Esofagite

Esophagitis ni kubyimba no guhumeka, bizwi nko kwangirika, kw'imikaya igize umuyoboro w'ibiryo. Umuyoboro w'ibiryo ni umuyoboro w'imikaya utwara ibiryo n'ibinyobwa uhereye mu kanwa ukagera mu gifu.

Esophagitis (uh-sof-uh-JIE-tis) ishobora gutera kubabara, kugira ikibazo cyo kwishima. Ishobora kandi gutera ububabare mu gituza. Ibintu bitandukanye bishobora gutera esophagitis. Bimwe mu bintu bisanzwe bitera birimo aside y'igifu izamuka mu muyoboro w'ibiryo, kwandura, imiti ifatwa mu kanwa na allergie.

Uburyo bwo kuvura esophagitis biterwa n'icyayiteye n'ingano y'ubwangirike bw'imikaya igize umuyoboro w'ibiryo. Iyo itavuwe, esophagitis ishobora kwangiza iyo mikaya. Umuyoboro w'ibiryo ushobora gutangira kugira ikibazo cyo kwambutsa ibiryo n'ibinyobwa uhereye mu kanwa ukagera mu gifu. Esophagitis ishobora kandi gutera ibindi bibazo bikomeye by'ubuzima. Ibi birimo ibikomere cyangwa gutomba kw'umuyoboro w'ibiryo, kugabanuka k'uburemere mu buryo budakwiye, no kukama umubiri.

Ibimenyetso bisanzwe bya esophagite birimo: Gukomeretsa kw'umutwe. Kubabara mu gihe cyo kurya. Ibiribwa byanyanywe bikaguma mu munwa, bizwi kandi nka food impaction. Kubabara nk'umuriro mu gituza, bizwi nka heartburn. Ni ihame kumva ubwo bubabare inyuma y'amagufa y'ibituza mu gihe cyo kurya. Amazi y'umubiri asubira mu munwa, bizwi nka acid reflux. Abana bato n'abana bamwe bafite esophagite baba bakiri bato cyane ku buryo badashobora gusobanura ibibabaza cyangwa kubabara. Ibimenyetso byabo bishobora kuba birimo: Kugira ibibazo mu gihe cyo konsa, nko guhita bababara, kugerageza kwirinda kurya no kudashaka kurya. Kudakura neza. Kubabara mu gituza cyangwa mu nda mu bana bakuru. Ibimenyetso byinshi bya esophagite bishobora guterwa n'ibibazo bitandukanye bigira ingaruka ku buryo bw'igogora. Reba umuganga wawe niba ibimenyetso: Bikomeje iminsi myinshi. Bitakira nyuma yo gukoresha imiti yitwa antacids iboneka nta rupapuro rw'umuganga. Bibi cyane ku buryo bigukomeretsa kurya cyangwa bigatuma ubaho. Bibaho hamwe n'ibimenyetso by'igicurane nko kubabara umutwe, guhinda umuriro no kubabara imikaya. Fata ubufasha bw'ubuvuzi bw'ibanze niba: Ufite ububabare mu gituza gikomeza iminota myinshi. Utekereza ko ufite ibiryo bifunze mu munwa. Ufite amateka y'indwara z'umutima kandi ukumva ububabare mu gituza. Ubabara mu kanwa cyangwa mu muhogo mu gihe cyo kurya. Ufite ikibazo cyo guhumeka cyangwa ububabare mu gituza bibaho nyuma gato yo kurya. Ugaragaza kugaragaza cyane, ukunze kuruka cyane cyangwa ugira ikibazo cyo guhumeka nyuma yo kuruka. Ubona ko ibyo uruka ari byera cyangwa byatukura, bisa nkaho ari ikawa y'ibishishwa, cyangwa bifite amaraso.

Ibisymptom byinshi bya esophagitis bishobora guterwa n'ibibazo bitandukanye bigira ingaruka ku gipimo cy'igogorwa. Reba umuganga wawe niba ibimenyetso:

• Bikomeje iminsi irenga mike.
• Bitakira nyuma yo gukoresha imiti yitwa antacids iboneka nta rupapuro rw'abaganga.
• Bikaze ku buryo bigukomerera kurya cyangwa bikubera impamvu yo kugabanya ibiro.
• Bibaho hamwe n'ibimenyetso by'igicurane nka: kubabara umutwe, guhinda umuriro no kubabara imikaya. Shaka ubufasha bwihuse niba:
• Ufite ububabare mu gituza gihora iminota irenga mike.
• Utekereza ko hari ibiryo byafunze mu munwa.
• Ufite amateka y'indwara z'umutima kandi ukumva ububabare mu gituza.
• Ubona ububabare mu kanwa cyangwa mu muhogo igihe urya.
• Ufite ikibazo cyo guhumeka cyangwa ububabare mu gituza bibaho vuba nyuma yo kurya.
• Ugaragaza kuruka cyane, ukunda kuruka cyane cyangwa ugira ikibazo cyo guhumeka nyuma yo kuruka.
• Ubona ko ibyo uruka ari byera cyangwa byicyatsi, bisa n'ibishishwa by'ikawa, cyangwa bikubiyemo amaraso.

Abaganga b’inzobere mu buvuzi bakunda kwita kuri esophagitis bitewe n’icyayiteye. Rimwe na rimwe, esophagitis ishobora kuba ifite imvano nyinshi. Zimwe mu njya zihura cyane zirimo izi zikurikira:

Umuvala witwa umuvana wo hasi w’umuyoboro w’ibiryo (lower esophageal sphincter) ubusanzwe ubuza aside y’igifu kwinjira mu muyoboro w’ibiryo. Ariko rimwe na rimwe uyu muvala ntabwo ufunga neza. Cyangwa urafunguka igihe kitagomba. Mu bamwe, igice cyo hejuru cy’igifu kiva mu gikombe kinini gitandukanya igifu n’ibituro. Ibi bizwi nka hiatal hernia. Bishobora kandi gutuma aside y’igifu isubira inyuma mu muyoboro w’ibiryo.

Indwara yo gusubira inyuma kw’aside y’igifu (GERD) ni uburwayi aho gusubira inyuma kw’aside kuba ikibazo kiba kenshi cyangwa gikomeza. GERD ishobora gutera kubyimba no kwangirika kw’imiterere y’umuyoboro w’ibiryo.

Esophagitis ni ukubyimba no gucika intege, bitwa inflammation, by’imiterere ikingira umuyoboro w’ibiryo. Umuyoboro muremure, woroshye, ufite camera ku mpera, witwa endoscope, ushobora gukoreshwa kugira ngo urebe imbere mu muyoboro w’ibiryo. Iyi shusho ya endoscopic ya eosinophilic esophagitis igaragaza impeta zibyimba z’imiterere idasanzwe zikomoka ku myanya y’ububabare. Izi zizwi nka impeta z’umuyoboro w’ibiryo.

Eosinophils (e-o-SIN-o-fils) ni utunyangingo tw’amaraso yera tugira uruhare rukomeye mu mubabaro w’allergie. Eosinophilic esophagitis ishobora kubaho niba utwo tunyangingo tw’amaraso yera twinshi twubatswe mu muyoboro w’ibiryo. Ibi birashoboka cyane kubera ikintu gitera allergie, aside isubira inyuma cyangwa byombi.

Ibiribwa bimwe na bimwe bishobora gutera ubu bwoko bwa esophagitis, birimo:

• Amata.
• Amayi.
• Ingano.
• Soja.
• Ibijumba.
• Ifishi.

Ibizamini bisanzwe byo kubona allergie akenshi ntibishobora kugaragaza ibi biribwa nk’ibitera allergie.

Abantu bafite eosinophilic esophagitis bashobora kugira allergie izindi zitaterwa n’ibiryo. Urugero, rimwe na rimwe allergie zo mu kirere, nka pollen, zishobora kuba ari zo zibitera. Kimwe mu bimenyetso bisanzwe bya eosinophilic esophagitis ni ibiryo bihagaze mu muyoboro w’ibiryo nyuma yo kubinywa. Ibi bita food impaction. Ikindi kimenyetso gisanzwe ni ugutinda kw’ibiryo mu muyoboro w’ibiryo, bitwa dysphagia.

Lymphocytic esophagitis (LE) si uburwayi busanzwe bw’umuyoboro w’ibiryo. Hamwe na LE, umubare munini udasanzwe w’utunyangingo tw’amaraso yera twitwa lymphocytes twubatswe mu gice cy’umuyoboro w’ibiryo. LE ishobora kuba ifitanye isano na eosinophilic esophagitis cyangwa na GERD.

Ibi kandi bita drug-induced esophagitis, ubu bwoko buva iyo imiti imwe ifatwa mu kanwa itera kwangirika kw’imiterere y’umuyoboro w’ibiryo. Kwanga kw’imiterere kubaho niba imiti igumana n’igice cy’umuyoboro w’ibiryo igihe kirekire. Urugero, ushobora kunywa imiti nta mazi cyangwa make. Niba ubikoze, imiti ubwayo cyangwa ibisigazwa byayo bishobora kuguma mu muyoboro w’ibiryo. Imiti yafitanye isano na esophagitis irimo:

• Imiti igabanya ububabare nka aspirine, ibuprofen (Advil, Motrin IB, izindi) na naproxen sodium (Aleve).
• Antibiyotike nka tetracycline na doxycycline.
• Imiti yitwa potassium chloride ikoreshwa mu kuvura ibibazo byo kubura uburyohe bwa potassium.
• Imiti yitwa bisphosphonates ivura ibibazo by’amagufa nka osteoporosis. Iyi miti irimo alendronate (Binosto, Fosamax).
• Ubuvuzi bw’indwara z’umutima bwitwa quinidine.

Ikibazo cy’ubwandu mu miterere y’umuyoboro w’ibiryo gishobora gutera esophagitis. Ubwandu bushobora guterwa na bagiteri, virusi cyangwa fungi. Infectious esophagitis ni gake. Bibaho cyane cyane mu bantu bafite ubudahangarwa bw’umubiri buke, nka bantu bafite HIV/AIDS cyangwa kanseri.

Fungi isanzwe iba mu kanwa yitwa Candida albicans ni yo itera infectious esophagitis. Ubu bwoko bw’ubwandu bwa fungi akenshi bufite isano n’ubudahangarwa bw’umubiri buke, diyabete, kanseri, cyangwa ikoreshwa ry’imiti ya steroide cyangwa antibiyotike.

Ibisanzwe, ibyago byo kwibasirwa na esophagitis biterwa n'icyateye iyo ndwara.

Ibintu byongera ibyago byo kwibasirwa na reflux gastroesophageal (GERD) ni nabyo byongera ibyago byo kwibasirwa na reflux esophagitis. Ibyo bintu birimo ibi bikurikira:

• Kurya mbere gato yo kuryama.
• Kurya amafunguro menshi kandi yuzuye amavuta.
• Kunywa itabi.
• Kugira ibiro byinshi, harimo no kubera gutwita.

Ibiribwa bishobora kongera ibimenyetso bya GERD cyangwa reflux esophagitis birimo:

• Caffeine.
• Alcool.
• Ibiribwa birimo amavuta.
• Chocolat.
• Peppermint.

Ibyago byo kwibasirwa na allergie esophagitis bishobora kuba birimo:

• Amateka y'uburyo runaka bwa allergie. Ibi birimo asma, atopic dermatitis na allergic rhinitis, bizwi kandi nka hay fever.
• Amateka yo mu muryango wa eosinophilic esophagitis.

Ibyago byo kwibasirwa n'ubu bwoko bwa esophagitis bikunze guhuzwa n'ibibazo bidindiza cyangwa bidatuma umuti ugenda neza kandi wihuse ujya mu gifu. Ibyo bintu birimo:

• Kumira umuti ufite amazi make cyangwa udafite na gato.
• Gufata imiti uri kuryamye.
• Gufata imiti mbere gato yo kuryama. Iki kintu gishobora kuba giterwa ahanini no kugabanuka kw'umusemburo w'amashyira ndetse no kugabanuka kw'imikorere yo kwishima mu gihe cyo kuryama.
• Kuba umuntu mukuru mu myaka. Ibi bishobora kuba ari ikintu giterwa n'impinduka ziterwa n'imyaka ku mitsi yo mu gifu cyangwa ku mitsi ikora umusemburo w'amashyira.
• Gufata imiti minini cyangwa ifite imiterere idasanzwe.

Ibyago byo kwibasirwa na esophagitis iterwa n'ubwandu bikunze guhuzwa n'imiti nka steroide cyangwa antibiotique. Abantu barwaye diabete nabo bafite ibyago byinshi byo kwibasirwa na esophagitis iterwa n'ubwandu bwa candida, cyane cyane.

Utujuje ubuvuzi, esofagite ishobora gutera impinduka mu buryo bwa esofaje. Ingaruka zishobora kuba:

• Udukoba cyangwa gutoha kwa esofaje, bizwi nka stenoze.
• Kwibasira uruhu rwa esofaje. Ibi bishobora guterwa no kuruka cyangwa abaganga banyuza ibikoresho byo kuvura mu gifu gifite umuriro mu gihe cyo gukora endoscopie. Endoscopie ni uburyo abaganga basuzumiramo uburyo imirire ikora.
• Indwara yitwa Barrett's esophagus aho utwuma dukora uruhu rwa esofaje tuba twangiritse n'umusemburo w'umwanda. Ibi byongera ibyago bya kanseri itangira muri esofaje, izwi kandi nka kanseri ya esofaje.

Endoscopy Kugura ishusho Funga Endoscopy Endoscopy Mu gihe cyo gukora endoscopy yo hejuru, umuhanga mu by’ubuzima ashyiramo umuyoboro muto, woroshye ufite umucyo na kamera munsi y’umunwa ukagera mu munwa. Kamera nto itanga igishushanyo cy’umunwa, umwijima n’intangiriro z’umwijima muto, bizwi nka duodenum. Kugereranya bimwe mu byo umuhanga mu by’ubuzima akora kugira ngo amenye niba ufite esophagitis. Umuhanga wawe mukuru mu by’ubuzima cyangwa inzobere ikubaza ibibazo ku bimenyetso byawe kandi ikakora isuzuma rusange. Ushobora kandi gukenera ibizamini bimwe cyangwa byinshi. Ibi bizamini bishobora kuba birimo ibi bikurikira: Endoscopy Endoscopy ni ikizamini gikoreshwa mu kugenzura uburyo bw’igogora. Umuhanga mu by’ubuzima ayobora umuyoboro muremure, muto ufite kamera nto munsi y’umunwa ukagera mu munwa. Iki gikoresho kitwa endoscope. Umuhanga wawe mu by’ubuzima ashobora gukoresha endoscope kugira ngo arebe niba umunwa usa neza uko bisanzwe. Ibice bito by’ingingo bishobora gufatwa kugira ngo bipimwe. Ibi bita biopsy. Umunwa ushobora kugaragara ukundi bitewe n’icyateye kubyimbagira, nko gufata imiti cyangwa reflux esophagitis. Mbere y’iki kizamini, uhabwa imiti igufasha kuruhuka. Capsule yo mu munwa Iki kizamini gishobora gukorwa mu biro by’umuhanga mu by’ubuzima. Kiba kigizwe no kumira capsule ifite umugozi. Capsule itangira gushonga mu gifu ikarekura icyuma. Umuhanga mu by’ubuzima akura icyuma mu kanwa akoresheje umugozi. Uko icyuma gikurwa, gifata ibice by’ingingo by’umunwa. Ibi bishobora gufasha umuhanga wawe mu by’ubuzima kumenya uko umunwa wawe ubyimbagira hatakozwe endoscopy. Barium X-ray Iki kizamini kigizwe no kunywa umuti cyangwa gufata igitonyanga kirimo ikintu cyitwa barium. Barium gipfuka imbere y’umunwa n’umwijima kugira ngo bigaragara ku mashusho yafashwe. Amashusho ashobora gufasha abahanga mu by’ubuzima kubona aho umunwa wamanutse n’ibindi bihinduka mu buryo. Amashusho ashobora kandi gufasha kubona hiatal hernia, imikaya cyangwa ibindi bibazo bishobora kuba bitera ibimenyetso. Ibizamini bya Laboratwari Ibice bito by’ingingo byakuweho mu gihe cyo gukora endoscopy byoherezwa muri laboratwari kugira ngo bipimwe. Bitewe n’icyatewe n’uburwayi, ibizamini bishobora gukoreshwa kugira ngo: Hagenwe indwara iterwa na bagiteri, virusi cyangwa fungus. Menya niba hari utunyangingo tw’amaraso tw’umweru twitwa eosinophils twubatswe mu munwa. Kugaragaza utunyangingo tudasanzwe. Utunyangingo nk’utwo dushobora kuba ibimenyetso bya kanseri y’umunwa cyangwa ibindi bihinduka byongera ibyago bya kanseri. Kwitaho muri Mayo Clinic Itsinda ryacu ryita ku barwayi ry’abahanga ba Mayo Clinic rishobora kugufasha mu bibazo byawe by’ubuzima bifitanye isano na esophagitis Tangira hano Amakuru y’inyongera Kwitaho kwa esophagitis muri Mayo Clinic Ibizamini by’uruhu by’allergie Upper endoscopy

Ubuvuzi bwa esofagite bugamije kugabanya ibimenyetso, gucunga ingaruka mbi no kuvura ibitera iyo ndwara. Uburyo bwo kuvura butandukanye bitewe n'icyateye esofagite. Ubuvuzi bwa esofagite iterwa no gusubira inyuma kw'amavunja bushobora kuba burimo:

• Imiti iboneka idafite ibyangombwa. Ibi birimo antacids (Maalox, Mylanta, n'ibindi); imiti yitwa H-2-receptor blockers igabanya aside y'igifu, nka cimetidine (Tagamet HB); n'imiti yitwa proton pump inhibitors ihagarika aside y'igifu kandi ikavura umuyoboro w'ibiryo, nka lansoprazole (Prevacid 24 HR) na omeprazole (Prilosec OTC), n'ibindi.
• Imiti isaba ibyangombwa by'abaganga. Ibi birimo H-2-receptor blockers na proton pump inhibitors bifite imbaraga nyinshi.
• Ubuganga. Ubwoko bw'ubuganga bwitwa fundoplication bushobora kunoza ubuzima bw'umuyoboro w'ibiryo niba ubundi buvuzi budakora. Umuganga ashyira igice cy'igifu ku gice cy'umuyoboro w'ibiryo gikuraho igifu. Icyo gice cyitwa lower esophageal sphincter. Ubu buganga bushobora gukomeza sphincter no kubuza aside gusubira inyuma mu muyoboro w'ibiryo. Ubuvuzi bwa esofagite iterwa na eosinophil bugizwe no kwirinda ibintu bitera ibimenyetso. Ubuvuzi kandi bugizwe no koroshya uburwayi bw'allergie hakoreshejwe imiti. Imiti ishobora kuba irimo:
• Proton pump inhibitors. Umuganga wawe ashobora kubanza kugutegurira proton pump inhibitor. Ushobora gufata imiti nka esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) cyangwa pantoprazole (Protonix).
• Steroids. Ubushakashatsi bumwe bwerekana ko steroids zinyobwa zishobora kugira ingaruka ku mubiri w'umuyoboro w'ibiryo mu kuvura esofagite iterwa na eosinophil. Steroid imwe yitwa budesonide (Eohilia) iba mu buryo bw'amazi. Ikindi steroid yitwa fluticasone irasinzika mu kanwa hanyuma igakonjeshwa. Umuganga wawe arashobora kukubwira uburyo bwo kunywa umuti wa steroid kugira ngo ukoreshe umuyoboro w'ibiryo. Kunywa umuti wa steroid ntabwo bishobora gutera ingaruka mbi cyane ugereranije no gufata imiti ya steroid mu kanwa.
• Ibiryo byakurwamo ibintu bimwe na bimwe n'ibiryo by'ibintu by'ibanze. Isesemi ku kintu runaka gishobora kuba ari cyo cyateye esofagite iterwa na eosinophil. Rero bishobora kugufasha guhagarika kurya ibiryo bisa nkaho bitera allergie. Ibizamini bisanzwe bya allergie ntibishobora kukubwira neza niba ufite allergie ku kintu runaka. Kubw'ibyo, umuganga wawe ashobora kugusaba gukuramo ibiryo bisanzwe biterwa na allergie. Hanyuma ushobora kongera gushyira ibiryo mu mirire yawe buhoro buhoro ukamenya igihe ibimenyetso bisubira. Ibi bizwi nka elimination diet. Bigomba gukorwa hakurikijwe amabwiriza y'umuganga wawe. Uburyo bugoye kurushaho ni ukukuraho ibiryo byose mu mirire yawe igihe runaka. Umuganga wawe asimbuza ibiryo ifu y'ibintu by'ibanze bya amino acide. Uko iminsi igenda, ugaruka buhoro buhoro kurya ibiryo. Ibi bita elemental diet. Bigomba kandi gukorwa munsi y'ubuyobozi bw'umuganga.
• Monoclonal antibodies. Ubu bwoko bw'imiti bukorera mu kuburizamo imikorere ya proteine zimwe na zimwe mu mubiri ziterwa na inflammation. Monoclonal antibody yitwa dupilumab (Dupixent) ishobora kuba uburyo bwo kuvura abantu bafite imyaka 12 n'irenga barwaye esofagite iterwa na eosinophil. Dupilumab itangwa nk'urushinge buri cyumweru cyangwa buri byumweru bibiri bitewe n'uburemere bwawe. Steroids. Ubushakashatsi bumwe bwerekana ko steroids zinyobwa zishobora kugira ingaruka ku mubiri w'umuyoboro w'ibiryo mu kuvura esofagite iterwa na eosinophil. Steroid imwe yitwa budesonide (Eohilia) iba mu buryo bw'amazi. Ikindi steroid yitwa fluticasone irasinzika mu kanwa hanyuma igakonjeshwa. Umuganga wawe arashobora kukubwira uburyo bwo kunywa umuti wa steroid kugira ngo ukoreshe umuyoboro w'ibiryo. Kunywa umuti wa steroid ntabwo bishobora gutera ingaruka mbi cyane ugereranije no gufata imiti ya steroid mu kanwa. Ibiryo byakurwamo ibintu bimwe na bimwe n'ibiryo by'ibintu by'ibanze. Isesemi ku kintu runaka gishobora kuba ari cyo cyateye esofagite iterwa na eosinophil. Rero bishobora kugufasha guhagarika kurya ibiryo bisa nkaho bitera allergie. Ibizamini bisanzwe bya allergie ntibishobora kukubwira neza niba ufite allergie ku kintu runaka. Kubw'ibyo, umuganga wawe ashobora kugusaba gukuramo ibiryo bisanzwe biterwa na allergie. Hanyuma ushobora kongera gushyira ibiryo mu mirire yawe buhoro buhoro ukamenya igihe ibimenyetso bisubira. Ibi bizwi nka elimination diet. Bigomba gukorwa hakurikijwe amabwiriza y'umuganga wawe. Uburyo bugoye kurushaho ni ukukuraho ibiryo byose mu mirire yawe igihe runaka. Umuganga wawe asimbuza ibiryo ifu y'ibintu by'ibanze bya amino acide. Uko iminsi igenda, ugaruka buhoro buhoro kurya ibiryo. Ibi bita elemental diet. Bigomba kandi gukorwa munsi y'ubuyobozi bw'umuganga. Ubuvuzi bwa esofagite iterwa n'imiti bugizwe no kutakoresha imiti itera ikibazo iyo bishoboka. Bugizwe kandi no kugabanya ibyago by'iyi ndwara hakoreshejwe imyifatire myiza yo gufata imiti. Umuganga wawe ashobora kugutegurira:
• Gufata indi miti idashobora gutera esofagite iterwa n'imiti.
• Gufata imiti iri mu buryo bw'amazi iyo bishoboka.
• Kwicara cyangwa guhagarara iminota nibura 30 nyuma yo gufata imiti.
• Kunywa ikirahure cyuzuye cy'amazi hamwe n'imiti. Ariko ubu buryo si bwo bukwiriye buri wese. Urugero, bamwe bagomba kunywa amazi make kubera ubundi burwayi, nka indwara z'impyiko. Umuganga wawe ashobora kugutegurira imiti yo kuvura indwara itera esofagite iterwa n'indwara. Imiti ishobora gufasha gukuraho indwara ziterwa na virusi, bacteria cyangwa fungi. Umuganga witwa gastroenterologist uvuza indwara z'igifu ashobora gukoresha ibikoresho by'ubuvuzi kugira ngo agurumure umuyoboro w'ibiryo. Ubu buvuzi bwitwa esophageal dilation. Busanzwe bukoreshwa gusa niba umuyoboro w'ibiryo ugabanuka cyane cyangwa niba ibiryo bikomeza mu muyoboro w'ibiryo. Mu gihe cya esophageal dilation, umuganga wawe ayobora imiyoboro mito yoroheje mu muyoboro w'ibiryo. Uburyo bw'ibyo bikoresho bushobora kuba bufite:
• Impera yoroshye itangira n'igice cyoroshye cyaguka buhoro buhoro.
• Umupira ushobora kwaguka nyuma yo gushyirwa mu muyoboro w'ibiryo.