Kodi mumamvanso kutentha pamtima ndi kupweteka pachifuwa? Tiyeni tiphunzire za acid reflux ndi GERD!

Mukatha kudya, kodi nthawi zina mumamva kutentha pachifuwa panu, kuwawa pakhosi panu, kapena kupsinjika m'mimba, monga kutentha pamtima? Izi ndi zizindikiro zofala za acid reflux zomwe anthu ambiri amakumana nazo. Ngakhale kuti ndi zachilendo kuti izi zichitike nthawi zina, ndi chinthu chodetsa nkhawa ngati zimachitika pafupipafupi.

Kodi Acid Reflux ndi chiyani? Tiyeni timvetse mosavuta!

Mwachidule, acid reflux ndi pamene zomwe zili m'mimba mwathu, makamaka asidi wa m'mimba , zimapita mmwamba, kutanthauza kuti, kubwerera kukhosi. Kawirikawiri, chakudya chomwe timadya chimapita m'mimba kenako n'kutsika. Koma pankhaniyi, zosiyana zimachitika.

Taganizirani izi, asidi uyu m'mimba mwathu ndi wamphamvu kwambiri. Amapangidwa kuti azigaya chakudya. Choncho chinthu chonga ichi chikalowa mu mkodzo - chitoliro cha chakudya - chingawononge minofu yofewa mkati mwa mkodzo ndikuyambitsa kutupa. Anthu ambiri amakumana ndi izi nthawi ndi nthawi. Ena amatcha "kusadya bwino" , ena amatcha "kutentha pamtima" , komwe ndi kutentha komwe kumamveka pakati pa chifuwa, pafupi ndi sternum.

Vuto la acid reflux nthawi zina silili matenda aakulu. Koma kwa anthu ena, limachitika nthawi zonse. Ndi acid reflux yokhazikika yotereyi, zimakhala zovuta kukhala ndi moyo wabwinobwino, ndipo zingawonongenso mmero wathu.

Ndiye kodi GERD ndi chiyani?

GERD ndi dzina lalifupi la Gastroesophageal Reflux Disease . M'mayiko ena, imalembedwanso kuti GORD (Gastro-oesophageal Reflux Disease) . Komabe, imalembedwanso kuti, imatanthauza vuto lomwe acid reflux m'mimba mwathu imachitika kwa nthawi yayitali (chronic acid reflux) . Ngati acid ibwera motere osachepera kawiri pa sabata, kwa milungu ingapo, ndiye kuti madokotala amaona kuti ndi vuto la GERD.

Asidi angabwere pazifukwa zina zakanthawi. Mwachitsanzo, kugona pansi mutadya kwambiri. Koma GERD si chinthu chomwe chimakhala chakanthawi. Ndi vuto losatha komanso lamakina . Ndiko kuti, njira zomwe zimaletsa asidi kulowa m'mimba sizikugwira ntchito bwino.

Kodi matenda amenewa ndi ofala bwanji?

Matenda onse awiri otchedwa gastroesophageal reflux disease (GERD) ndi GERD ndi ofala kwambiri. M'dziko ngati America, akuti pafupifupi 20% ya akuluakulu ndi pafupifupi 10% ya ana ali ndi GERD. Matendawa amatha kuwoneka m'dziko lathu kwambiri kapena pang'ono.

Kodi zizindikiro za izi ndi ziti? Onani ngati muli nazonso!

Pali zizindikiro zingapo za acid reflux ndi GERD. Onani ngati chimodzi mwa izi chikumveka chodziwika bwino kwa inu:

• Kusamba m'mbuyo/Kubwezeretsa chakudya: Mukatha kudya, mungamve ngati asidi m'mimba, tinthu ta chakudya, ndi madzi akumwa abwerera m'khosi mwanu. Izi zimatchedwa kubwezeretsanso chakudya . Nthawi zina zimatha kutsagana ndi kukoma kowawasa .
• Kumva kutentha: Popeza asidi ndi chinthu champhamvu, chimayambitsa kutentha m'mimba. Ngati izi zimveka pachifuwa, zimatchedwa kutentha pamtima . Ngati zimveka m'mimba, zimatchedwa kusagaya chakudya .
• Kupweteka pachifuwa kosakhala kwa mtima: Anthu ena amamva kupweteka pachifuwa komwe sikumveka ngati kutentha. Mitsempha yomwe imamva kupweteka pachifuwa ndi yofanana ndi mitsempha yomwe imamva kupweteka mumtima, kotero nthawi zina imatha kusokonezedwa ndi matenda a mtima.
• Nseru: Kutuluka kwa asidi m'mimba kungayambitse nseru ndi kusowa chilakolako cha chakudya. Ngakhale patapita nthawi yayitali, m'mimba mungakhalebe ndi njala.
• Kupweteka pakhosi: Ngati asidi alowa pakhosi, angayambitse kupweteka pakhosi, kumva ngati pali chinachake chomwe chakhazikika pakhosi, komanso kuvutika kumeza. Nthawi zambiri, asidi amalowa pakhosi usiku mukagona.
• Zizindikiro za mphumu: GERD ikhoza kukulitsa zizindikiro za mphumu mwa anthu omwe ali ndi mphumu, ndipo ngakhale kwa anthu omwe alibe mphumu, ingayambitse kutsokomola, kupuma movutikira, komanso kupuma movutikira . Izi zili choncho chifukwa tinthu ta asidi titha kufinya njira zopumira ngati titalowa m'thupi.

Kodi zizindikiro zimenezi zimamveka nthawi yanji kwambiri?

• Mukagona kapena kugona usiku .
• Mukadya chakudya chambiri kapena chakudya cholemera kwambiri .
• Mukawerama patsogolo.
• Mukasuta kapena kumwa mowa .

Kodi makanda aang'ono nawonso amadwala GERD?

Ndizachilendo kwambiri kuti makanda obadwa kumene abwerere mkaka. Asidi wochepa angabwere ndi mkaka, koma sangayambitse mavuto aakulu kwa mwana. Komabe, GERD ndi vuto lalikulu kwambiri. Lingayambitse kusasangalala komanso mavuto poyamwitsa.

Makanda obadwa msanga kapena omwe ali ndi vuto la m'mero ​​amakhala ndi mwayi waukulu wopeza matenda a GERD. Ndibwino kukaonana ndi dokotala wa ana ngati mwana wanu ali ndi zizindikiro izi:

• Ngati nthawi zonse mumalira popanda chifukwa .
• Ngati mukuvutika kugona .
• Ngati simukukonda kumwa mkaka .
• Ngati nthawi zonse mukusanza pang'ono .
• Ngati mukupanga phokoso lopuma pamene mukupuma kapena ngati mawu anu ndi osamveka bwino .
• Ngati muli ndi fungo loipa lochokera mkamwa mwanu .

Kodi asidi uyu amatuluka chifukwa chiyani? Kodi zifukwa zake ndi ziti?

Kuti asidi alowe mu mkodzo, ayenera kudutsa mu valavu yomwe ili kumapeto kwa mkodzo yomwe nthawi zambiri imaletsa zinthu kuti zisabwerere mmwamba. Vavu iyi imatchedwa Lower Esophageal Sphincter (LES) .

LES iyi ndi minofu yozungulira. Imatseguka tikameza chakudya, kenako imatsekanso kuti zomwe zili m'mimba zisungike bwino. Imatsegulanso pang'ono tikamatuwa, monga tikamadumphadumpha, kuti mpweya utuluke.

Asidi amatuluka pamene LES ikhala yofooka kapena yomasuka kwambiri . Zinthu zina zakanthawi zingapangitse LES kumasuka. Mwachitsanzo, kugona pansi mutadya chakudya chambiri. Koma ngati muli ndi GERD, LES yanu imakhala yomasuka nthawi zonse.

Zifukwa zomwe zimayambitsa kufooka kwa LES ndi izi:

• Hernia ya Hiatal: Apa ndi pamene gawo lapamwamba la mimba limakankhira mmwamba kudzera mu dzenje lomwe lili mu diaphragm komwe m'mero ​​umatsikira. Kenako limatha kukakamira ndi m'mero, zomwe zimapangitsa kuti asidi azisonkhana. Komanso, chifukwa LES ili pamwamba pa mimba, imakhala ndi minofu yochepa yothandizira. Matendawa amapezeka kwambiri ndi ukalamba ndipo amatha kukula pang'onopang'ono.
• Mimba: Kupuma kwa asidi kwakanthawi kumachitika kwambiri panthawi ya mimba. Kupanikizika kwa mwana amene akukula m'mimba kumatha kutambasula ndikufooketsa minofu yothandizira LES. Komanso, mahomoni omwe amatulutsidwa panthawi ya mimba, monga relaxin ( yomwe imamasula minofu kuti ipatse mwana malo), estrogen, ndi progesterone, amathanso kumasula LES.
• Kunenepa Kwambiri: Kunenepa kwambiri kungathenso kuwonjezera kuthamanga kwa magazi m'mimba, komwe kungakhudze LES, monga momwe zimakhudzira mimba. Kunenepa kwambiri kumatha kukhala nthawi yayitali kuposa mimba, ndipo minofu imatha kufooka kwamuyaya. Ichi ndi chifukwa chachikulu cha hernias ya hiatal. Popeza minofu yamafuta imatulutsa estrogen, kuchuluka kwa estrogen mwa anthu onenepa kwambiri kumawonjezekanso.
• Kusuta: Zinthu zomwe zili mu fodya zimamasula LES. Izi zitha kuchitika kaya mukusuta kapena kupuma utsi pamene ena akusuta (utsi wogwiritsidwa ntchito). Kusuta kumayambitsa kutsokomola, ndipo mukatsokomola, LES imatseguka. Kupitiriza kusuta ndi kutsokomola kungafooketse minofu ya khoma la m'mimba ndikuyambitsa hernia yobereka. Sikuti zokhazo, kusuta kumachepetsanso kugaya chakudya ndipo kumapangitsa kuti m'mimba mupange asidi wambiri .

Zina zomwe zingayambitse GERD ndi izi:

• Zilema zina zobadwa nazo: Mwachitsanzo, matenda okhudza m'mero ​​monga esophageal atresia .
• Matenda a minofu yolumikizana: Matenda monga scleroderma angakhudze minofu ya m'mero.
• Opaleshoni isanachitike: Opaleshoni pachifuwa kapena pamimba chapamwamba mwina inawononga m'mero.
• Mankhwala ena: Mankhwala ena amatha kupumula LES.
• Benzodiazepines (mankhwala ochepetsa nkhawa)
• Mankhwala oletsa kuthamanga kwa magazi (calcium channel blockers )
• Mankhwala oletsa kuvutika maganizo otchedwa Tricyclic antidepressants (mankhwala ochizira kuvutika maganizo ndi ululu)
• NSAIDs (mankhwala oletsa kutupa omwe si a steroidal) - mankhwala ochepetsa ululu monga aspirin ndi ibuprofen
• Theophylline (mankhwala ofala a mphumu)
• Mankhwala a mahomoni (HT) pa kusamba

Kodi chakudya ndi zakumwa zimakhudza izi?

Chakudya ndi zakumwa zokha sizingayambitse asidi kubwerera m'thupi, koma zimatha kuipitsa. Kudya zinthu zambiri monga chokoleti, khofi, mowa, timbewu ta ...

Zakudya zamafuta zimawonjezera asidi m'mimba ndipo zimatenga nthawi yayitali kuti zigayidwe. Chifukwa chake pali mwayi waukulu woti asidi abwerere m'mimba. Ngati mudya chakudya cholemera chamadzulo, sichingagayidwe musanagone.

Kodi ndi mavuto otani omwe angabwere ngati izi zipitirira?

Asidi m'mimba mwathu ndi wamphamvu kwambiri. Amapangidwa kuti azigaya chakudya chomwe timadya. M'mimba mwathu muli thin membrane mkati mwake kuti ateteze ku asidi uyu. Koma ziwalo zina zathu zilibe chitetezo ichi.

Kubwerera m'mimba kwa asidi kumakhudza kwambiri mmero. Koma nthawi zina asidi uyu amathanso kukwera m'mapapo kapena m'njira zopumira. Ngakhale asidi pang'ono atatuluka, amatha kuyambitsa kusasangalala, koma ngati atatuluka nthawi zonse, amatha kuwononga ziwalo izi.

Mavuto omwe angakhalepo:

• Esophagitis: Uku ndi kutupa kwa khoma la m'mero. Kutupa kwa m'mero ​​kwa nthawi yayitali kungayambitse ululu ndi zilonda zosalekeza m'mero. Pakapita nthawi, kungayambitse zipsera kapena metaplasia m'matumbo, vuto lomwe lingayambitse khansa.
• Mphuno ya Barrett: Ili ndi dzina lomwe limaperekedwa ku vuto lotchedwa intestinal metaplasia mu mphuno. Apa ndi pamene mphuno imasintha ndikukhala ngati mphuno ya m'matumbo. Izi zimachitika chifukwa chokhala ndi asidi ndi kutupa kwa nthawi yayitali. Ichi ndi chiopsezo cha khansa ya m'mero .
• Kutsekeka kwa m'mero: Minofu ya zipsera ingapangidwe mummero kuti iteteze ku kutupa ndi kuwonongeka kwa nthawi yayitali. Minofu ya zipsera iyi ingapangitse kuti m'mero ​​mutsekeke. Izi zimatchedwa stricture . Izi zingapangitse kuti zikhale zovuta kumeza ndi kudya.
• Kubwerera m'mbuyo kwa asidi m'khosi ndi m'khosi (Laryngopharyngeal reflux - LPR):Anthu ena omwe ali ndi GERD amakhalanso ndi LPR, yomwe ndi pamene asidi amakwera pakhosi. Asidi amatha kulowa pakhosi mukamagona. Izi zingayambitse kutupa pakhosi, mawu anu kukhala osamveka bwino, komanso kukula kwa mawu . Tinthu ta asidi tingathenso kutuluka m'mapapo mwanu.
• Mphumu: Kupuma mpweya woipa kungawonjezere mphumu mwa anthu omwe ali ndi mphumu kale, ndipo ngakhale mwa anthu omwe alibe vuto la kupuma, zizindikiro zofanana ndi za mphumu zimatha kuonekera. Tinthu tating'onoting'ono ta asidi titha kufalikira m'machubu a bronchial, zomwe zimapangitsa kuti achepetse, zomwe zimapangitsa kuti atsokomole komanso azivutika kupuma.

Kodi mungadziwe bwanji ngati muli ndi GERD? Kodi mayeso azachipatala ndi ati?

Dokotala wa matenda a m'mimba adzayang'ana mmero wanu kuti adziwe ngati muli ndi GERD. Pali mayeso angapo omwe angachite kuti adziwe izi:

• Esophagram: Iyi ndi mayeso a X-ray. M'mero ​​umayesedwa pogwiritsa ntchito X-ray (fluoroscopy) yomwe imayenda pamene mukumeza. Mumapatsidwa madzi okhala ngati choko otchedwa barium kuti mumwe.
• Kujambula pa upper endoscopy: Izi zimaphatikizapo kuyika chubu chopyapyala chokhala ndi kamera kudzera pakamwa panu kuti muwone mkati mwa mmero mwanu. Mudzapatsidwa mankhwala ochepetsa ululu pang'ono ndikugonedwa.
• Kuyesa kwa pH ya m'mero: Izi zimayesa kuchuluka kwa asidi mummero. Pa nthawi ya endoscopy, dokotala amaika sensa yaying'ono yopanda zingwe (wolandila opanda zingwe) mummero.
• Esophageal manometry: Izi zimayesa ntchito ya minofu ya m'mero. Izi zimachitika pogwiritsa ntchito masensa opanikizika omwe amaikidwa mu chubu cha nasogastric. Izi zimatha kudziwa ngati LES kapena minofu ina ikugwira ntchito bwino.

Kodi chithandizo chamankhwala ndi chiyani pa izi?

Anthu ena amatha kuchepetsa acid reflux yawo mwa kusintha moyo wawo, monga kusintha kadyedwe kawo, kuchepetsa kumwa mowa ndi kusuta fodya, komanso kuchepetsa thupi. Madokotala amalimbikitsanso anthu kutsatira njira izi.

Koma ngati muli ndi vuto la chronic acid reflux kapena GERD, madokotala angakupatseni mankhwala omwe amachepetsa asidi m'mimba. Ndiye, ngakhale asidiyo atatuluka, sadzakhala ndi vuto lalikulu. Mankhwalawa amapezeka mosavuta ndipo ndi othandiza kwambiri pa GERD.

Mankhwala

Mankhwala ogulitsidwa kunja kwa chipatala (OTC) omwe amapezeka m'ma pharmacy opanda mankhwala:

• Mankhwala Oletsa Kutupa: Mankhwala Oletsa Kutupa, monga Tums® ndi Rolaids®, amachepetsa asidi m'mimba. Izi zikutanthauza kuti ngakhale asidi atatuluka, sadzawononga kwambiri mmero. Izi ndi zabwino pochiza matenda a asidi nthawi zina, koma zingayambitse zotsatirapo zoyipa ngati zitamwedwa nthawi zonse, kotero si njira yabwino yothetsera vutoli kwa nthawi yayitali.
• Alginates:Alginate ndi shuga wachilengedwe wochokera ku udzu wa m'nyanja. Umayandama pamwamba pa asidi, zomwe zimapangitsa kuti pakhale chotchinga pakati pa asidi ndi m'mero. Pali mankhwala omwe ali ndi alginate yokha, komanso mankhwala omwe amaphatikiza alginate ndi mankhwala oletsa asidi.

Mankhwala olembedwa ndi dokotala:

• Mankhwala oletsa histamine receptor (H2 blockers): Mankhwala oletsa H2 amachepetsa kupanga asidi m'mimba. Izi zili choncho chifukwa amaletsa mankhwala (histamine) omwe amauza thupi kuti lipange asidi. Mankhwalawa amatha kumwedwa nthawi zambiri kuposa mankhwala oletsa asidi, koma nthawi zina sagwira ntchito kwa nthawi yayitali. Thupi limatha kuwazolowera.
• Mankhwala oletsa kupopera kwa proton (PPIs): Ma PPI ndi mtundu wa mankhwala omwe amaletsa asidi bwino komanso amalimbikitsa kuchira kwa minofu. Dokotala wanu angakulangizeni izi poyamba ngati GERD yanu ili yoopsa kapena ngati muli ndi zizindikiro za kuwonongeka kwa minofu m'mero. Ndi othandiza 90% pochepetsa acid reflux.
• Baclofen: Baclofen ndi mankhwala opumulira minofu. Nthawi zambiri amaperekedwa kuti achepetse kupweteka kwa minofu. Angachepetsenso kuchuluka kwa nthawi zomwe LES imapumula, zomwe zingachepetse kuchuluka kwa asidi komwe kumabwera. Si mankhwala oyamba a acid reflux, koma akhoza kukhala gawo la dongosolo lanu la chithandizo.

Kodi palibe njira yothetsera kapena kuchiza acid reflux kwathunthu?

Ngakhale kuti mankhwala amatha kuchepetsa zizindikiro ndi zotsatira za GERD, sangathe kuiletsa kwathunthu. Ngakhale munthu amene ali ndi GERD yoopsa akumwa mankhwala, mungakumanebe ndi mavuto, ngakhale simukudziwa.

Zikatero, pamafunika njira yokhazikika yothetsera asidi kuti asatuluke. Izi nthawi zambiri zimatanthauza opaleshoni yolimbitsa LES . Izi nthawi zambiri si opaleshoni yayikulu, ndi njira zochiritsira zakunja, ndipo zimakhala zopambana kwambiri.

Opaleshoni

Ma opaleshoni a GERD:

• Nissen fundoplication: Iyi ndi opaleshoni yofala kwambiri ya GERD. Ngati n'kotheka, imachitika pogwiritsa ntchito laparoscopically . Izi zikutanthauza kuti imachitika kudzera m'mabala ang'onoang'ono, zomwe zikutanthauza kuti nthawi yochira imakhala yochepa. Dokotala wa opaleshoni amatenga gawo lapamwamba la mimba, n'kulikulunga mozungulira gawo la pansi la m'mero, ndikulisoka pamodzi. Opaleshoniyi imachitikanso kwa anthu omwe ali ndi hiatal hernias.
• Chipangizo cha LINX: Iyi ndi njira yatsopano. Chipangizo chotchedwa LINX chimayikidwa opaleshoni. Chipangizo cha LINX ndi mphete yaying'ono ya maginito. Chimathandiza kuti kulumikizana pakati pa mimba ndi mmero kukhale kotsekedwa.

Kodi mungachite chiyani kuti muchepetse acid reflux kunyumba?

Yesani zinthu izi kuti muchepetse acid reflux kunyumba:

• Idyani zakudya zazing'ono:Zakudya zazikulu zimadzaza m'mimba ndipo zimaika mphamvu pa LES. Zakudya zazing'ono zimagayidwa mwachangu ndipo sizipanga asidi wambiri m'mimba.
• Idyani chakudya chamadzulo msanga: Ndi bwino kudya maola angapo musanagone ndi kugona usiku, chifukwa mphamvu yokoka imathandiza kuti asidi asagwe.
• Gonani cha kumanzere kwanu: Mukagona motere, LES yanu imakhala pamwamba pa zomwe zili m'mimba mwanu, ngati thumba la mpweya. Kugona cham'mbali kapena cha kumanja kungayambitse kugwa kwa valavu.
• Chepetsani kupanikizika m'mimba mwanu: Valani zovala zotayirira. Ngati muli onenepa kwambiri, yesani kuchepetsa thupi. Izi zidzakuthandizani pakapita nthawi komanso kwa nthawi yayitali.
• Siyani kusuta fodya ndi kumwa mowa: Fodya ndi mowa zimafooketsa LES. Zimawonjezeranso asidi m'mimba, zomwe zimawonjezera nthawi yogaya chakudya.
• Mankhwala operekedwa ndi dokotala: Khalani ndi mankhwala monga mankhwala oletsa asidi ndi alginates pafupi . Gwiritsani ntchito mankhwalawa makamaka ngati mukudziwa kuti mudzadya chakudya cholemera komanso chopanda asidi.

Kodi mumatani ngati asidi atuluka mwadzidzidzi?

Yesani kuchita zinthu izi nthawi yomweyo:

• Imirirani: mphamvu yokoka ili kumbali yanu.
• Imwani madzi pang'ono kapena awiri: Musamwe kwambiri, koma kumwa madzi pang'ono kungathandize kuchotsa asidi.
• Masulani lamba: Tsegulani lamba, kapena sinthani mathalauza ngati mungathe.
• Imwani mankhwala ochepetsa asidi: Ngati mulibe mankhwala enaake pafupi, mankhwala enaake monga Pepto Bismol® angathandize.

Kodi ndiyenera kupita liti kwa dokotala pankhani imeneyi?

Ngati muli ndi kutentha pamtima pafupipafupi, pitani kwa dokotala . Ndikofunikira kumvetsetsa momwe izi zikukhudzira thupi lanu. GERD si vuto lokhalo losasangalatsa - lingakhale loopsa. Ndipo pali mankhwala abwino ochizira.

Anthu ambiri amamva kutentha pamtima nthawi ndi nthawi. Kutentha pamtima, kupweteka m'mimba, komanso acid reflux zingapangitse kuti zikhale zovuta kupirira tsiku lonse. Pali zinthu zomwe mungachite kuti muchepetse kuchuluka kwa zizindikirozi.

Koma ngati mumakhala ndi kutentha pamtima pafupipafupi ndipo kukukhudzani, mwina muli ndi GERD. Ndikoyenera kulankhula ndi dokotala za zizindikiro zanu. Angakuthandizeni kusankha ngati chithandizo chingathandize.

Kumbukirani chinthu chofunika kwambiri (Uthenga Wopita Nawo Kunyumba)

Matenda a acid reflux ndi GERD ndi matenda omwe amakhudza anthu ambiri. Ngakhale kuti nthawi zina zimakhala zachilendo, ndikofunikira kudziwa ngati ali ndi vuto lokhazikika.

• Dziwani zizindikiro zanu. Samalani zinthu monga kukoma kowawa pakhosi, kupweteka pachifuwa, komanso kuvutika kumeza.
• Kusintha moyo wanu mosavuta kungapangitse kusiyana kwakukulu. Ganizirani zomwe mumadya, nthawi yomwe mumadya, komanso momwe mumagona.
• Pewani kusuta fodya ndi kumwa mowa.Izi zikuwonjezera vutoli.
• Ngati simungathe kuwongolera ndi mankhwala apakhomo, onetsetsani kuti mwapeza upangiri wa dokotala . GERD ndi matenda ochiritsika. Komabe, ngati sanachiritsidwe, angayambitse mavuto.
• Musadandaule. Vutoli lingathe kuthetsedwa bwino ndi uphungu ndi chithandizo choyenera. Lankhulani momasuka ndi dokotala wanu.

Ndikukhulupirira kuti izi zikuthandizani. Khalani ndi thanzi labwino!

Kutupa kwa asidi , GERD, kutentha pamtima, kutupa m'mimba, kusagaya bwino chakudya, esophagitis, chithandizo chamankhwala