43
H Tiêu hóa
Map 3.5 B nh trào ngư c d dày th c qu n (GORD)
Đi u tr
•
B o t n: giáo d c s c kh e, gi m cân, n m
đ u cao khi ng và tránh các y u t thu n l i như
hút thu c, ăn quá no.
•
N i khoa:
○
Trung hòa acid, e.g. aluminium hydroxide.
○
Thu c c ch receptor H2, e.g. ranitidine.
○
Thu c c ch bơm proton, e.g. omeprazole.
•
Ngo i khoa: Ph u thu t Nissen’s
fundoplication (tái t o phình v )
Causes
•
Genetic inheritance of
angle of lower
oesophageal sphincter.
•
Oesophagitis.
•
Sliding hiatus hernia.
•
Rolling hiatus hernia.
Risk factors
•
Smoking.
•
Excessive alcohol.
•
Excessive coffee.
•
Obesity.
•
Pregnancy.
•
Drugs, e.g. calcium channel
blockers, antimuscarinics and
tricyclic antidepressants.
Investigations
Age dependent:
•
If the patient is <55 years old:
○
Proceed to treatment unless
they have ALARM symptoms,
e.g. unintentional weight loss,
dysphagia, haematemesis,
melaena and anorexia.
•
If >55 years old:
○
Send patient to endoscopy:
diagnostic and allows for biopsy.
○
24-h pH monitoring.
Bi n ch ng: Barrett th c qu n
Barrett th c qu n là gì?
Là quá trình d s n c a l p bi u mô v y
ph n dư i c a th c qu n thành bi u mô
tr . Thư ng g p b nh nhân GORD sau
vài năm. Là m t d ng t n thương ti n
ung thư.
C n lâm sàng
•
N i soi có sinh thi t c 4 góc ph n tư
Đi u tr
•
Đ t b ng sóng cao t n (RFA) b ng h
th ng HALO ho c c t b ph n niêm m c lo n
s n n ng
Bi n ch ng
•
Ung thư bi u mô tuy n th c qu n
What is GORD?
This is abnormal reflux where acid from the stomach
refluxes into the oesophagus subsequently damaging
the squamous oesophageal lining, causing discomfort.
Signs and symptoms
•
Heartburn – pain is worse in certain positions, e.g. lying
down/stooping and is worse after heavy meals.
•
Acid taste in mouth.
○
Regurgitation.
•
Water brash (excess salivation).
•
Dysphagia.
•
Nocturnal asthma/chronic cough.
•
Laryngitis.
MAP 3.5 Gastro-Oesophageal Reflux Disease (GORD)
Chapter_03.indd 43
08/12/14 2:30 PM
