Eseme ry’ Kugira Ikibazo cyo Kwishima (Dysphagia): Ibimenyetso, Impamvu, n’Uko Wakivura

Dysphagia ni ijambo ry’abaganga rikoreshwa mu kwerekeza ku kubaho kw’ikibazo cyo kwishima ibiryo, ibinyobwa, cyangwa ndetse n’umusemburo wawe. Iki kibazo kigira abantu babarirwa muri za miriyoni, kandi gishobora kuba kuva ku gukomaga gato mu gihe cyo kurya ibiryo bimwe na bimwe kugeza ku kutahishima rwose mu buryo butekanye.

Nubwo rimwe na rimwe kugira ikibazo cyo kwishima bishobora kubaho kuri buri wese, ibibazo byo kwishima bikomeza bisaba ko uhabwa ubuvuzi. Igikorwa cyo kwishima kigizwe n’imikaya isaga 50 n’imiterere y’imikorere y’imitsi, bityo iyo hari ikintu kibangamiye ubu bufatanye, bishobora kugira ingaruka zikomeye ku buzima bwawe bwa buri munsi n’imirire yawe.

Ni ibihe bimenyetso bya dysphagia?

Ikimenyetso cyigaragara cyane ni ukumva nk’aho ibiryo cyangwa ibinyobwa bihagaze mu muhogo wawe cyangwa mu kifuba igihe ugerageza kwishima. Ariko rero, ibimenyetso bya dysphagia bishobora kuba bitandukanye cyane, rimwe na rimwe bikaba bigoye kubimenya.

Dore ibimenyetso bisanzwe ushobora guhura na byo:

• Ibiryo cyangwa ibinyobwa bikumva bihagaze mu muhogo wawe, mu kifuba, cyangwa inyuma y’ibere ryawe
• Kubabara mu gihe cyo kwishima (bita odynophagia)
• Gukama cyangwa gukorora mu gihe cyo kurya cyangwa kunywa, cyangwa nyuma yaho
• Gusubiza ibiryo hejuru (regurgitation)
• Gusohora umusemburo cyangwa kugira ikibazo cyo kugenzura umusemburo
• Ijwi ridafite imbaraga cyangwa riguma rihindagurika nyuma yo kurya
• Kubabara kenshi mu gifu cyangwa gutakaza aside
• Gutakaza ibiro bitunguranye kubera kwirinda ibiryo
• Gukoresha igihe kirekire kurusha igihe usanzwe umara gutema cyangwa kwishima
• Kugomba kwishima inshuro nyinshi kuri buri kigabano

Bamwe mu bantu bagira kandi ibimenyetso bitagaragara cyane nko kwirinda ibirori byo kurya hamwe n’abandi, gutema ibiryo mu duce duto cyane, cyangwa kumva bafite ubwoba bwo kurya. Izi mpinduka mu myitwarire zikunda kuza gahoro gahoro uko umubiri wawe ugerageza kwihanganira ibibazo byo kwishima.

Mu bihe bikomeye, ushobora kubona indwara z’ibyago cyangwa iz’ubuhumekero, bishobora kubaho igihe ibiryo cyangwa ibinyobwa byinjira mu mpyiko zawe aho kwinjira mu gifu.

Ni iyihe mitype ya dysphagia?

Abaganga bakunda gushyira dysphagia mu bwoko bubiri bushingiye aho ikibazo giva mu gikorwa cyo kwishima. Gusobanukirwa ubwo bwoko bufasha kumenya impamvu nyamukuru n’uburyo bwiza bwo kuvura.

Oropharyngeal dysphagia igira ingaruka ku kanwa n’umwanya w’umunwa. Ubu bwoko butuma bigoye kwimura ibiryo kuva mu kanwa kawe ujya mu muhogo wawe no kujya mu cyo bita esophagus. Ushobora kumva nk’aho utazi gutangira kwishima, cyangwa ibiryo bihagaze inyuma y’umunwa wawe.

Esophageal dysphagia ibaho igihe ibiryo bihagaze muri esophagus yawe, umuyoboro utwara ibiryo kuva mu muhogo wawe ujya mu gifu. Muri ubwo bwoko, ushobora gutangira kwishima uko bisanzwe, ariko ibiryo bikumva bihagaze mu kifuba.

Buri bwoko bufite impamvu n’ibimenyetso bitandukanye, niyo mpamvu muganga wawe azakubaza ibibazo birambuye ku bijyanye n’aho n’igihe wumva ugira ikibazo cyo kwishima.

Ni iki gitera dysphagia?

Dysphagia ishobora guterwa n’ibibazo bitandukanye bigira ingaruka ku bice bitandukanye by’umubiri wawe ushinzwe kwishima. Impamvu ziterwa ahanini n’ubwoko bwa dysphagia ufite.

Impamvu zisanzwe ziterwa na oropharyngeal dysphagia zirimo:

• Ibisubizo by’ubwonko nka stroke cyangwa indwara za Parkinson
• Cancer y’umutwe n’ijosi cyangwa uburyo bwo kuyivura
• Ubusembere bw’imikaya nka myasthenia gravis
• Dementia cyangwa kugabanuka kw’ubwenge
• Indwara z’umunwa cyangwa kubyimba
• Ibibazo by’amenyo cyangwa imyenda y’amenyo idakwiranye
• Imiti itera umunwa wumye cyangwa ubusembere bw’imikaya

Esophageal dysphagia ikunda guterwa na:

• Indwara ya Gastroesophageal reflux (GERD) itera udukoba
• Imikaya y’esophagus ikorora
• Kubabara kwa esophagus kubera kubyimba cyangwa udukoba
• Ubusembere muri esophagus cyangwa bugakanda esophagus
• Hiatal hernia
• Indwara z’imiterere y’umubiri nka scleroderma
• Eosinophilic esophagitis (kubyimba kubera allergie)

Rimwe na rimwe, dysphagia iterwa n’ingaruka z’imiti, cyane cyane izigira ingaruka ku mikorere y’imikaya cyangwa itera umunwa wumye. Impinduka ziterwa n’imyaka zishobora kandi kugira uruhare, kuko imikaya ikora ku kwishima ishobora kugenda ibura imbaraga uko imyaka igenda yiyongera.

Mu bihe bitoroshye, dysphagia ishobora guterwa n’ibibazo nka achalasia, aho umusemburo wa esophageal udashobora kuruhuka neza, cyangwa indwara z’umubiri ziterwa n’ubwirinzi bw’umubiri zigira ingaruka ku mikaya ikora ku kwishima.

Ni ryari ukwiye kujya kwa muganga kubera dysphagia?

Ukwiye kuvugana n’umuganga wawe niba ibibazo byo kwishima bikomeza iminsi irenga mike cyangwa bikabangamira kurya no kunywa kwawe. Ntugatege amatwi niba ikibazo gikomeza cyangwa kigira ingaruka ku mirire yawe.

Shaka ubuvuzi bw’ihutirwa niba ugira:

• Kudahishema rwose ibinyobwa cyangwa ibiryo
• Gukama bikomeye
• Ibimenyetso byo gutakaza amazi cyangwa gutakaza ibiro byinshi
• Umuhango hamwe n’ibibazo byo kwishima
• Kubabara mu kifuba bikomeza mu gihe cyo kwishima
• Kuruka amaraso cyangwa ibintu bisa n’ibicupa by’ikawa

Ndetse n’ibimenyetso bito bisaba ko uhabwa ubuvuzi niba bikomeza. Gusuzuma hakiri kare bishobora gufasha kumenya impamvu zishobora kuvurwa no gukumira ingaruka nka malnutrition cyangwa aspiration pneumonia.

Muganga wawe ashobora kumenya niba ibimenyetso byawe bisaba ubuvuzi bw’ihutirwa cyangwa bishobora gufatwaho ingamba z’impinduka mu mibereho n’uburyo bwo kuvura.

Ni ibihe bintu byongera ibyago byo kugira dysphagia?

Ibintu byinshi bishobora kongera ibyago byo kugira ibibazo byo kwishima. Gusobanukirwa ibyo bintu bishobora kugufasha kumenya ibibazo bishoboka no gushaka ubufasha igihe bikenewe.

Imyaka ni kimwe mu bintu byongera ibyago byinshi, kuko imikaya n’imitsi ikora ku kwishima ishobora kugenda ibura imbaraga uko imyaka igenda yiyongera. Abantu barengeje imyaka 65 nibo bafite ibyago byinshi, cyane cyane niba bafite ibindi bibazo by’ubuzima.

Indwara zikunda kongera ibyago bya dysphagia zirimo:

• Indwara z’imitsi y’ubwonko (stroke, indwara ya Parkinson, sclerosis nyinshi)
• Cancer y’umutwe n’ijosi
• Indwara ya Gastroesophageal reflux (GERD)
• Indwara z’imiterere y’umubiri
• Dementia cyangwa kugabanuka kw’ubwenge
• Guhabwa imirasire mu mutwe cyangwa mu ijosi mbere
• Indwara z’impyiko zidakira
• Indwara ziterwa n’ubwirinzi bw’umubiri

Imiti imwe na imwe ishobora kongera ibyago byawe, cyane cyane iziterwa n’umunwa wumye, kuruhuka kw’imikaya, cyangwa gusinzira. Niba ufata imiti myinshi, ingaruka zose hamwe zishobora kugira ingaruka ku mikorere yawe yo kwishima.

Ibintu by’imibereho nko kunywa itabi no kunywa inzoga nyinshi bishobora kubabaza umunwa wawe na esophagus, bigatuma ugira ibibazo byo kwishima uko imyaka igenda yiyongera.

Ni iyihe ngaruka zishoboka za dysphagia?

Iyo idakize, dysphagia ishobora gutera ibibazo bikomeye by’ubuzima bigira ingaruka ku mibereho yawe muri rusange. Inkuru nziza ni uko ingaruka nyinshi zishobora kwirindwa hakoreshejwe uburyo bwiza bwo kuyivura.

Ingaruka zisanzwe zirimo:

• Gutakaza imirire n’amazi kubera kwirinda ibiryo n’ibinyobwa
• Gutakaza ibiro bitateganijwe
• Aspiration pneumonia (igihe ibiryo cyangwa ibinyobwa byinjira mu mpyiko)
• Indwara z’ubuhumekero zikomeza
• Kwikura mu bandi kubera kwirinda ibirori byo kurya hamwe n’abandi
• Ubwoba cyangwa kwiheba bijyanye n’ibibazo byo kurya
• Gukama

Aspiration pneumonia ikwiye kwitabwaho cyane kuko ishobora kuba ikomeye, cyane cyane mu bantu bakuze cyangwa abafite ubudahangarwa bw’umubiri buke. Ibi bibaho igihe ibiryo, ibinyobwa, cyangwa umusemburo byinjira mu mpyiko zawe aho kwinjira mu gifu.

Ingaruka nke ariko zikomeye zishobora kuba harimo gutakaza amazi cyane bisaba kujya mu bitaro, cyangwa kubabara kwa esophagus bisaba ubuvuzi bw’ihutirwa.

Ingaruka zo mu mutwe ntizikwiye kwirengagizwa. Abantu benshi bafite dysphagia bagira ubwoba bwo kurya, ibyo bishobora kongera ikibazo no kugira ingaruka ku mibereho yabo.

Uko wakwirinda dysphagia

Nubwo utazi kwirinda impamvu zose za dysphagia, cyane cyane izijyanye n’indwara z’imitsi y’ubwonko cyangwa cancer, hari intambwe ushobora gutera kugira ngo ugabanye ibyago byawe kandi urinde ubushobozi bwawe bwo kwishima.

Kwita ku ndwara ziriho ni ingenzi. Kwita ku ndwara nka GERD, diyabete, n’umuvuduko ukabije w’amaraso hamwe n’umuganga wawe. Izo ndwara zishobora kugira uruhare mu bibazo byo kwishima niba zititaweho.

Ibikorwa by’imibereho bishobora gufasha birimo:

• Kwirinda kunywa itabi no kunywa inzoga nyinshi
• Kunywa amazi ahagije
• Kwita ku buzima bw’amenyo no kujya kwa muganga w’amenyo buri gihe
• Kurya buhoro buhoro no gutema neza
• Kwirinda kuvugira mu gihe cyo kurya
• Kwicara uhagaze mu gihe cyo kurya no nyuma yaho
• Kwita ku guhangayika, bishobora kugira ingaruka ku mikorere y’imikaya

Niba uri mu kaga kubera imyaka cyangwa ibibazo by’ubuzima, gusuzuma buri gihe hamwe n’umuganga wawe bishobora gufasha kumenya ibibazo hakiri kare. Bashobora kugutegurira imyitozo yo kwishima cyangwa bagutuma kwa muganga w’umuvugizi kugira ngo aguhe uburyo bwo kwirinda.

Ku bantu bakira stroke cyangwa ibindi bibazo by’imitsi y’ubwonko, gukorana n’inzobere mu kuvura hakiri kare bishobora gufasha kubungabunga cyangwa kunoza ubushobozi bwo kwishima.

Uko dysphagia imenyekanishwa

Muganga wawe azatangira aganira nawe ku bimenyetso byawe, amateka yawe y’ubuzima, n’imiti ufata. Azashaka kumenya neza igihe n’aho wumva ugira ikibazo cyo kwishima, ibiryo cyangwa ibinyobwa biterwa n’ibibazo, niba ibimenyetso bikomeza.

Isuzuma rya physique ririmo kureba mu kanwa kawe, mu muhogo, no mu ijosi, ndetse no kumva uko ijwi ryawe riri n’ukureba uko wishima amazi make.

Bishingiye ku bimenyetso byawe, muganga wawe ashobora gutegeka ibizamini bitandukanye:

• Isuzuma rya barium swallow (modified barium swallow cyangwa videofluoroscopic swallow study)
• Upper endoscopy kugira ngo arebe imbere ya esophagus na gifu
• Esophageal manometry kugira ngo apime umuvuduko w’imikaya n’imikorere yayo
• CT scan cyangwa MRI niba hari ibibazo by’imiterere bikekwa
• pH monitoring kugira ngo arebe niba hari aside itakaza

Barium swallow niyo isuzuma rikunda gukorwa mbere. Uzanywa umusemburo ufite barium mu gihe ama rayons X afatwa kugira ngo arebe uko umusemburo ugendera mu gikorwa cyo kwishima. Iryo suzuma rishobora kwerekana aho ikibazo giva.

Mu bihe bimwe na bimwe, ushobora kujyanwa kwa muganga w’inzobere nka gastroenterologist, neurologist, cyangwa speech-language pathologist kugira ngo akore isuzuma rirambuye n’igenamigambi yo kuvura.

Uko wavura dysphagia

Uburyo bwo kuvura dysphagia biterwa n’impamvu nyamukuru n’ubwoko bw’ikibazo cyo kwishima ufite. Intego ni ugufasha kwishima neza mu gihe ubungabunga imirire myiza no gukumira ingaruka.

Ku oropharyngeal dysphagia, uburyo bwo kuvura burimo:

• Ubuvuzi bw’umuvugizi
• Kwigira uburyo bwo kwishima n’imyitozo
• Guhindura imiterere y’ibiryo n’ibinyobwa
• Guhindura imyanya yo kurya cyangwa uburyo bwo kurya
• Kuvura ibibazo biriho nka GERD cyangwa indwara

Uburyo bwo kuvura esophageal dysphagia burimo:

• Imiti igabanya aside itakaza cyangwa irutuza imikaya ya esophagus
• Uburyo bwo kwagura ahantu hafunze
• Kubaga kugira ngo bakureho ibintu bibangamira cyangwa bagorore ibibazo by’imiterere
• Injuru za Botox ku mikaya ikorora
• Kuvura ibibazo biriho nka eosinophilic esophagitis

Abantu benshi bagira akamaro ko gukorana n’inzobere mu mirire kugira ngo baze babone imirire ihagije mu gihe bayobora ibibazo byo kwishima. Bashobora kugufasha guhitamo imiterere y’ibiryo n’ibinyobwa bikwiranye.

Mu bihe bikomeye aho kurya mu kanwa bitakwiriye, imiyoboro yo kugaburira by’igihe gito cyangwa burundu ishobora kuba ikenewe kugira ngo habeho imirire myiza no kwirinda aspiration.

Uko wakwitwara mu rugo

Nubwo ubuvuzi bw’inzobere ari ingenzi, hari uburyo bwinshi ushobora gukoresha mu rugo kugira ngo kwishima kuba byoroshye kandi bitaguteye ikibazo. Ibyo bintu bikora neza iyo bifatanije n’amabwiriza y’itsinda ryawe ry’abaganga.

Uburyo bwo kurya bufasha burimo:

• Kwica uhagaze mu gihe cyo kurya no guhora uhagaze iminota 30 nyuma yaho
• Kurya utuce duto n’utunyobwa duto
• Gutema neza mbere yo kwishima
• Kwishima kabiri kuri buri kigabano niba ari ngombwa
• Kwirinda kuvugira mu gihe cyo kurya
• Kwirinda ibintu bikurangaza mu gihe cyo kurya
• Kurya igihe uri maso kandi utarambirwa

Guhindura ibiryo n’ibinyobwa bishobora kuba harimo gukora ibinyobwa bikaze, guhitamo ibiryo byoroshye, cyangwa kwirinda ibiryo bikunda gutera ibibazo nka nuts, imbuto, cyangwa inyama zikomeye. Umuganga w’umuvugizi ashobora kugutera inama zihariye bishingiye ku isuzuma ryawe ry’uburyo bwo kwishima.

Kurema ahantu heza ho kurya bishobora kandi gufasha. Ubwoba n’ihungabana bishobora kongera ibibazo byo kwishima, bityo gufata umwanya wo kuruhuka mbere yo kurya bishobora kunoza ibimenyetso byawe.

Komereza amakuru y’ubufasha bw’ihutirwa, kandi menya ko abagize umuryango wawe bazi icyo bakora niba ugize ikibazo cyo gukama.

Uko wakwitegura kujya kwa muganga

Kwitabira inama yawe uriteguye bizafasha muganga wawe gusobanukirwa neza ibimenyetso byawe no gukora igenamigambi ry’uburyo bwiza bwo kuvura. Tangira ukoresheje igihe cyo kwandika ibimenyetso byawe iminsi mike mbere y’inama yawe.

Andika igihe ibibazo byo kwishima bibaho, ibyo warimo urya cyangwa unywa, n’aho wumva ugira ikibazo. Bandika niba ibiryo bimwe na bimwe cyangwa imyanya imwe na imwe bituma ibimenyetso bigenda cyangwa bigakomeza.

Zana amakuru akurikira mu nama yawe:

• Urutonde rwuzuye rw’imiti n’ibindi ufata ubu
• Amateka yawe y’ubuzima, harimo indwara cyangwa ibyabaye vuba aha
• Amateka y’umuryango wawe ajyanye n’ibibazo byo kwishima cyangwa ibibazo bifitanye isano
• Ibibazo ku bimenyetso byawe n’uburyo bwo kuvura
• Urutonde rw’ibiryo cyangwa ibinyobwa biterwa n’ibibazo byinshi

Tegura gusobanura ibimenyetso byawe mu buryo burambuye. Muganga wawe azashaka kumenya niba ikibazo kiri mu gutangira kwishima, cyangwa niba ibiryo bihagaze hagati. Azakubaza kandi ku bimenyetso bifitanye isano nko kubabara mu gifu, gutakaza ibiro, cyangwa impinduka z’ijwi.

Niba warigeze gukora ibizamini cyangwa kuvurwa kubera ibibazo byo kwishima, zana ibyo byanditswe. Ayo makuru ashobora gufasha kwirinda gukora ibizamini bitari ngombwa.

Icyingenzi kuri dysphagia

Dysphagia ni indwara ishobora kuvurwa igira abantu babarirwa muri za miriyoni, kandi ntugomba kubana n’ibibazo byo kwishima. Nubwo bishobora kuguha ubwoba cyangwa kukubabaza, gusobanukirwa ibimenyetso byawe no gukorana n’inzobere mu buvuzi bishobora kunoza cyane imibereho yawe.

Ikintu cy’ingenzi cyo kwibuka ni uko ibibazo byo kwishima bikomeza bisaba ubuvuzi. Gusuzuma no kuvura hakiri kare bishobora gukumira ingaruka zikomeye no kugufasha kubona imirire myiza n’imibanire myiza n’abandi mu bijyanye n’ibiryo.

Abantu benshi bafite dysphagia bashobora kwiga uburyo bwo kwishima neza kandi mu buryo bworoshye. Ukoresheje ubuvuzi bw’umuvugizi, guhindura imirire, ubuvuzi, cyangwa guhuza uburyo butandukanye, hari uburyo bwiza bwo gucunga iyi ndwara.

Komeza ukorane n’itsinda ryawe ry’abaganga, ukore ibyo bagutegetse, kandi ntutinye kubabaza ibibazo ku igenamigambi ryawe ry’ubuvuzi. Ukoresheje uburyo bwiza bwo kuyicunga, ushobora gukomeza kwishima neza mu gihe urinda ubuzima bwawe muri rusange.

Ibibazo byakunda kubazwa kuri dysphagia

Dysphagia ishobora gukira yonyine?

Bimwe mu bibazo bya dysphagia bishobora gukira byonyine, cyane cyane niba biterwa n’ibibazo by’igihe gito nka indwara z’umunwa cyangwa ingaruka z’imiti. Ariko rero, ibibazo byo kwishima bikomeza bisaba ubuvuzi kugira ngo birindwe ingaruka kandi ibimenyetso bigakira. Ni ngombwa kujya kwa muganga aho gutegereza ko ikibazo gikira.

Dysphagia ihora ikomeye?

Nubwo dysphagia ishobora kuba kuva ku gukomaga gato kugeza ku kuba ikomeye, ibibazo byose byo kwishima bikomeza bigomba gufatwa nk’ibikomeye kubera ingaruka zishoboka nka malnutrition cyangwa aspiration pneumonia. Ndetse na dysphagia yoroheje ishobora kugira ingaruka zikomeye ku mibereho yawe kandi ishobora kuba mbi uko imyaka igenda yiyongera niba impamvu nyamukuru zititaweho.

Ni ibihe biryo nakwirinda mfite dysphagia?

Ibiryo bikunda gutera ibibazo birimo nuts, imbuto, popcorn, inyama zikomeye, ibiryo bikomeye nka peanut butter, n’ibiryo bifite imiterere itandukanye nka cereal hamwe na amata. Ariko rero, inama zihariye ku biribwa biterwa n’uburyo bwawe bwo kwishima kandi bigomba kumenyeshwa n’umuganga w’umuvugizi cyangwa umuganga wawe.

Umuvuduko ushobora kongera dysphagia?

Yego, umuvuduko n’ihungabana bishobora kongera ibibazo byo kwishima bituma imikaya idakora neza kandi bikagutera umunaniro mu gihe cyo kurya. Abantu benshi basanga kurema ahantu heza ho kurya no gukora imyitozo yo kuruhuka bishobora gufasha kunoza ibimenyetso byo kwishima. Kwita ku guhangayika bijyanye no kurya ni ingenzi mu buryo bwo kuvura.

Biramba gute kugira ngo ubone impinduka mu gihe cyo kuvura dysphagia?

Igihe cyo kubona impinduka gitandukanye cyane biterwa n’impamvu nyamukuru n’uburyo bwo kuvura. Bamwe mu bantu babona impinduka mu byumweru bike batangiye kuvurwa cyangwa imiti, abandi bashobora gukenera amezi menshi y’ubuvuzi buhoraho. Itsinda ryawe ry’abaganga rishobora kuguha igitekerezo cyiza cy’icyo witeze bishingiye ku mimerere yawe.