Loaʻa pinepine iā ʻoe ka ʻeha puʻuwai? E like me ka gastritis? Manaʻo ʻoe e hoʻi mai ana ka meaʻai i kou puʻu ma hope o ka ʻai ʻana? Hoʻopoina ka hapa nui o mākou i kēia mau mea, me ka manaʻo he "maʻamau" lākou. Akā ma hope o kēia mau hōʻailona liʻiliʻi, aia paha kekahi mea a mākou e noʻonoʻo ʻole ai a pono e nānā iki ʻia. ʻO ia ke kūlana a mākou e kamaʻilio nei ma kēia ʻatikala i kēia lā. ʻO ia hoʻi ʻo "Barrett's Esophagus."
I ka ʻōlelo maʻalahi, he aha ka Barrett's Esophagus?
ʻAe, e wehewehe maʻalahi kākou i kēia. Ua ʻike ʻoe i ka wā e ale ai kākou i ka meaʻai, hele ia mai ko kākou waha a i ko kākou ʻōpū ma o kahi paipu i kapa ʻia ʻo ka esophagus . E like me ko kākou ʻōnaehana gastrointestinal holoʻokoʻa (GI tract), ua uhi ʻia ka ʻaoʻao o loko o kēia esophagus me kahi papa lahilahi a pale o nā cell.
Akā e noʻonoʻo i ka wā lōʻihi, hoʻomau kekahi mea i ka hōʻino a hoʻonāukiuki paha i kēia ʻili palupalu. No ka laʻana, hiki iā ʻoe ke loaʻa mau i ka reflux acid o ka ʻōpū i loko o kou puʻu. Ke hoʻomau nei kēia, ʻaʻole hiki i nā cell i loko o kou esophagus ke hoʻomanawanui i ka hōʻino. A laila, hoʻomaka kēlā mau cell e loli e pale iā lākou iho.
Hiki mai kēia loli ke hoʻomaka nā pūnaewele maʻamau i loko o ka esophagus e ulu i loko o kahi ʻano pūnaewele ʻokoʻa, e like me nā pūnaewele i loko o ko kākou ʻōpū. I ka lāʻau lapaʻau, kapa mākou i kēia (Intestinal Metaplasia) .
I ka ʻōlelo maʻalahi, ke hoʻāʻo ka esophagus e pale iā ia iho, hoʻololi ia i ke ʻano o nā cell e hoʻopili ana i loko. Ua like kēia me ke kau ʻana i kahi papa kāpeti ma luna o ke alanui maʻamau ke lepo ia mai ke kaʻa mau. Akā, ʻaʻole kēia mau cell hou nā cell no ka esophagus.
He kūlana weliweli anei kēia? E hoʻoulu anei ia i ka maʻi kanesa?
ʻO kēia paha ka nīnau mua e hiki mai ana i kou manaʻo. Eia ka pane: ʻAʻole ka maʻi kanesa ka esophagus a Barrett. Eia naʻe, he kūlana ia e hoʻonui iki i ka pilikia o ka loaʻa ʻana o ka maʻi kanesa esophageal.
Akā, mai hopohopo. ʻAʻole nui kēia pilikia e like me kou manaʻo. Ua ʻike ʻia e ka noiʻi ʻana he liʻiliʻi loa ka manawa kūpono o kekahi me kēia maʻi e loaʻa ai ka maʻi kanesa i kēlā me kēia makahiki, ma kahi o 0.5%.
ʻO ka mea nui, he lohi loa kēia mau loli o nā cell. Ma mua o ka lilo ʻana o nā cell i maʻi kanesa, hele lākou ma kahi pae waena ʻē aʻe. Kāhea mākou iā ia he (Dysplasia) . ʻO ia hoʻi, nā loli cell pre-cancerous. Hiki i nā kauka ke ʻike i kēia pae (Dysplasia) i ka wā mua, wehe i kēlā mau cell a hoʻōki i ka ulu ʻana o ke kanesa. ʻO ia ke kumu he mea nui e makaʻala i kēia kūlana.
He aha nā hōʻailona o kēia?
Eia ka mea kupanaha. ʻAʻohe hōʻailona kikoʻī o ka esophagus o Barrett. ʻO ia hoʻi, inā loaʻa iā ʻoe ke ʻano, ʻaʻole ʻoe e ʻike i ka ʻeha a i ʻole ka ʻoluʻolu ʻole.
No laila pehea ʻoe e ʻike ai i kēia?
Loaʻa iā mākou nā hōʻailona ma muli o ke kumu nui o kēia ʻano. E like me kā mākou i kūkākūkā ai ma mua, ʻo kēia ma muli o ka hōʻino lōʻihi i ka esophagus. ʻO ke kumu nui o kēia hōʻino ʻo ia ka gastritis (GERD - Gastroesophageal Reflux Disease) . ʻO ia hoʻi, piʻi pinepine ka waikawa i loko o ka ʻōpū i loko o ka esophagus.
No laila, inā loaʻa iā ʻoe nā hōʻailona e hiki mai ana no ka manawa lōʻihi, pono ʻoe e hopohopo:
- ʻEha pinepine o ka umauma: He manaʻo e like me ke ahi ma waenakonu o ka umauma.
- Paʻakikī ke ale ʻana: He manaʻo e like me he mea lā ua paʻa i ka puʻu.
- ʻO nā mea o loko o ka ʻōpū (ʻakika, meaʻai) e piʻi ana i loko o ka puʻu: He ʻono ʻawaʻawa i ka waha, ʻoiai i ka wā e moe ana i ka pō a kūlou paha i mua.
- ʻEha mau ka ʻāʻī a i ʻole ke kuni.
- ʻEha ka umauma.
ʻO ka mea nui kēia: Loaʻa i kekahi poʻe kēia mau hōʻailona no nā makahiki, akā ʻaʻole lākou e lawe i ka lāʻau lapaʻau no lākou. Aia wale nō i ka wā e hōʻino ʻia ai ka esophagus i kahi manawa lōʻihi e hiki ai ke ulu ka esophagus Barrett. No laila, inā loaʻa iā ʻoe kēia mau hōʻailona, mai hoʻowahāwahā iā lākou. E hōʻoia e ʻike i ke kauka a loaʻa ka ʻōlelo aʻoaʻo.
ʻO wai ka mea i ʻoi aku ka nui o ka pilikia o ka hoʻomohala ʻana i kēia?
ʻOiai hiki i kekahi ke loaʻa i ka esophagus ʻo Barrett, aia kekahi poʻe i kahi pilikia kiʻekiʻe iki. E nānā kākou iā lākou.
| Kumu pilikia | Wehewehena |
|---|---|
| ʻO ka gastritis mau loa (GERD) | ʻO kēia ke kumu pilikia nui. ʻOi aku ka nui o ka pilikia o ka poʻe i loaʻa i ka gastritis no nā makahiki he 10 a ʻoi. Ma kahi o 10% - 15% o ka poʻe me GERD e loaʻa paha kēia maʻi. |
| Makahiki | ʻIke pinepine ʻia ia i nā poʻe ma luna o 55 mau makahiki. ʻO kēia no ka mea he manawa ka lōʻihi e loli ai kēia mau cell. |
| Kāne/Wahine | ʻOi aku ka nui o ka loaʻa ʻana o kēia maʻi i nā kāne ʻelua a ʻekolu paha manawa ma mua o nā wahine. |
| Puhipaka | ʻO ka puhi paka kekahi kumu nui ʻē aʻe. |
Pehea e ʻike ai ke kauka i kēia?
Ma hope o ka hoʻolohe ʻana i kāu mau hōʻailona, inā kānalua ke kauka i kēia, e kuhikuhi ʻo ia iā ʻoe i kahi loea, he gastroenterologist. E hana ʻo ia i kahi hoʻāʻo koʻikoʻi e hōʻoia i kēia kūlana. ʻO ia ka endoscopy .
He aha ka endoscopy?
ʻO kēia ke komo ʻana i kahi ʻōmole lahilahi a palupalu me kahi kāmela ma ka hopena ma kou waha a nānā i kou esophagus, ʻōpū, a me ka hapa mua o kou ʻōpū liʻiliʻi. ʻAʻole ʻoe e ʻeha i ka wā o kēia hoʻāʻo ʻana, no ka mea, e hoʻomaha ʻia ʻoe.
Ke nānā nei ma o ke kāmela, ʻike ke kauka i kahi loli i ke kala a me ke ʻano o ka uhi o ka vagina.
- ʻOiai he poni māmā a laumania ka uhi o kahi vagina maʻamau,
- ʻO nā wahi me Barrett's e like paha me ke kala samona a ʻano ʻinoʻino iki.
Ke ʻike ke kauka i kēia loli, lawe ʻo ia i kekahi mau ʻāpana liʻiliʻi o nā ʻiʻo mai nā wahi i loli. Kāhea mākou i kēia he biopsy . A laila, nānā ʻia kēia mau ʻāpana ʻiʻo ma lalo o kahi microscope e hōʻoia i ka 100% inā ua loli maoli nā cell, ʻo ia hoʻi, inā he maʻi i kapa ʻia ʻo Intestinal Metaplasia.
Pehea ʻoe e hoʻokaʻawale ai i ke kūlana ma hope o ka hoʻāʻo ʻana?
Ke hiki mai ka hōʻike biopsy, e hoʻokaʻawale ke kauka i kou kūlana. Hoʻokumu nui ʻia kēia ma luna o ʻelua mau kumu.
1. Pehea ka nui o ka lōʻihi o ka esophagus i hoʻopilikia ʻia e kēia hoʻololi.
2. Inā paha he mau loli cell precancerous (dysplasia).
| Hoʻokaʻawale ʻana | Manaʻo |
|---|---|
| Wahi a nā loli o nā cell pre-cancerous (Dysplasia) | |
| (Metaplasia ʻaʻole dysplastic) | Ua loli nā ʻāpana, akā ʻaʻole i hoʻomaka e hoʻomohala i nā loli pre-cancerous. He haʻahaʻa loa ka pilikia o ka maʻi kanesa. |
| ʻO ka dysplasia haʻahaʻa | Ua hoʻomaka ka ulu ʻana o nā loli o nā cell precancerous. Aia kahi pilikia iki o ka maʻi kanesa. |
| ʻO ka dysplasia kiʻekiʻe | Ua ʻike maopopo ʻia nā loli o nā cell pre-cancerous. Ua piʻi nui ka pilikia o ka maʻi kanesa. |
| Ka maʻi ʻaʻai (Carcinoma) | Ua ʻoi aʻe ka ʻino o ke kūlana (dysplasia) a ua lilo i ka maʻi ʻaʻai. |
He mea nui loa kēia hoʻokaʻawale ʻana, no ka mea, hoʻoholo ia i nā lāʻau lapaʻau āu e loaʻa ai a me ka pinepine o kou hoʻāʻo hou ʻia ʻana.
He aha nā lāʻau lapaʻau no kēia?
ʻEkolu mau pahuhopu nui o ka mālama ʻana i ka esophagus a Barrett.
1. E hoʻōki i ka piʻi ʻana o ka maʻi ma ka mālama ʻana i ke kumu kumu.
2. Ka nānā mau ʻana no ka hoʻomohala ʻana o nā loli pre-cancerous (dysplasia).
3. Inā loaʻa ka dysplasia, e wehe i nā pūnaewele i hoʻopilikia ʻia.
1. Ke mālama ʻana i ke kumu kumu
ʻOiai he nui ka poʻe e loaʻa i kēia maʻi ma muli o ka gastritis mau loa (GERD), ʻo ka mea mua e hana ai, ʻo ia ke mālama pono iā ia. E aʻo aku kāu kauka iā ʻoe ma kēia:
- Nā Hoʻololi o ke ʻAno o ka Noho ʻana: E hōʻemi i nā mea ʻala a me nā mea ʻaila, ke kofe, a pēlā aku, a mai moe koke ma hope o ka ʻaina ahiahi.
- Lāʻau lapaʻau: He kūpono loa nā lāʻau lapaʻau e hōʻemi ana i ka hana ʻakika o ka ʻōpū, ʻoiai nā Proton Pump Inhibitors (PPIs) (e.g. Omeprazole, Esomeprazole, Pantoprazole). Hoʻōki lākou i ka hōʻino ʻana i ka esophagus a kōkua i ka ho'ōla ʻana o nā ʻiʻo.Pono e lawe ʻia kēia mau lāʻau lapaʻau ma ke ʻōlelo aʻo a ke kauka wale nō.
2. Ka nānā mau ʻana (Surveillance)
Ma muli o kou kūlana, e haʻi aku kāu kauka iā ʻoe i ka pinepine o kou pono ʻana i kahi endoscopy.
- A i ʻole, ua lawa ka nānā ʻana i kēlā me kēia 3-5 mau makahiki.
- Inā he dysplasia haʻahaʻa haʻahaʻa, ʻōlelo lākou e nānā iā ia ma kahi o hoʻokahi manawa i ka makahiki.
3. Ke mālama ʻana i ke kūlana (Dysplasia)
Inā hōʻoia ka biopsy aia nā loli cell precancerous (dysplasia), e ʻōlelo aku nā kauka e wehe i kēlā mau cell. Aia kekahi mau ʻano hana no kēia.
- ʻO ka Ablation Therapy: Pili kēia i ka hoʻohana ʻana i kahi mea kūikawā i ka wā o ka endoscopy e luku i ka papa cell ʻano ʻē. Hiki ke hana ʻia kēia me ka hoʻohana ʻana i ka wela kiʻekiʻe (radiofrequency) a i ʻole ke anu kiʻekiʻe (cryotherapy).
- Endoscopic Mucosal Resection (EMR): He hana ʻoki liʻiliʻi kēia i hana ʻia ma o ka endoscopy. Maanei, ʻoki ʻia a wehe ʻia nā ʻiʻo ʻē wale nō.
- ʻO ke ʻoki kino (Esophagectomy): Inā koʻikoʻi loa ka dysplasia a ua holomua paha i ka maʻi kanesa, pono paha ke ʻoki kino e wehe loa i ka ʻāpana i hoʻopilikia ʻia o ka esophagus.
Hiki ke ho'ōla loa ʻia kēia maʻi?
ʻAʻole e ola maikaʻi ka metaplasia, a i ʻole ka loli ʻana o nā cell, ma kāna iho. Eia nō naʻe, hiki i nā lāʻau lapaʻau a mākou i kūkākūkā ai ma mua (Ablation, EMR) ke wehe i nā cell i loli. Eia kekahi, inā mālama pono ʻia ke kumu kumu (e like me GERD) a ua hoʻōki ʻia ka hōʻino ʻana i ka esophagus, hiki ke hoʻomalu ʻia ke kūlana.
Akā ma hope o ka mālama ʻia ʻana, aia kahi manawa liʻiliʻi e hoʻi hou mai ai kēia maʻi. No laila, he mea nui loa e hoʻomau i ka hele ʻana no nā hoʻokolohua hahai e like me ka ʻōlelo a ke kauka.
Hiki i ke kanaka me ka esophagus Barrett ke ola i kahi ola maʻamau. ʻO ka mea nui loa, ʻo ia ka pale ʻana i ke kūlana mai ka ʻino ʻana. Inā ʻike ʻia a mālama ʻia nā loli precancerous i ka wā mua, ʻaʻole pono ʻoe e hopohopo no kou wā e hiki mai ana.
Leka Lawe-Home
- ʻAʻole ka Barrett's Esophagus he maʻi kanesa, akā he kūlana ia e hoʻonui iki ai i ka pilikia o ka maʻi kanesa esophageal.
- ʻO ke kumu nui o kēia, ʻo ia ka gastritis lōʻihi (GERD).
- Inā ʻoe e ʻike nei i nā hōʻailona e like me ka ʻeha pinepine o ka umauma a i ʻole ka meaʻai e paʻa ana i kou puʻu, mai hoʻowahāwahā iā ia. E ʻike pono i ke kauka a e kiʻi i ka ʻōlelo aʻo.
- Hoʻomaopopo ʻia kēia maʻi ma o ka endoscopy a me ka biopsy.
- Inā ʻaʻohe loli precancerous (dysplasia), ʻaʻohe kumu e makaʻu ai. Eia nō naʻe, he mea nui loa ka hana ʻana i nā nānā maʻamau e like me ka papa kuhikuhi i ʻōlelo ʻia e kāu kauka.
- Hiki ke mālama pono ʻia kēia kūlana ma ka mālama pono ʻana i ke kumu kumu a, inā pono, e wehe i nā pūnaewele i hoʻopilikia ʻia.
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