Peptic rwj

Mob rwj yog qhov nqaij to lossis nqaij nyoos nyob rau sab hauv lub plab lossis lub plab hnyuv.

Muaj ob hom mob ncauj plab:

• Lub plab zom mov - tshwm sim hauv lub plab
• Duodenal rwj - tshwm sim hauv thawj feem ntawm txoj hnyuv

Nquag, lub hauv ob sab phuv ntawm lub plab thiab cov hnyuv me tuaj yeem tiv thaiv nws tus kheej ntawm cov kua qaub hauv lub plab. Tab sis yog tias lub ob sab phlu tsoo lawm, qhov tshwm sim yuav yog:

• O thiab cov nqaij mos (mob caj pas)
• Kev mob rwj

Feem ntau cov mob txhab tshwm sim rau thawj txheej txheej ntawm lub hauv ob sab phlu. Ib lub qhov hauv plab lossis duodenum yog hu ua perforation. Nov yog ntawv kho mob ti tes ti taw.

Feem ntau ntawm qhov ua kom mob txhab yog mob ntawm lub plab los ntawm cov kab mob hu ua Helicobacter pylori (H pylori)). Feem coob cov neeg mob raum muaj cov kab mob nyob hauv lawv cov hnyuv. Tsis tau, ntau tus neeg uas muaj cov kab mob no hauv lawv lub plab tsis muaj qhov mob rwj.

Cov xwm txheej hauv qab no ua rau koj qhov kev pheej hmoo rau mob ncauj plab:

• Haus cawv ntau dhau
• Kev siv cov tshuaj aspirin, ibuprofen, naproxen, lossis lwm cov tshuaj tiv thaiv tsis zoo (NSAIDs)
• Haus luam yeeb lossis luam yeeb luam yeeb
• Raug mob hnyav, xws li siv lub tshuab ua pa
• Kev siv hluav taws xob ntau
• Kev ntxhov siab

Ib qho mob tsis tshua muaj tshwm, hu ua Zollinger-Ellison syndrome, ua rau mob plab thiab duodenal mob.

Cov mob txhab me me yuav tsis ua mob. Qee qhov mob txhab tuaj yeem ua rau los ntshav loj.

Mob plab (feem ntau nyob rau sab saud lub plab mog) yog cov tsos mob tshwm sim. Qhov mob yuav txawv ntawm ib tug neeg mus rau lwm tus. Qee tus neeg tsis muaj mob.

Qhov mob tshwm sim:

• Hauv nruab plab sab saud
• Thaum tsaus ntuj thiab tsa koj sawv
• Thaum koj hnov ​​zoo mob plab tas, 1 mus rau 3 teev tom qab koj noj mov

Lwm cov tsos mob muaj xws li:

• Zoo li lub siab tag nrho thiab teeb meem haus dej ntau npaum li niaj zaus
• Xeev siab
• Ntuav
• Los ntshav lossis tsaus, tso quav cov quav
• Kev mob hauv siab
• Nkees
• Ntuav, muaj ntshav ntxiv
• Lub cev yuag
• Ua zawv siab

Txhawm rau txhawm rau kuaj qhov txhab, tej zaum koj yuav xav tau qhov kev sim hu ua sab qaum (endoscopy) (EGD).

• Qhov no yog kev ntsuam xyuas kom pom cov roj hauv cov yeeb nkab, lub plab, thiab thawj ntu ntawm cov hnyuv me.
• Nws ua tiav nrog lub koob yees duab me me (yoog endoscope) uas tau muab tso rau ntawm caj pas.
• Qhov kev ntsuas no feem ntau xav tau kev ua kom loog los ntawm txoj hlab ntshav.
• Muaj qee kis, siv qhov endoscope me dua uas siv rau hauv lub plab los ntawm lub qhov ntswg. Qhov no tsis tas yuav tsum tau ua kom loog.

EGD tau ua tiav rau feem ntau ntawm cov neeg thaum mob rwj paub los yog thaum koj muaj:

• Kev kuaj ntshav qis (ntshav tsis txaus)
• Teeb meem nqos
• Ntshav ntuav
• Ntshav lossis tsaus nti thiab tarry-saib cov quav
• Poob phaus yam tsis tau sim
• Lwm qhov kev tshawb pom uas tau txhawj txog qhov mob qog noj ntshav hauv plab

Kev kuaj sim rau H pylori kuj tseem xav tau. Qhov no tuaj yeem ua los ntawm kev kuaj ib ce ntawm lub plab thaum lub sij hawm endoscopy, nrog txoj kev sim tso quav, los yog kuaj urea.

Lwm txoj kev kuaj uas koj yuav muaj:

• Hemoglobin kev kuaj ntshav los kuaj xyuas ntshav tsis ua haujlwm
• Tso quav mus tso ntshav kuaj cov ntshav hauv koj cov quav

Qee zaum, koj yuav xav tau kev sim hu ua ntu GI sab saud. Kev yees duab xoo hluav taws xob tom qab yog koj haus cov tuab uas hu ua barium. Qhov no tsis tas yuav tsum tau ua kom loog.

Koj tus kws kho mob yuav qhia cov tshuaj kom kho koj lub qhov txhab thiab tiv thaiv kom txhob huam mob tuaj. Cov tshuaj yuav:

• Tua tus H pylori cov kab mob, yog tias muaj.
• Txo cov kua qaub ntau hauv lub plab. Cov no suav nrog H2 blockers xws li ranitidine (Zantac), lossis proton twj tso kua mis inhibitor (PPI) xws li pantoprozole.

Noj tag nrho koj cov tshuaj raws li koj tau hais. Lwm yam kev hloov pauv hauv koj lub neej kuj tuaj yeem pab tau.

Yog tias koj muaj mob rwj yuav nrog ib H pylori kev kis kab mob, kev kho mob tus qauv siv cov tshuaj sib txawv ntawm cov tshuaj hauv qab no rau 7 txog 14 hnub:

• Ob qhov tshuaj tiv thaiv sib txawv rau tua H pylori.
• PPIs xws li omeprazole (Prilosec), lansoprazole (Prevacid), lossis esomeprazole (Nexium).
• Bismuth (cov tshuaj tseem ceeb hauv Pepto-Bismol) ntxiv rau kom pab tua cov kab mob.

Koj yuav yuav tau noj PPI li 8 lub lim piam yog tias:

• Koj muaj qhov mob txhab tsis muaj H pylori kis tau tus mob.
• Koj mob rwj yog tshwm sim los ntawm kev noj cov tshuaj aspirin lossis NSAIDs.

Koj tus kws kho mob kuj tseem yuav sau cov tshuaj no tsis tu ncua yog tias koj noj tshuaj aspirin lossis NSAIDs mus rau lwm yam mob.

Lwm yam tshuaj siv rau qhov mob txhab yog:

• Misoprostol, ib hom tshuaj uas tuaj yeem pab tiv thaiv kom tsis txhob mob rau tus neeg noj NSAIDs tsis tu ncua
• Cov tshuaj uas tiv thaiv cov ntaub so ntswg hauv lub cev, xws li cov neeg ua tsis tau zoo

Yog tias qhov ncauj rwj ua rau ntshav los ntau heev, yuav tsum muaj EGD los ua kom ntshav los ntshav. Cov hau kev siv los tiv thaiv kom los ntshav suav nrog:

• Txhaj tshuaj rau hauv qhov txhab
• Ua ntawv thov cov hlau los yog kub kho rau qhov txhab

Yuav tsum muaj kev phais mob yog tias:

• Yuav tsis tiv thaiv kom tsis txhob los ntshav nrog tus EGD
• Tus mob rwj ua rau kua muag

Mob plab hlaub yuav rov qab los yog tias tsis kho. Muaj lub caij nyoog zoo tias H pylori kev kis kab mob yuav kho tau yog tias koj noj koj cov tshuaj thiab ua raws li koj tus kws kho mob qhia. Koj yuav tsawg dua yuav muaj lwm qhov kiav txhab.

Teeb meem yuav suav nrog:

• Mob ntshav siab heev
• Qhov caws pliav los ntawm qhov mob rwj yuav ua rau nyuaj rau lub plab khoob
• Caws los yog lub qhov ntawm lub plab thiab cov hnyuv

Nrhiav kev pab kho mob sai li sai tau yog tias koj:

• Tsim dheev, mob plab plab
• Muaj qhov txhav, tawv plab uas yog qhov sib chwv mus kov
• Muaj cov tsos mob ntawm kev poob siab, xws li tsaus muag, tawm hws ntau dhau, lossis tsis meej pem
• Ntuav ntshav los yog muaj ntshav hauv koj cov quav (tshwj xeeb yog tias yog maroon lossis tsaus, tarry dub)

Hu rau koj tus kws khomob yog:

• Koj mloog tau tias kiv taub hau lossis taubhau me ntsis.
• Koj muaj mob rwj.

Tsis txhob noj tshuaj aspirin, ibuprofen, naproxen, thiab lwm yam tshuaj NSAIDs. Sim tshuaj acetaminophen hloov. Yog tias koj yuav tsum noj cov tshuaj no, nrog koj tus kws kho mob tham ua ntej. Koj tus kws khomob yuav:

• Ntsuas koj rau H pylori ua ntej koj noj cov tshuaj no
• Hais kom koj coj PPIs lossis H2 acid blocker
• Qhia ib cov tshuaj hu ua misoprostol

Cov kev hloov hauv lub neej hauv qab no tuaj yeem pab tiv thaiv kom tsis txhob mob plab:

• TSIS TXHOB haus luam yeeb lossis zom luam yeeb.
• Zam txhob haus cawv.

Ulcer - peptic; Ulcer - duodenal; Ulcer - plab zom mov; Duodenal mob rwj; Tsam plab zom mov; Dyspepsia - mob txhab; Los ntshav rwj; Rawv plab los ntshav - mob rwj; Lub plab zom mov hemorrhage - mob rwj; G.I. los ntshav - peptic rwj; H. pylori - mob rwj plab; Helicobacter pylori - muaj mob rwj

• Noj tshuaj antacids

• Ulcer kev kub ntxhov
• Txoj kev kuaj mob gastrocopy
• Qhov chaw ntawm peptic mob
• Ua rau muaj peptic rwj
• Mob plab lossis raug mob

Chan FKL, Lau JYW. Peptic rwj kab mob. Hauv: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger thiab Fordtran mob hnyuv thiab nplooj siab mob. 11th ed. Philadelphia, PA: Elsevier; 2021: chap 53.

Npog TL, Blaser MJ. Helicobacter pylori thiab lwm yam pais plab Helicobacter hom. Hauv: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, thiab Bennett's Cov Ntsiab Cai thiab Kev Coj Ua ntawm Kab Mob Kis. 9le ed. Philadelphia, PA: Elsevier; 2020: cha 217.

Lanas A, Chan FKL. Peptic rwj kab mob. Kev Looj MemCov. 2017; 390 (10094): 613-624. PMID: 28242110 www.pubmed.ncbi.nlm.nih.gov/28242110/.