I te nuinga o te wā ka kiia ko te GERD hei poto. Ko tēnei wai hoki ki runga ka kiia ko te reflux o te waikawa, ā, ka taea e tēnei te whakaheke i te paparinga o te esophagus.

He tokomaha ngā tāngata e pā ana ki te reflux o te waikawa i ētahi wā. Heoi, ina puta mai te reflux o te waikawa kia maha tonu i te wā, ka taea e tēnei te whakaeke i te GERD.

Ka taea e te nuinga o ngā tāngata te whakahaere i te mamae o te GERD mā ngā huringa oranga me ngā rongoā. Ā, ahakoa he mea onge, ka hiahia pea etahi ki te pokanga hei āwhina i ngā tohu.

Ngā tohu noa o te GERD e whai ake nei:

• Te āhua wera i roto i te uma, e kiia ana he ngakau wera. E puta ana te ngakau wera i muri i te kai, ā, e kaha ake pea i te pō, i te wā e takoto ana rānei.
• Te hoki mai o te kai, te wai kawa rānei ki te korokoro.
• Te mamae o te puku ranei o te uma o runga.
• Te raruraru ki te horomi, e kiia ana he dysphagia.
• Te āhua o te pūngāwerewere i roto i te korokoro.

Ki te pēhea te reflux o te waikawa i te pō, ka pā pea koe ki:

• Te mare i te roa.
• Te mumura o ngā aho reo, e kiia ana he laryngitis.
• Te mate huango hou, te kino ake rānei.

Rapua te awhina hauora i tenei wa tonu ki te pēhia to uma, ina koa ki te pēhia ano hoki to manawa poto, te mamae rānei o te kauae, o te ringa rānei. Ko ēnei pea ngā tohu o te ngākau ngākau. Whakahaere rāhui ki te kaimahi hauora ki te:

• He nui te mamae o te GERD, te maha rānei.
• Tangohia ngā rongoā kore-whakahaunga mō te ngakau-pūkahukahu neke atu i te rua i te wiki.

Ko te GERD te take i te maha o te reflux o te waikawa, te reflux ranei o nga mea kaore i te waikawa mai i te kopu.

Ina horomia e koe, ka okioki te poka o te uaua i te raro o te esophagus, e kiia nei ko te lower esophageal sphincter, kia taea ai te rere o te kai me te wai ki te kopu. Katahi ka kati ano te sphincter.

Ki te kore te sphincter e okioki penei i te tikanga, ki te ngoikore ranei, ka taea e te waikawa o te kopu te rere ki te esophagus. Ko tenei horoinga tonu o te waikawa ka whakaheke i te papanga o te esophagus, ka tino puta he mumura.

Ka puta he hernia hiatal ina pupū te wahi o runga o te puku ki waho o te diaphragm ki roto i te kohanga o te uma.

Ko ngā āhuatanga ka taea te whakapiki ake i te tūponotanga o te GERD ko:

• Te momona.
• Te pupū o te pito o runga o te puku ki runga ake i te diaphragm, e mohiotia ana ko te hernia hiatal.
• Te hapu.
• Ngā mate pūtau hono, pēnei i te scleroderma.
• Te whakaroa o te whakapakarite o te puku.

Ko ngā take ka taea te whakaiti i te reflux waikawa ko:

• Te wāhine.
• Te kai i ngā kai nui, te kai i te pō.
• Te kai i ētahi kai, pēnei i ngā kai momona, ngā kai kohuatia.
• Te inu i ētahi inu, pēnei i te waiū, te kōpi.
• Te tango i ētahi rongoā, pēnei i te aspirin.

Ne te roanga o te wā, ka taea e te mumura roa i roto i te whekau kai te tupu:

• Te mumura o te kiko i roto i te whekau kai, e kiia nei ko te esophagitis. Ka taea e te waikawa o te kopu te wawahi i te kiko i roto i te whekau kai. Ka taea e tenei te tupu o te mumura, te toto, ā, i etahi wā he wheka tuwhera, e kiia nei ko te ulcer. Ka taea e te Esophagitis te tupu o te mamae me te uaua ki te horomi.
• Te whakaiti o te whekau kai, e kiia nei ko te esophageal stricture. Ko te pakaru o te whekau kai raro mai i te waikawa o te kopu te take o te hanganga o te kiko mamae. Ka whakaiti te kiko mamae i te huarahi kai, ā, ka arahi ki ngā raruraru ki te horomi.
• Ngā huringa precancerous ki te whekau kai, e kiia nei ko te Barrett esophagus. Ko te pakaru mai i te waikawa te take o ngā huringa i te kiko e hipoki ana i te whekau kai raro. Ka hono enei huringa ki te nui haere o te tūpono o te mate pukupuku whekau kai.

Kaore he uara (NaN)

I te wā o te endoscopy o runga, ka whakauruhia e te tohunga hauora he pūtau angiangi, ngawari e whakapaipai ana i te rama me te kamera ki raro i te korokoro, ka uru ki te esophagus. Ka homai e te kamera iti te tirohanga o te esophagus, te kopu, me te tīmatanga o te whekau iti, e kiia nei ko te duodenum.

Ka taea pea e te tohunga hauora te whakatau i te GERD i runga i te hītori o ngā tohu me te whakamātautau tinana.

Hei whakau i te whakatau o te GERD, i te tirotiro rānei mō ngā raruraru, ka taea pea e te tohunga tiaki te tūtohutia:

• Whakamātautau pūtoro waikawa (pH) haereere. Ka whakanohoia he kaitirotiro ki te esophagus hei whakatau i te wā, me te roa o te whakahoki mai o te waikawa kopu ki reira. Ka hono te kaitirotiro ki te rorohiko iti e mau ana i te hope, i te potae rānei i runga i te pokohiwi.

  Ka taea pea te kaitirotiro he pūtau angiangi, ngawari, e kiia nei ko te catheter, e whakatārewatia ana i roto i te ihu ki te esophagus. Ā, ka taea pea he kapu e whakanohoia ana ki te esophagus i te wā o te endoscopy. Ka pāwhiri te kapu ki te paru i muri i te rua rā.

• X-ray o te pūnaha kai o runga. Ka tangohia ngā X-ray i muri i te inu i te wai parauri e hipoki ana, e whakaki ana i te taha o roto o te pūnaha kai. Ka taea e te hipoki te tohunga hauora te kite i te ata o te esophagus me te kopu. He whai hua tēnei mō te hunga e raruraru ana ki te horomi.

  I etahi wā, ka mahia he X-ray i muri i te horomi i te nati pāriamu. Ka taea tēnei te awhina i te whakatau i te whakaiti o te esophagus e āwangawanga ana ki te horomi.

• Manometry esophageal. Ka ine tenei whakamātautau i ngā whakawhāiti uaua auau i roto i te esophagus i te wā e horomi ana. Ka ine hoki te manometry esophageal i te hononga me te kaha e whakamahia ana e ngā uaua o te esophagus. Ka mahia tēnei i te nuinga o te wā ki te hunga e raruraru ana ki te horomi.

• Esophagoscopy transnasal. Ka mahia tēnei whakamātautau hei rapu i ngā pakaru i roto i te esophagus. Ka whakanohoia he pūtau angiangi, ngawari me te kamera ataata i roto i te ihu, ka nekehia ki raro i te korokoro ki te esophagus. Ka tuku te kamera i ngā pikitia ki te mata ataata.

Endoscopy o runga. Ka whakamahi te endoscopy o runga i te kamera iti kei te pito o te pūtau ngawari hei tirotiro i te pūnaha kai o runga. Ka āwhina te kamera ki te homai i te tirohanga o roto o te esophagus me te kopu. Ka kore pea e whakaatu ngā hua whakamātautau i te wā e puta mai ana te reflux, engari ka taea e te endoscopy te kimi i te mumura o te esophagus, i ētahi atu raruraru rānei.

Ka taea hoki te whakamahi i te endoscopy hei kohikohi i te tauira o te kiko, e kiia nei ko te biopsy, hei whakamātautau mō ngā raruraru pēnei i te esophagus Barrett. I ētahi wā, ki te kitea he whakaiti i roto i te esophagus, ka taea te totoro, te whakawhanui rānei i te wā o tēnei tukanga. Ka mahia tēnei hei whakapai ake i te raruraru o te horomi.

Whakamātautau pūtoro waikawa (pH) haereere. Ka whakanohoia he kaitirotiro ki te esophagus hei whakatau i te wā, me te roa o te whakahoki mai o te waikawa kopu ki reira. Ka hono te kaitirotiro ki te rorohiko iti e mau ana i te hope, i te potae rānei i runga i te pokohiwi.

Ka taea pea te kaitirotiro he pūtau angiangi, ngawari, e kiia nei ko te catheter, e whakatārewatia ana i roto i te ihu ki te esophagus. Ā, ka taea pea he kapu e whakanohoia ana ki te esophagus i te wā o te endoscopy. Ka pāwhiri te kapu ki te paru i muri i te rua rā.

X-ray o te pūnaha kai o runga. Ka tangohia ngā X-ray i muri i te inu i te wai parauri e hipoki ana, e whakaki ana i te taha o roto o te pūnaha kai. Ka taea e te hipoki te tohunga hauora te kite i te ata o te esophagus me te kopu. He whai hua tēnei mō te hunga e raruraru ana ki te horomi.

I etahi wā, ka mahia he X-ray i muri i te horomi i te nati pāriamu. Ka taea tēnei te awhina i te whakatau i te whakaiti o te esophagus e āwangawanga ana ki te horomi.

Ka uru pea te pokanga mō te GERD ki te mahi hei whakapakari i te sphincter esophageal raro. Ko te mahi e kiia nei ko te fundoplication Nissen. I roto i tēnei mahi, ka takai te taote i te pito o te puku ki te esophagus raro. Ka whakapakaritia ai te sphincter esophageal raro, ka iti ake te tūpono o te hoki mai o te waikawa ki te esophagus. Ko te taputapu LINX he mowhiti ka horapa o ngā piira maikuku e pupuri ana i te waikawa o te puku kei te hoki mai ki te esophagus, engari ka tukua te kai ki te haere ki te puku. He tino tūpono ka tūtohu tetahi kaimahi hauora kia ngana ki ngā huringa noho ora me ngā rongoā kore-tūtohu hei rongoā tuatahi. Ki te kore koe e kite i te whakaora i roto i ngā wiki torutoru, ka tūtohu pea te rongoā tūtohu me ētahi atu whakamātautau. Ko ētahi kōwhiringa: - Ngā antacid e whakakore ana i te waikawa o te puku. Ka āwhina pea ngā antacid kei roto te calcium carbonate, pēnei i te Mylanta, Rolaids me te Tums, ki te whakaora tere. Engari kāore ngā antacid anake e whakaora i te esophagus mumura kua pakaru e te waikawa o te puku. Ko te nui rawa o te whakamahinga o ētahi antacid ka puta mai ngā pānga taha, pēnei i te ruaki, te mate pukupuku rānei i ētahi wā. - Ngā rongoā hei whakaiti i te whakaputa waikawa. Ko ēnei rongoā — e mohiotia ana ko ngā kaihoroi histamine (H-2) — kei roto ko te cimetidine (Tagamet HB), famotidine (Pepcid AC) me te nizatidine (Axid). Kāore ngā kaihoroi H-2 e mahi tere penei i ngā antacid, engari ka hoatu e rātou te whakaora roa ake, ā, ka whakaiti pea i te whakaputa waikawa mai i te puku tae atu ki te 12 haora. Kei te wātea ngā putanga kaha ake mā te tūtohu. - Ngā rongoā e aukati ana i te whakaputa waikawa me te whakaora i te esophagus. Ko ēnei rongoā — e mohiotia ana ko ngā kaihoroi pupuhi proton — he kaihoroi waikawa kaha atu i ngā kaihoroi H-2, ā, ka tukua te wā mō te kōeke esophageal kua pakaru kia ora. Ko ngā kaihoroi pupuhi proton kore-tūtohu kei roto ko te lansoprazole (Prevacid), omeprazole (Prilosec OTC) me te esomeprazole (Nexium). Ki te tīmata koe ki te tango i tetahi rongoā kore-tūtohu mō te GERD, kia tino whakamōhio koe ki tō kaiwhakarato tiaki. Ko ngā maimoatanga kaha-tūtohu mō te GERD kei roto: - Ngā kaihoroi pupuhi proton kaha-tūtohu. Kei roto ko te esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) me te dexlansoprazole (Dexilant). Ahakoa te tino pai te manawanui, ka puta pea ēnei rongoā i te ruaki, te mamae o te ūtū, te ruaki rānei, i roto i ngā take onge, ngā taumata iti o te huaora B-12, te magnesium rānei. - Ngā kaihoroi H-2 kaha-tūtohu. Kei roto ko te famotidine me te nizatidine kaha-tūtohu. Ko ngā pānga taha mai i ēnei rongoā he ngawari, he pai te manawanui. Ngā kaihoroi pupuhi proton kaha-tūtohu. Kei roto ko te esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) me te dexlansoprazole (Dexilant). Ahakoa te tino pai te manawanui, ka puta pea ēnei rongoā i te ruaki, te mamae o te ūtū, te ruaki rānei, i roto i ngā take onge, ngā taumata iti o te huaora B-12, te magnesium rānei. Ka taea te whakahaere i te GERD mā te rongoā. Engari ki te kore ngā rongoā e āwhina, ki te hiahia rānei koe ki te karo i te whakamahinga rongoā roa, ka tūtohu pea tetahi kaimahi hauora: - Fundoplication. Ka takai te taote i te pito o te puku ki te sphincter esophageal raro, hei whakakīia te uaua me te aukati i te reflux. Ka mahia te nuinga o te fundoplication mā te mahi iti-whakauru, e kiia nei ko te laparoscopic. Ka taea te takai o te pito o runga o te puku he wāhanga, he katoa rānei, e kiia ana ko te fundoplication Nissen. Ko te mahi wāhanga tino noa ko te fundoplication Toupet. Ko tō taote te tino tūtohu i te momo pai mōu. - Taputapu LINX. Ka takaihia he mowhiti o ngā piira maikuku iti ki te hononga o te puku me te esophagus. Ko te hī i waenga i ngā piira he kaha ki te pupuri i te hononga kia kati ki te waikawa refluxing, engari he ngoikore ki te tuku i te kai ki te haere. Ka taea te whakauru i te taputapu LINX mā te pokanga iti-whakauru. Kāore ngā piira maikuku e pā ki te haumarutanga o te taunga rererangi, te whakaahua whakaata maikuku rānei. - Transoral incisionless fundoplication (TIF). Ko tēnei mahi hou kei roto te whakakīia o te sphincter esophageal raro mā te hanga i te takai wāhanga ki te esophagus raro mā te whakamahi i ngā taputapu polypropylene. Ka mahia te TIF mā te waha mā te whakamahi i tetahi endoscope, ā, kāore e hiahiatia he tapahi pokanga. Ko ona painga kei roto ko te whakaora tere me te manawanui nui. Ki te whai koe i te hernia hiatal nui, kāore te TIF anake he kōwhiringa. Heoi, ka taea pea te TIF ki te whakakotahihia ki te whakatikatika hernia hiatal laparoscopic. Transoral incisionless fundoplication (TIF). Ko tēnei mahi hou kei roto te whakakīia o te sphincter esophageal raro mā te hanga i te takai wāhanga ki te esophagus raro mā te whakamahi i ngā taputapu polypropylene. Ka mahia te TIF mā te waha mā te whakamahi i tetahi endoscope, ā, kāore e hiahiatia he tapahi pokanga. Ko ona painga kei roto ko te whakaora tere me te manawanui nui. Ki te whai koe i te hernia hiatal nui, kāore te TIF anake he kōwhiringa. Heoi, ka taea pea te TIF ki te whakakotahihia ki te whakatikatika hernia hiatal laparoscopic. Nō te mea ka taea te taumaha nui te tūpono mō te GERD, ka tūtohu pea tetahi kaimahi hauora i te pokanga ngaro taumaha hei kōwhiringa mō te maimoatanga. Kōrero atu ki tō rōpū hauora kia kite mena he kaitono koe mō tēnei momo pokanga.

Ka āhei pea te whakaiti i te tūponotanga o te reflux waikawa mā ngā huringa oranga. Whakamātauria kia:

• Whakamutu i te wāhine. Ka whakaiti te wāhine i te kaha o te sphincter esophageal iti ki te mahi tika.
• Whakaarahia te ūtanga o tō moenga. Ki te pangia koe e te hāmama ngākau i te wa e moe ana, whakatūwherahia ngā rākau rakau, rānei ngā poraka siminiti i raro i ngā waewae i te pito o mua o tō moenga. Whakaarahia te pito o mua ki te 6 ki te 9 inihi. Ki te kore e taea e koe te whakaara i tō moenga, ka taea e koe te whakauru i te poraka i waenganui i tō moenga me te puna moenga hei whakaara i tō tinana mai i te hope ake. Kāore te whakaara i tō ūtanga ki ētahi atu ururua e whai hua ana.
• Tīmata ki tō taha maui. I te wa e moe ana koe, tīmata mā te takoto ki tō taha maui hei āwhina i te whakaiti i te tūponotanga o te reflux.
• Kaua e takoto i muri i te kai. Tatū ki te toru haora i muri i te kai i mua i te takoto, i te moe rānei.
• Kai ngā kai mā te ngawari, ka ngākau nui te ngau. Whakatūria tō pūāhua i muri i ia wahi ka tango anō i te wa kua ngau, kua horomia hoki taua wahi.
• Kaua e kai i ngā kai me ngā inu e whakaohooho ana i te reflux. Ko ngā mea e whakaohooho ana ko te waiū, te tiakarete, te caffeine, ngā kai momona, te pepa mīti rānei.

Ka taea pea te tūtohutia ētahi rongoā tāpiri me ngā rongoā rerekē, pēnei i te ginger, te chamomile me te rakau ngawha, hei whakaora i te GERD. Heoi, kāore tetahi o ēnei i whakamāramahia hei whakaora i te GERD, i te whakahoki mai rānei i te kino ki te esophagus. Kōrero atu ki tetahi kaimahi hauora ki te whakaaro koe ki te tango i ngā rongoā rerekē hei whakaora i te GERD.