Isifo Sokubuyela Emuva Kwesisu (Gerd)

Ukubuyela emuva kwesidodana kwenzeka lapho umsipha we-sphincter ekugcineni komlomo wokudla ukhululeka ngesikhathi esingalungile, uvumela ukuba isidodana sesisu sibuyele emuva esiswini. Lokhu kungabangela ukushisa kwenhliziyo nezinye izimpawu. Ukubuyela emuva okuvamile noma okuqhubekayo kungabangela i-GERD.

Isifo sokubuyela emuva kwesisu nesigodo yisimo lapho isidodana sesisu siphinde sigeleze siye phezulu etubeni ehlanganisa umlomo nesisu, elibizwa ngokuthi yi-esophagus. Ngokuvamile kubizwa ngokuthi yi-GERD ngamafuphi. Lokhu kubuyela emuva kwaziwa ngokuthi ukubuyela emuva kwesidodana, futhi kungakhungathekisa ukugqoka komlomo wokudla.

Abantu abaningi baye baba nokuhlangenwe nakho kokubuyela emuva kwesidodana ngezikhathi ezithile. Noma kunjalo, uma ukubuyela emuva kwesidodana kwenzeka ngokuphindaphindiwe ngokuhamba kwesikhathi, kungabangela i-GERD.

Abantu abaningi bangaphatha ukungakhululeki kwe-GERD ngokushintsha indlela yokuphila nezinhlungu. Futhi nakuba kungavamile, abanye bangadinga ukuhlinzwa ukuze basize ngezimpawu.

Izimpawu ezivamile ze-GERD zihlanganisa:

• Ukuzwakala kokushisa esifubeni, okuvame ukubizwa ngokuthi ukushisa kwenhliziyo. Ukushisa kwenhliziyo ngokuvamile kwenzeka ngemva kokudla futhi kungaba kubi kakhulu ebusuku noma uma ulele phansi.
• Ukubuyela emuva kokudla noma ulwetshe oluvuthayo emlonyeni.
• Ubuhlungu emathunjini angaphezulu noma esifubeni.
• Ubunzima bokuginya, okuthiwa yi-dysphagia.
• Ukuzwakala kwenqwaba emlonyeni.

Uma une-acid reflux ebusuku, ungase futhi uhlangabezane noku:

• Ukuhlanza okuqhubekayo.
• Ukuvuvukala kwezintambo zezwi, okuthiwa yi-laryngitis.
• I-asthma entsha noma ebiyelayo.

Funani usizo lwezokwelapha ngokushesha uma unezinhlungu esifubeni, ikakhulu uma futhi unethukutheki lokuphefumula, noma ubuhlungu emaxwini noma engalweni. Lezi zingaba izimpawu zokuhluleka kwenhliziyo. Yenza i-aphoyintimenti nochwepheshe wezempilo uma:

• Unezimpawu ezinzima noma eziqhele ngokweqile ze-GERD.
• Uthatha imithi engekho ngaphansi kwelokusetshenziswa kwemithi ngaphezu kabili ngesonto.

I-GERD ibangelwa ukubuyela emuva kwesidumbu noma okuqukethwe okungesona i-acid kusuka esiswini. Uma uginya, ibhendi yemisipha esiqalayo phansi kwesisu, ebizwa ngokuthi yi-lower esophageal sphincter, iphumula ukuvumela ukudla noketshezi ukuba kugeleze esiswini. Khona-ke i-sphincter ivaliwe futhi. Uma i-sphincter ingaphumi njengoba kujwayelekile noma ibuthakathaka, i-acid yesisu ingabuya esiswini. Lokhu kubuyela emuva okuqhubekayo kwe-acid kukhungathekisa ukugqoka kwesisu, ngokuvamile kubangela ukuba kuqale ukuvuvukala.

Isifo se-hiatal hernia siqala lapho ingxenye engaphezulu yesisu iphuma khona ngaphansi kwes diaphragm iye egumbini losifuba.

Izimo ezingandisa ingozi ye-GERD zihlanganisa:

• Ukukhuluphala.
• Ukuphakama kwengxenye engaphezulu yesisu ngaphezulu kwes diaphragm, okwaziwa ngokuthi yi-hiatal hernia.
• Ukukhulelwa.
• Izifo ze-connective tissue, njenge-scleroderma.
• Ukuphazamiseka kokukhishwa kwesisu.

Izici ezingenza ukubuyela emuva kwesidumbu kube sibi zihlanganisa:

• Ukubhema.
• Ukudla ukudla okukhulu noma ukudla ebusuku.
• Ukudla ukudla okuthile, njengokudla okunemafutha noma okubhaqedile.
• Ukuphuza izithelo ezithile, njengotshwala noma ikhofi.
• Ukuthatha imithi ethile, njenge-aspirin.

Ngokuhamba kwesikhathi, ukuvuvukala okungapheli esibindini kungabangela:

• Ukuvuvukala kwezicubu esibindini, okwaziwa ngokuthi i-esophagitis. Ama-asidi esisu angawonakalisa amathumbu esibindini. Lokhu kungabangela ukuvuvukala, ukuphuza igazi, futhi ngezinye izikhathi isifo esivulekile, esibizwa ngokuthi isihlungu. I-esophagitis ingabangela ubuhlungu futhi yenze ukugwinya kube nzima.
• Ukunciphisa kwesibindini, okubizwa ngokuthi i-esophageal stricture. Ukonakala kwengxenye engezansi yesibindini yi-asidi yesisu kubangela ukwakheka kwezicubu zesilonda. Izicubu zesilonda zinciphisa indlela yokudla, okuholela ezinkingeni zokugwinya.
• Ukushintsha okungaphambi komdlavuza esibindini, okwaziwa ngokuthi i-Barrett esophagus. Ukonakala okuvela e-asidi kungabangela ukushintsha ekuqaleni kwesibindini. Lezi zinguquko zihambisana nengozi ephakeme yomdlavuza wesibindini.

Phakathi nesikhathi se-upper endoscopy, ochwepheshe wezokunakekelwa kwempilo ufake ithyube elithin, elithambile elihlanganiswe nokukhanya nekamelo phansi komlomo futhi angene esibindini. Ikhamera encane inikeza umbono wesibindini, isisu nokuqala kwesibindini esincane, okuthiwa yi-duodenum.

Ochwepheshe wezokunakekelwa kwempilo bangase bakwazi ukuxilonga i-GERD ngokusekelwe emlandweni wezimpawu nokuhlolwa komzimba.

Ukuqinisekisa ukuxilongwa kwe-GERD, noma ukuhlola izinkinga, ochwepheshe wokunakekelwa bangase bancome:

• Uvivinyo lwe-probe ye-acid (pH) oluhambayo. I-monitor ifakwe esibindini ukuhlonza ukuthi nini, nokuthi isikhathi esingakanani, i-acid yesisu ibuyela lapho. I-monitor ixhunywe kukhompyutha encane egqokwe ezingalweni noma ngebhande phezu kwehlombe.

  I-monitor ingaba yithyube elithin, elithambile, okuthiwa yi-catheter, eliqoshwe ngaphandle kwempumulo liye esibindini. Noma ingaba yikhapulethi ebekwe esibindini ngesikhathi se-endoscopy. Ikhapulethi idlula emathunjini ngemva kwezinsuku ezimbili.

• I-X-ray yesistimu yokugaya ukudla engaphezulu. I-X-rays ithathwa ngemva kokupuza ulwetshe oluthambile oluqopha futhi lugcwalise ukugqoka kwangaphakathi kwesigaxa sokuhlanza. Ukugqoka kuvumela ochwepheshe wezokunakekelwa kwempilo ukubona isithunzi sesibindini nesisu. Lokhu kuwusizo kakhulu kubantu abanamahloni okuginya.

Ngezinye izikhathi, i-X-ray yenziwa ngemva kokugwinya iphilisi le-barium. Lokhu kungasiza ekuxilongeni ukuncipha kwesibindini okuvimbela ukugwinya.

• I-Esophageal manometry. Lovivinyo luqapha ukucindezela kwemisipha ekuhlanganiseni esibindini ngesikhathi sokugwinya. I-Esophageal manometry iqapha futhi ukuxhumana namandla asebenziswa yimisipha yesibindini. Lokhu kuvame ukwenziwa kubantu abanamahloni okuginya.
• I-Transnasal esophagoscopy. Lovivinyo lenziwa ukufuna noma yiluphi uhlobo lokulimala esibindini. Ithyube elithin, elithambile elina-video camera libekwe ngaphandle kwempumulo futhi liqoshwe phansi komlomo liye esibindini. Ikhamera ithumela izithombe esikrinini sevidiyo.

I-Upper endoscopy. I-Upper endoscopy isebenzisa ikhamera encane ekupheleni kwethyube elithambile ukuhlola ngokubonakalayo isistimu yokugaya ukudla engaphezulu. Ikhamera iyasiza ukunikeza umbono wangaphakathi kwesibindini nesisu. Imiphumela yokuhlola ingase ingabonisi ukuthi i-reflux ikhona, kodwa i-endoscopy ingathola ukuvuvukala kwesibindini noma ezinye izinkinga.

I-endoscopy ingasetshenziswa futhi ukuqoqa isampula yethishu, okuthiwa yi-biopsy, ukuhlolwa izinkinga ezinjenge-Barrett esophagus. Kwezinye izimo, uma kuncipha kubonakala esibindini, kungasabalalisa noma kuqiniswe ngesikhathi sale nqubo. Lokhu kwenziwa ukuthuthukisa inkinga yokugwinya.

Uvivinyo lwe-probe ye-acid (pH) oluhambayo. I-monitor ifakwe esibindini ukuhlonza ukuthi nini, nokuthi isikhathi esingakanani, i-acid yesisu ibuyela lapho. I-monitor ixhunywe kukhompyutha encane egqokwe ezingalweni noma ngebhande phezu kwehlombe.

I-monitor ingaba yithyube elithin, elithambile, okuthiwa yi-catheter, eliqoshwe ngaphandle kwempumulo liye esibindini. Noma ingaba yikhapulethi ebekwe esibindini ngesikhathi se-endoscopy. Ikhapulethi idlula emathunjini ngemva kwezinsuku ezimbili.

I-X-ray yesistimu yokugaya ukudla engaphezulu. I-X-rays ithathwa ngemva kokupuza ulwetshe oluthambile oluqopha futhi lugcwalise ukugqoka kwangaphakathi kwesigaxa sokuhlanza. Ukugqoka kuvumela ochwepheshe wezokunakekelwa kwempilo ukubona isithunzi sesibindini nesisu. Lokhu kuwusizo kakhulu kubantu abanamahloni okuginya.

Ngezinye izikhathi, i-X-ray yenziwa ngemva kokugwinya iphilisi le-barium. Lokhu kungasiza ekuxilongeni ukuncipha kwesibindini okuvimbela ukugwinya.

Ukuhlinzwa kwe-GERD kungabandakanya inqubo yokunciphisa i-sphincter ye-esophageal ephansi. Le nqubo ibizwa ngokuthi i-Nissen fundoplication. Kule nqubo, udokotela uhlanganisa ingxenye ephezulu yesisu ngaphezulu kwe-esophagus ephansi. Lokhu kunciphisa i-sphincter ye-esophageal ephansi, okwenza kube nzima ukuba i-asidi ibuye emuva e-esophagus. Idivayisi ye-LINX iyiringi ebanzi yama-magnetic beads egcina i-asidi yesisu ingabuyi emuva e-esophagus, kodwa ivumela ukudla ukudlula esiswini. Uchwepheshe wezempilo cishe uzokuncoma ukuzama ukushintsha indlela yokuphila nezinye izidakamizwa ezingelona iresiphi njengendlela yokuqala yokwelapha. Uma ungazizwa ukhululekile ezinsukwini ezimbalwa, imithi ye-prescription kanye nokuhlolwa okwengeziwe kungase kunconywe. Izindlela zihlanganisa:

• Izidakamizwa ze-antacids ezithambisa i-asidi yesisu. I-antacids eziqukethe i-calcium carbonate, njengeMylanta, iRolaids neTums, zingase zinikeze impumuzo esheshayo. Kodwa i-antacids zodwa ngeke zilulame i-esophagus ebuhlungu eyonakele yi-asidi yesisu. Ukusetshenziswa kakhulu kwezinye i-antacids kungabangela imiphumela emibi, njengokweluka noma ngezinye izikhathi izinkinga zezinkalweni.
• Imithi yokunciphisa ukukhiqizwa kwe-asidi. Le mithi — eyaziwa ngokuthi yi-histamine (H-2) blockers — ihlanganisa i-cimetidine (Tagamet HB), i-famotidine (Pepcid AC) ne-nizatidine (Axid). I-H-2 blockers ayisebenzi ngokushesha njenge-antacids, kodwa inikeza impumuzo ende futhi inganciphisa ukukhiqizwa kwe-asidi esiswini kuze kube amahora angu-12. Izingxenye ezinamandla kakhulu ziyatholakala nge-prescription.
• Imithi evikela ukukhiqizwa kwe-asidi futhi ilulame i-esophagus. Le mithi — eyaziwa ngokuthi yi-proton pump inhibitors — iyizidakamizwa ze-asidi ezinamandla kakhulu kune-H-2 blockers futhi inika isikhathi sokuba izicubu ze-esophageal ezonakele zilulame. I-proton pump inhibitors ezingelona iresiphi zihlanganisa i-lansoprazole (Prevacid), i-omeprazole (Prilosec OTC) ne-esomeprazole (Nexium). Uma uqala ukuthatha imithi engelona iresiphi ye-GERD, qiniseka ukuthi uqaphele umhlinzeki wakho wokunakekelwa kwezempilo. Izindlela zokwelapha i-GERD ezinamandla ze-prescription zihlanganisa:
• I-proton pump inhibitors enamandla e-prescription. Lezi zihlanganisa i-esomeprazole (Nexium), i-lansoprazole (Prevacid), i-omeprazole (Prilosec), i-pantoprazole (Protonix), i-rabeprazole (Aciphex) ne-dexlansoprazole (Dexilant). Nakuba ngokuvamile ziyamukeleka kahle, le mithi ingabangela ukweluka, izikhathi zikhanda, isicanucanu noma, ezimweni ezingavamile, amazinga aphansi e-vitamin B-12 noma i-magnesium.
• I-H-2 blockers enamandla e-prescription. Lezi zihlanganisa i-famotidine enamandla e-prescription ne-nizatidine. Imiphumela emibi kule mithi ngokuvamile ilula futhi iyamukeleka kahle. I-proton pump inhibitors enamandla e-prescription. Lezi zihlanganisa i-esomeprazole (Nexium), i-lansoprazole (Prevacid), i-omeprazole (Prilosec), i-pantoprazole (Protonix), i-rabeprazole (Aciphex) ne-dexlansoprazole (Dexilant). Nakuba ngokuvamile ziyamukeleka kahle, le mithi ingabangela ukweluka, izikhathi zikhanda, isicanucanu noma, ezimweni ezingavamile, amazinga aphansi e-vitamin B-12 noma i-magnesium. I-GERD ngokuvamile ingalawulwa ngemithi. Kodwa uma imithi ingasizi noma ufuna ukugwema ukusetshenziswa kwemithi isikhathi eside, uchwepheshe wezempilo angase akuncome:
• Fundoplication. Udokotela uhlanganisa ingxenye ephezulu yesisu ngaphezulu kwe-sphincter ye-esophageal ephansi, ukuqinisa umsipha nokuvimbela ukubuyela emuva. I-fundoplication ngokuvamile yenziwa ngenqubo encane, ebizwa ngokuthi i-laparoscopic. Ukuhlanganisa ingxenye ephezulu yesisu kungaba okuphelele noma okungaphelele, okuzwiwa ngokuthi i-Nissen fundoplication. Inqubo evamile engaphelele yi-Toupet fundoplication. Udokotela wakho ngokuvamile uyakuncoma uhlobo olufanele kuwe.
• Idivayisi ye-LINX. Iringi yama-magnetic beads amancane ihlanganiswe ngaphezulu kokuxhumana kwesisu ne-esophagus. Ukuheha kwe-magnetic phakathi kwama-beads kunamandla ngokwanele ukugcina uxhumano luvaliwe e-asidi ebuyela emuva, kodwa buthakathaka ngokwanele ukuvumela ukudla ukudlula. Idivayisi ye-LINX ingafakwa ngokuhlinzwa okuncane. Ama-magnetic beads awathinti ukhuseleko lwezindiza noma i-magnetic resonance imaging.
• Transoral incisionless fundoplication (TIF). Le nqubo entsha ihlanganisa ukuqinisa i-sphincter ye-esophageal ephansi ngokwenza ukuhlanganisa okungaphelele ngaphezulu kwe-esophagus ephansi usebenzisa ama-polypropylene fasteners. I-TIF yenziwa ngomlomo usebenzisa i-endoscope futhi ayidingi ukuhlinzwa. Izinzuzo zayo zihlanganisa isikhathi esisheshayo sokuphulukisa nokubekezelela okuphezulu. Uma une-hiatal hernia enkulu, i-TIF yodwa ayilona ikhetho. Noma kunjalo, i-TIF ingase ikwazi uma ihlanganiswa nokulungiswa kwe-laparoscopic hiatal hernia. Transoral incisionless fundoplication (TIF). Le nqubo entsha ihlanganisa ukuqinisa i-sphincter ye-esophageal ephansi ngokwenza ukuhlanganisa okungaphelele ngaphezulu kwe-esophagus ephansi usebenzisa ama-polypropylene fasteners. I-TIF yenziwa ngomlomo usebenzisa i-endoscope futhi ayidingi ukuhlinzwa. Izinzuzo zayo zihlanganisa isikhathi esisheshayo sokuphulukisa nokubekezelela okuphezulu. Uma une-hiatal hernia enkulu, i-TIF yodwa ayilona ikhetho. Noma kunjalo, i-TIF ingase ikwazi uma ihlanganiswa nokulungiswa kwe-laparoscopic hiatal hernia. Ngenxa yokuthi ukukhuluphala kungaba yingozi ye-GERD, uchwepheshe wezempilo angase aphakamise ukuhlinzwa kokulahlekelwa isisindo njengendlela yokwelapha. Khuluma neqembu lakho lokunakekelwa kwezempilo ukuthola ukuthi ungumuntu ofanele kule hlobo lokuhlinzwa.

Ukushintsha kwendlela yokuphila kungasiza ekunciphiseni ukubuyela emuva kwesisu. Zama ukwenza okulandelayo:

• Yekela ukubhema. Ukubhema kunciphisa ikhono le-sphincter esophageal ephansi lokusebenza kahle.
• Phakamisa ikhanda lembhede yakho. Uma uhlale uhlushwa yi-heartburn uma uzama ukulala, faka amabhlogo wezinkuni noma isimenti ngaphansi kwezinyawo ekhanda lembhede yakho. Phakamisa ikhanda ngamasentimitha ayi-6 kuya kwangu-9. Uma ungakwazi ukuphakamisa imbhede yakho, ungafaka i-wedge phakathi kwamatresi akho ne-box spring ukuze uphakamise umzimba wakho kusukela embelini phezulu. Ukuphakamisa ikhanda lakho ngamaphilisi engeziwe akuphumeleli.
• Qala ulele ngakwesobunxele. Uma uya ekulolweni, qala ngokuqala ulele ngakwesobunxele ukuze kwenze kube nzima ukuba nokuphindaphinda.
• Ungalali ngemva kokudla. Linda okungenani amahora amathathu ngemva kokudla ngaphambi kokulala noma uya ekulolweni.
• Dla ukudla kancane futhi ugaye kahle. Beka ifolokhwe yakho phansi ngemva kwesigamu ngasinye bese uyithatha futhi uma usuqayile futhi uginile leso sigamu.
• Ungadli ukudla neziphuzo ezibangela ukuphindaphinda. Izinto ezivame ukubangela lokhu zihlanganisa utshwala, i-chocolate, i-caffeine, ukudla okunemafutha noma i-peppermint.

Ezinye izindlela zokwelapha ezingezona ezemithi, ezifana nejinja, i-chamomile ne-slippery elm, zingase zinconywe ekwelapheni i-GERD. Noma kunjalo, azikho ezibonisiwe ukuthi zilapha i-GERD noma zibuyisela umonakalo esibindini. Khuluma nodokotela uma ucabanga ukuthatha izindlela ezingelona ubuciko zokwelapha i-GERD.