{"id":3170,"date":"2023-04-15T22:42:46","date_gmt":"2023-04-15T15:42:46","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=3170"},"modified":"2023-04-18T15:25:46","modified_gmt":"2023-04-18T08:25:46","slug":"benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/","title":{"rendered":"B\u1ec7nh GERD – Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o"},"content":{"rendered":"

B\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n (GERD) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd do tr\u00e0o ng\u01b0\u1ee3c c\u00e1c th\u00e0nh ph\u1ea7n trong d\u1ea1 d\u00e0y v\u00e0o th\u1ef1c qu\u1ea3n g\u00e2y tri\u1ec7u ch\u1ee9ng v\u00e0 ho\u1eb7c bi\u1ebfn ch\u1ee9ng. GERD \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a m\u1ed9t c\u00e1ch kh\u00e1ch quan l\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c \u0111\u1eb7c tr\u01b0ng th\u1ea5y \u0111\u01b0\u1ee3c qua n\u1ed9i soi v\u00e0\/ho\u1eb7c th\u1ef1c qu\u1ea3n ti\u1ebfp x\u00fac v\u1edbi acid d\u1ecbch v\u1ecb qua \u0111o pH th\u1ef1c qu\u1ea3n.<\/strong><\/p>\n

1. C\u00e1c kh\u00e1i ni\u1ec7m.<\/strong><\/h2>\n

GERD<\/strong> \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c<\/strong><\/em>, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n v\u00e0 b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00f4ng b\u00e0o m\u00f2n (NERD)<\/strong> ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng tr\u00e0o ng\u01b0\u1ee3c m\u00e0 kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng th\u1ef1c qu\u1ea3n.
\nTr\u00e0o ng\u01b0\u1ee3c c\u00f3 th\u1ec3 chia ra 2 th\u1ec3: th\u1ec3 c\u00f3 acid (chua) v\u00e0 th\u1ec3 kh\u00f4ng acid (acid y\u1ebfu ho\u1eb7c ki\u1ec1m).
\nGERD kh\u00e1ng tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf ti\u1ebft acid<\/strong><\/em> (PPI): l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd trong \u0111\u00f3 (i) c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n kh\u00f4ng l\u00e0nh v\u00e0\/ho\u1eb7c (ii) tri\u1ec7u ch\u1ee9ng tr\u00e0o ng\u01b0\u1ee3c ngh\u0129 do GERD \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi \u0111i\u1ec1u tr\u1ecb PPI li\u1ec1u chu\u1ea9n 8 tu\u1ea7n.
\nGERD kh\u00e1ng tr\u1ecb v\u1edbi thu\u1ed1c c\u1ea1nh tranh K+ ch\u1eb9n men H, K, ATPase (PCAB)<\/em><\/strong>: t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n kh\u00f4ng l\u00e0nh v\u00e0\/ho\u1eb7c tri\u1ec7u ch\u1ee9ng GERD k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi vonoprazan 20mg 4 \u2013 8 tu\u1ea7n.
\nVi\u00eam th\u1ef1c qu\u1ea3n do ph\u1eabu thu\u1eadt<\/strong><\/em>: tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t sau c\u1eaft d\u1ea1 d\u00e0y, c\u1eaft th\u1ef1c qu\u1ea3n ho\u1eb7c ph\u1eabu thu\u1eadt ch\u1ed1ng tr\u00e0o ng\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb GERD.<\/p>\n

2. C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a b\u1ec7nh GERD.<\/strong><\/h2>\n

B\u1ec7nh sinh c\u1ee7a GERD do gi\u1ea3m ch\u1ee9c n\u0103ng c\u01a1 th\u1eaft th\u1ef1c qu\u1ea3n; h\u00e0ng r\u00e0o ch\u1ed1ng tr\u00e0o ng\u01b0\u1ee3c c\u1ee7a c\u01a1 th\u1eaft th\u1ef1c qu\u1ea3n d\u01b0\u1edbi v\u00e0 tr\u1ee5 c\u01a1 ho\u00e0nh, k\u00e8m theo gi\u1ea3m l\u00e0m tr\u1ed1ng th\u1ef1c qu\u1ea3n v\u00e0 m\u1ea5t s\u1ef1 to\u00e0n v\u1eb9n c\u1ee7a bi\u1ec3u m\u00f4 th\u1ef1c qu\u1ea3n. Vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c x\u1ea3y ra khi d\u1ecbch v\u1ecb k\u00edch th\u00edch gi\u1ea3i ph\u00f3ng cytokine v\u00e0 chemokine thu h\u00fat c\u00e1c t\u1ebf b\u00e0o vi\u00eam v\u00e0 c\u0169ng g\u00e2y c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u1ee7a GERD. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 kh\u00e1c g\u00e2y n\u00ean tri\u1ec7u ch\u1ee9ng nh\u01b0 gi\u1ea3m ti\u1ebft n\u01b0\u1edbc b\u1ecdt, ch\u1eadm l\u00e0m tr\u1ed1ng d\u1ea1 d\u00e0y v\u00e0 t\u0103ng ph\u1ea3n \u1ee9ng th\u1ef1c qu\u1ea3n. Nh\u01b0 v\u1eady, ti\u1ebfp c\u1eadn GERD kh\u00f4ng n\u00ean ch\u1ec9 coi l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd \u0111\u1ed9c l\u1eadp, m\u00e0 v\u1edbi nhi\u1ec1u ki\u1ec3u h\u00ecnh kh\u00e1c nhau v\u00e0 c\u1ea7n xem x\u00e9t k\u0129 c\u00e1c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t.<\/p>\n

3. Tri\u1ec7u ch\u1ee9ng h\u1ecdc b\u1ec7nh GERD<\/a>.<\/strong><\/h2>\n

Hai tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a GERD l\u00e0 \u1ee3 n\u00f3ng v\u00e0 tr\u1edb. \u1ee2 n\u00f3ng l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a GERD, \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 c\u1ea3m gi\u00e1c n\u00f3ng r\u00e1t sau x\u01b0\u01a1ng \u1ee9c lan t\u1eeb th\u01b0\u1ee3ng v\u1ecb l\u00ean c\u1ed5. Tr\u1edb l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a tr\u00e0o ng\u01b0\u1ee3c c\u00e1c th\u00e0nh ph\u1ea7n trong d\u1ea1 d\u00e0y kh\u00f4ng ch\u1ee7 \u00fd l\u00ean tr\u00ean, \u0111\u1ebfn mi\u1ec7ng, th\u01b0\u1eddng k\u00e8m theo v\u1ecb chua. \u0110au ng\u1ef1c th\u01b0\u1eddng ch\u01b0a lo\u1ea1i tr\u1eeb ngu\u1ed3n g\u1ed1c t\u1eeb tim c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n k\u00e8m v\u1edbi \u1ee3 n\u00f3ng v\u00e0 tr\u1edb ho\u1eb7c b\u1ec7nh nh\u00e2n ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a GERD. Tri\u1ec7u ch\u1ee9ng GERD kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 c\u00f3 th\u1ec3 ch\u1ed3ng l\u1ea5p ho\u1eb7c nh\u1ea7m l\u1eabn v\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n kh\u00e1c nh\u01b0 nhai l\u1ea1i, co th\u1eaft t\u00e2m v\u1ecb, vi\u00eam th\u1ef1c qu\u1ea3n b\u1ea1ch c\u1ea7u \u00e1i toan, tr\u00e0o ng\u01b0\u1ee3c t\u0103ng nh\u1ea1y c\u1ea3m, b\u1ec7nh r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng, b\u1ec7nh tim ho\u1eb7c ph\u1ed5i v\u00e0 tho\u00e1t v\u1ecb c\u1ea1nh th\u1ef1c qu\u1ea3n.
\nGERD c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng ngo\u00e0i th\u1ef1c qu\u1ea3n, \u1edf thanh qu\u1ea3n v\u00e0 ph\u1ed5i nh\u01b0 kh\u00e0n ti\u1ebfng, h\u1eafng gi\u1ecdng, ho m\u1ea1n v\u00e0 c\u00e1c b\u1ec7nh nh\u01b0 vi\u00eam thanh qu\u1ea3n, vi\u00eam h\u1ea7u v\u00e0 x\u01a1 ph\u1ed5i. GERD c\u00f2n \u0111\u01b0\u1ee3c cho r\u1eb1ng c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t hen.<\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh GERD.<\/strong><\/h2>\n

Kh\u00f4ng c\u00f3 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n GERD. Do \u0111\u00f3, ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o k\u1ebft h\u1ee3p tri\u1ec7u ch\u1ee9ng, \u0111\u00e1nh gi\u00e1 ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n qua n\u1ed9i soi, pH th\u1ef1c qu\u1ea3n 24h v\u00e0 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u1eed. Trong \u0111\u00f3 \u1ee3 n\u00f3ng v\u00e0 tr\u1edb l\u00e0 2 tri\u1ec7u ch\u1ee9ng nh\u1ea1y v\u00e0 \u0111\u1eb7c hi\u1ec7u cho GERD, \u0111\u1ed9 nh\u1ea1y \u0111\u1ed1i v\u1edbi vi\u00eam th\u1ef1c qu\u1ea3n \u0103n m\u00f2n (EE) l\u00e0 30 \u2013 76%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 62 \u2013 96%.<\/p>\n

Theo Hi\u1ec7p h\u1ed9i ti\u00eau h\u00f3a th\u1ebf gi\u1edbi WGO 2017.<\/em><\/strong><\/p>\n

4.1. H\u1ecfi b\u1ec7nh v\u00e0 ti\u1ec1n s\u1eed:<\/strong><\/h3>\n

C\u00e1c y\u1ebfu t\u1ed1 sau gi\u00fap h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng GERD:
\n– Y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y v\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1: gi\u1ea3m c\u01a1 th\u1eaft d\u01b0\u1edbi th\u1ef1c qu\u1ea3n, d\u00e3n d\u00e2y ch\u1eb1ng ho\u00e0nh \u2013 th\u1ef1c qu\u1ea3n, r\u1ed1i lo\u1ea1n nhu \u0111\u1ed9ng th\u1ef1c qu\u1ea3n, t\u0103ng \u00e1p l\u1ef1c d\u1ea1 d\u00e0y, t\u0103ng ch\u00eanh \u00e1p gi\u1eefa b\u1ee5ng v\u00e0 ng\u1ef1c, hi\u1ebfm h\u01a1n h\u1ed9i ch\u1ee9ng Zollinger-Ellison.
\n– Th\u00f3i quen sinh ho\u1ea1t v\u00e0 \u0103n u\u1ed1ng: n\u1eb7ng c\u00e2n, BMI cao, ch\u1ebf \u0111\u1ed9 \u0103n nhi\u1ec1u m\u1ee1, u\u1ed1ng \u0111\u1ed3 ng\u1ecdt tr\u01b0\u1edbc ng\u1ee7, \u0103n qu\u00e1 no, khom l\u01b0ng, n\u1eb1m sau \u0103n. Y\u1ebfu t\u1ed1 thuy\u00ean gi\u1ea3m nh\u01b0 s\u1eed d\u1ee5ng bicarbonate, antacid, s\u1eefa.
\n– Thu\u1ed1c: ch\u1eb9n k\u00eanh calci, NSAIDs. M\u1ed9t s\u1ed1 thu\u1ed1c t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c nh\u01b0 K+, tetracycline, biphosphonate.
\n– Mang thai.
\n– H\u1ecfi c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o: nu\u1ed1t kh\u00f3, nu\u1ed1t \u0111au, h\u00edt s\u1eb7c nhi\u1ec1u l\u1ea7n g\u00e2y vi\u00eam ph\u1ed5i, r\u1ed1i lo\u1ea1n ph\u00e1t \u00e2m, ho k\u00e9o d\u00e0i, ch\u1ea3y m\u00e1u ti\u00eau h\u00f3a, n\u00f4n\/bu\u1ed3n n\u00f4n nhi\u1ec1u, \u0111au b\u1ee5ng k\u00e9o d\u00e0i, thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft, s\u1ee5t c\u00e2n, h\u1ea1ch to, kh\u1ed1i u th\u01b0\u1ee3ng v\u1ecb; tri\u1ec7u ch\u1ee9ng m\u1edbi kh\u1edfi ph\u00e1t sau 45 \u2013 55 tu\u1ed5i. Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 adenoma tuy\u1ebfn th\u1ef1c qu\u1ea3n ho\u1eb7c d\u1ea1 d\u00e0y.
\n– \u0110\u00e1nh gi\u00e1 thang \u0111i\u1ec3m reflux disease questionnaires (RDQ).<\/p>\n

4.2. Kh\u00e1m l\u00e2m s\u00e0ng.<\/strong><\/h3>\n

– \u0110o v\u00f2ng b\u1ee5ng, c\u00e2n n\u1eb7ng, BMI \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1.
\n– Kh\u00e1m t\u00ecm tri\u1ec7u ch\u1ee9ng x\u01a1 c\u1ee9ng b\u00ec (hi\u1ebfm).
\n– \u0110\u00e1nh gi\u00e1 v\u00e0 t\u1ea7m so\u00e1t \u0111\u1ec3 lo\u1ea1i tr\u1eeb hen, b\u1ec7nh tim, ung th\u01b0.<\/p>\n

4.3. T\u1ea7m so\u00e1t nhi\u1ec5m Hp.<\/strong><\/h3>\n

Xem th\u00eam b\u00e0i \u201cPh\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb Hp theo H\u1ed9i ti\u00eau h\u00f3a Vi\u1ec7t Nam 2023\u201d.<\/p>\n

\u0110a s\u1ed1 \u0111\u1ed3ng thu\u1eadn v\u00e0 khuy\u1ebfn c\u00e1o hi\u1ec7n nay \u0111\u1ec1u \u1ee7ng h\u1ed9 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb th\u1eed v\u1edbi PPI \u1edf b\u1ec7nh nh\u00e2n c\u00f3 \u1ee3 n\u00f3ng v\u00e0 tr\u1edb \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n GERD, n\u1ebfu c\u00f3 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, m\u1eb7c d\u00f9 \u0111\u1ed9 nh\u1ea1y ch\u1ec9 78% v\u00e0 \u0111\u1eb7c hi\u1ec7u 54%.
\nC\u00e1c tri\u1ec7u ch\u1ee9ng ngo\u00e0i th\u1ef1c qu\u1ea3n nh\u01b0 ho m\u1ea1n, r\u1ed1i lo\u1ea1n ph\u00e1t \u00e2m, hen, vi\u00eam xoang, vi\u00eam thanh qu\u1ea3n, m\u00f2n r\u0103ng c\u00f3 th\u1ec3 li\u00ean quan GERD nh\u01b0ng \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1eb7c hi\u1ec7u th\u1ea5p cho ch\u1ea9n \u0111o\u00e1n GERD.<\/p>\n

Theo H\u1ed9i ti\u00eau h\u00f3a M\u1ef9 2022<\/em><\/strong><\/p>\n

4.4. \u0110i\u1ec1u tr\u1ecb th\u1eed v\u1edbi PPI 8 tu\u1ea7n.<\/strong><\/h3>\n

– \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u1ee3 n\u00f3ng v\u00e0\/ho\u1eb7c tr\u1edb, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o. Tri\u1ec7u ch\u1ee9ng ph\u1ea3i \u0111\u1ee7 v\u1ec1 t\u1ea7n su\u1ea5t v\u00e0 m\u1ee9c \u0111\u1ed9 \u0111\u1ec3 g\u00e2y gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.
\n– N\u1ebfu h\u1ebft tri\u1ec7u ch\u1ee9ng ho\u00e0n to\u00e0n, d\u1eebng PPI. Tr\u01b0\u1eddng h\u1ee3p tri\u1ec7u ch\u1ee9ng t\u00e1i ph\u00e1t l\u1ea1i, ch\u1ec9 \u0111\u1ecbnh n\u1ed9i soi ti\u00eau h\u00f3a tr\u00ean sau d\u1eebng PPI 2 \u2013 4 tu\u1ea7n.
\n– N\u1ebfu tri\u1ec7u ch\u1ee9ng kh\u00f4ng h\u1ebft ho\u00e0n to\u00e0n, ch\u1ec9 \u0111\u1ecbnh n\u1ed9i soi ti\u00eau h\u00f3a tr\u00ean sau d\u1eebng PPI 2 \u2013 4 tu\u1ea7n.
\n– K\u1ebft qu\u1ea3 n\u1ed9i soi l\u00e0 vi\u00eam th\u1ef1c qu\u1ea3n ph\u00e2n \u0111\u1ed9 B\/C\/D theo LA, ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh GERD. K\u1ebft qu\u1ea3 n\u1ed9i soi b\u00ecnh th\u01b0\u1eddng, n\u00ean ch\u1ec9 \u0111\u1ecbnh \u0111o pH th\u1ef1c qu\u1ea3n 24h v\u00e0 ng\u1eebng PPI. \u0110o pH th\u1ef1c qu\u1ea3n b\u1ea5t th\u01b0\u1eddng ta c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh GERD. N\u1ebfu b\u00ecnh th\u01b0\u1eddng c\u1ea7n t\u00ecm nguy\u00ean nh\u00e2n kh\u00e1c.<\/p>\n

4.5. C\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/p>\n

– Ch\u1ee5p th\u1ef1c qu\u1ea3n c\u1ea3n quang barium: \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p.
\n– N\u1ed9i soi ti\u00eau h\u00f3a tr\u00ean: \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n. \u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ea3nh b\u00e1o nh\u01b0 nu\u1ed1t kh\u00f3, s\u1ee5t c\u00e2n, ch\u1ea3y m\u00e1u ti\u00eau h\u00f3a, n\u00f4n, v\u00e0\/ho\u1eb7c thi\u1ebfu m\u00e1u. C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a vi\u00eam th\u1ef1c qu\u1ea3n b\u00e0o m\u00f2n v\u00e0 th\u1ef1c qu\u1ea3n Barrett\u2019s. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi vi\u00eam th\u1ef1c qu\u1ea3n \u0111\u1ed9 B theo LA k\u00e8m tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a GERD v\u00e0 \u0111\u00e1p \u1ee9ng PPI, khi vi\u00eam t\u1eeb \u0111\u1ed9 C tr\u1edf l\u00ean, th\u01b0\u1eddng l\u00e0 GERD.
\n– Ch\u1ea9n \u0111o\u00e1n NERD ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n khi d\u1eebng PPI 2 \u2013 4 tu\u1ea7n do PPI d\u1ec5 l\u00e0m l\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n.
\n– \u0110o tr\u01b0\u01a1ng l\u1ef1c c\u01a1 th\u1eaft th\u1ef1c qu\u1ea3n: \u0111\u00e1nh gi\u00e1 b\u1ea5t th\u01b0\u1eddng nhu \u0111\u1ed9ng. T\u01b0\u01a1ng l\u1ef1c c\u01a1 th\u1eaft th\u1ef1c qu\u1ea3n d\u01b0\u1edbi y\u1ebfu v\u00e0 l\u00e0m tr\u1ed1ng th\u1ef1c qu\u1ea3n kh\u00f4ng hi\u1ec7u qu\u1ea3 th\u01b0\u1eddng g\u1eb7p trong GERD n\u1eb7ng.
\n– \u0110o pH th\u1ef1c qu\u1ea3n 24h. \u0110\u00e1nh gi\u00e1 th\u1eddi gian ti\u1ebfp x\u00fac acid d\u1ecbch v\u1ecb \u0111\u1ec3 thi\u1ebft l\u1eadp ho\u1eb7c lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n.<\/p>\n

GERD l\u00e0 m\u1ed9t b\u1ec7nh ph\u1ed5 bi\u1ebfn trong d\u00e2n s\u1ed1 tuy nhi\u00ean c\u00f4ng vi\u1ec7c ch\u1ea9n \u0111o\u00e1n kh\u00e1 ph\u1ee9c t\u1ea1p do c\u1ea7n ti\u1ebfp c\u1eadn nhi\u1ec1u nguy\u00ean nh\u00e2n v\u00e0 c\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi nhi\u1ec1u b\u1ec7nh l\u00fd. C\u00e1ch ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo H\u1ed9i ti\u00eau h\u00f3a M\u1ef9 2022 \u0111\u01b0\u1ee3c \u0111\u01b0a ra m\u1ed9t c\u00e1ch r\u00f5 r\u00e0ng, d\u1ec5 s\u1eed d\u1ee5ng cho th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng t\u1ea1i Vi\u1ec7t Nam.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o:
\nWorld Gastroenterology Organisation Global Guidelines
\nGERD Global Perspective on Gastroesophageal Reflux Disease<\/p>\n

ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease<\/p>\n

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n (GERD) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd do tr\u00e0o ng\u01b0\u1ee3c c\u00e1c th\u00e0nh ph\u1ea7n trong d\u1ea1 d\u00e0y v\u00e0o th\u1ef1c qu\u1ea3n g\u00e2y tri\u1ec7u ch\u1ee9ng v\u00e0 ho\u1eb7c bi\u1ebfn ch\u1ee9ng. GERD \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a m\u1ed9t c\u00e1ch kh\u00e1ch quan l\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c \u0111\u1eb7c tr\u01b0ng th\u1ea5y \u0111\u01b0\u1ee3c qua n\u1ed9i soi v\u00e0\/ho\u1eb7c th\u1ef1c qu\u1ea3n ti\u1ebfp x\u00fac v\u1edbi acid d\u1ecbch v\u1ecb qua \u0111o pH th\u1ef1c qu\u1ea3n.
\nGERD \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n v\u00e0 b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00f4ng b\u00e0o m\u00f2n (NERD) ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng tr\u00e0o ng\u01b0\u1ee3c m\u00e0 kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng th\u1ef1c qu\u1ea3n.
\nTr\u00e0o ng\u01b0\u1ee3c c\u00f3 th\u1ec3 chia ra 2 th\u1ec3: th\u1ec3 c\u00f3 acid (chua) v\u00e0 th\u1ec3 kh\u00f4ng acid (acid y\u1ebfu ho\u1eb7c ki\u1ec1m).
\nGERD kh\u00e1ng tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf ti\u1ebft acid (PPI): l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd trong \u0111\u00f3 (i) c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n kh\u00f4ng l\u00e0nh v\u00e0\/ho\u1eb7c (ii) tri\u1ec7u ch\u1ee9ng tr\u00e0o ng\u01b0\u1ee3c ngh\u0129 do GERD \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi \u0111i\u1ec1u tr\u1ecb PPI li\u1ec1u chu\u1ea9n 8 tu\u1ea7n.
\nGERD kh\u00e1ng tr\u1ecb v\u1edbi thu\u1ed1c c\u1ea1nh tranh K+ ch\u1eb9n men H, K, ATPase (PCAB): t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n kh\u00f4ng l\u00e0nh v\u00e0\/ho\u1eb7c tri\u1ec7u ch\u1ee9ng GERD k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi vonoprazan 20mg 4 \u2013 8 tu\u1ea7n.
\nVi\u00eam th\u1ef1c qu\u1ea3n do ph\u1eabu thu\u1eadt: tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t sau c\u1eaft d\u1ea1 d\u00e0y, c\u1eaft th\u1ef1c qu\u1ea3n ho\u1eb7c ph\u1eabu thu\u1eadt ch\u1ed1ng tr\u00e0o ng\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb GERD.<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"\nB\u1ec7nh GERD - Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o - Vinmec<\/title>\n<meta name=\"description\" content=\"GERD \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n v\u00e0 b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00f4ng b\u00e0o m\u00f2n (NERD), ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"B\u1ec7nh GERD - Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o - Vinmec\" \/>\n<meta property=\"og:description\" content=\"GERD \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n v\u00e0 b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00f4ng b\u00e0o m\u00f2n (NERD), ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-15T15:42:46+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-18T08:25:46+00:00\" \/>\n<meta name=\"author\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/\",\"name\":\"B\u1ec7nh GERD - Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-15T15:42:46+00:00\",\"dateModified\":\"2023-04-18T08:25:46+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e\"},\"description\":\"GERD \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n v\u00e0 b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00f4ng b\u00e0o m\u00f2n (NERD), ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"B\u1ec7nh GERD – Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e\",\"name\":\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g\",\"caption\":\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/meogods1234gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"B\u1ec7nh GERD - Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o - Vinmec","description":"GERD \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n v\u00e0 b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00f4ng b\u00e0o m\u00f2n (NERD), ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"B\u1ec7nh GERD - Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o - Vinmec","og_description":"GERD \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n v\u00e0 b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00f4ng b\u00e0o m\u00f2n (NERD), ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/","og_site_name":"Vinmec","article_published_time":"2023-04-15T15:42:46+00:00","article_modified_time":"2023-04-18T08:25:46+00:00","author":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/","name":"B\u1ec7nh GERD - Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o - Vinmec","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-15T15:42:46+00:00","dateModified":"2023-04-18T08:25:46+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e"},"description":"GERD \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n v\u00e0 b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00f4ng b\u00e0o m\u00f2n (NERD), ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/benh-gerd-tiep-can-chan-doan-theo-cac-khuyen-cao\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"B\u1ec7nh GERD – Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n theo c\u00e1c khuy\u1ebfn c\u00e1o"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e","name":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g","contentUrl":"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g","caption":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/meogods1234gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/3170"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/69"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=3170"}],"version-history":[{"count":16,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/3170\/revisions"}],"predecessor-version":[{"id":24140,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/3170\/revisions\/24140"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=3170"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=3170"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=3170"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}