dokumen.tips faringitis gerd

17
Laporan Kasus FA RINGITIS KRONIS EKSASERBASI AKUT e.c suspek GERD Oleh Dwi Putri Saraswati H1A 006010 DALAM RANGKA MENGIKUTI KEPANITERAAN KLINIK MADYA DI AGIAN ILMU PENYAKIT TELINGA! HIDUNG DAN TENGGOROKAN "AKULTAS KEDOKTERAN UNI#ERSITAS MATARAM RUMAH SAKIT UMUM PRO#INSI NUSA TENGGARA ARAT $011

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7/17/2019 Dokumen.tips Faringitis Gerd

http://slidepdf.com/reader/full/dokumentips-faringitis-gerd 1/17

Laporan Kasus

FARINGITIS KRONIS EKSASERBASI AKUT e.c suspek GERD

Oleh

Dwi Putri Saraswati

H1A 006010

DALAM RANGKA MENGIKUTI KEPANITERAAN KLINIK MADYA

DI AGIAN ILMU PENYAKIT TELINGA! HIDUNG DAN TENGGOROKAN

"AKULTAS KEDOKTERAN UNI#ERSITAS MATARAM

RUMAH SAKIT UMUM PRO#INSI NUSA TENGGARA ARAT

$011

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LAPORAN KASUS

Identitas pasien

 Na%a & T'(

U%ur & $) tahu'

*e'is +ela%i' & La+i,la+i

Ala%at & Pa-esa'-a'

Pe+er.aa' & swasta

Ananesa

Ke!u"an utaa #

 N/eri aa te'--2r2+ 

Ri$a%at pen%akit sekaran&

Pasie' ata'- e'-a' +eluha' '/eri aa te'--2r2+a' se.a+ $ hari /a'- lalu( Pasie' tia+ 

%e'-eluh+a' '/eri %e'ela'! 3atu+ 4,5! ile+ 4,5( Pasie' %erasa+a' e%a% /a'- tia+ terlalu

ti'--i se.a+ $ hari /a'- lalu( Pasie' %e'-eluh+a' te'--2r2+a''/a terasa +eri'- a' a'as(

Pasie' .u-a %erasa+a' ite'--2ra+a''/a terasa seerti %e'-a'.al( Pasie' %e'-ata+a'

+eluha' i'i suah seri'- irasa+a' se.a+ $ 3ula' /a'- lalu! '/eri te'--2r2+a' /a'- irasa+a'

+a%3uh +a%3uha' teruta%a setelah asie' %e'-eluh+a' %aa-'/a +a%3uh( Pasei'

%e%ili+ riwa/at %e'erita e'/a+it %aa-! seri'- %e'-eluh+a' %ual a' terasa a'as serta

ter3a+ar aa aa /a'- teruta%a i+eluh+a' saat asie' telat %a+a' a' %i'u% +2i atau

teh(

Ri$a%at Pen%akit Da"u!u

Pasie' seri'- %e'-ala%i +eluha' serua(

Riwa/at %aa- 4 7 5! te+a'a' arah ti'--i 4 , 5! DM 4 , 5! As%a 4 , 5

Ri$a%at Pen%akit Ke!uar&a

Keluar-a asie' tia+ aa /a'- %e'-ala%i +eluha' serua(

Ri$a%at a!er&i

Pasie' tia+ %e%ili+i riwa/at aler-i terhaa %a+a'a' atauu' 23at(

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Ri$a%at pen&o'atan

Pasie' er'ah 3er23at e'-a' +eluha' serua! +e%uia' i3eri+a' a'ti3i2ti+ 4a%28i9illi'5

a' as(%e:e'a%at a+a' tetai +eluha' asie' tia+ 3er+ura'-( Pasie' .u-a %e'-a+u

%e'-+2'su%si 23at %aa- 4%ila'ta5 /a'- i%i'u% saat asie' %erasa+a' -e.ala '/eri uluhati

a' %ual /a'- 3erat(

Peeriksaan (isik 

Keaaa' u%u% & 3ai+ 

Kesaara' &Compos mentis

Ta'a ;ital &

Te'si & 1$0<=0 %%H-! 'ai >68<%'t! resirasi $08<%'t! suhu alasi '2r%al(

Status !oka!is

Te!in&a

Ka'a' Kiri

Teli'-a Ka'a' Teli'-a Kiri

I'se+si &

Auri+ula

Preauri+ula

Retr2auri+ula

Palasi

MAE

Ee%a 4,5! hiere%i 4,5!

%assa 4,5

Ee%a 4,5! hiere%i 4,5!

%assa 4,5! :istula 4,5! a3ses 4,5

Ee%a 4,5! hiere%i 4,5!

%assa 4,5! :istula 4,5! a3ses 4,5

 N/eri er-era+a' auri+ula 4,5!

'/eri te+a' tra-us 4,5! '/eri

te+a' retr2auri+ula 4,5

Ee%a 4,5! hiere%i 4,5!

Ee%a 4,5! hiere%i 4,5!

%assa 4,5

Ee%a 4,5! hiere%i 4,5!

%assa 4,5! :istula 4,5! a3ses 4,5

Ee%a 4,5! hiere%i 4,5!

%assa 4,5! :istula 4,5! a3ses 4,5

 N/eri er-era+a' auri+ula 4,5!

'/eri te+a' tra-us 4,5! '/eri

te+a' retr2auri+ula 4,5

Ee%a 4,5! hiere%i 4,5!

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Ketera'-a'

Mu+2sa 3u+al

Mu+2sa -i-i

Mu+2sa :ari'-

T2'sil +a'a' +iri

@ar'a %erah %ua! hiere%i 4,5

@ar'a %erah %ua! hiere%i 4,5

Hiere%i 475! ee%a 4,5! ul+us 4,5! -ra'ul 475! lateral 3a' 4,5!

'e2;as+ularisasi 475

Hiere%i 4,5! u+ura' T1,T1! +rite %ele3ar 4,5! etritus 4,5

Dia&nosis & "ari'-itis +r2'is e+saser3asi a+ut e(9 sus GERD

Usu!an peeriksaan #

• Swa3 te'--2r2+a'

• E'2s+2i

• Pe'-u+ura' PH es2:a-us

• K2'sul e'-a' e'/a+it ala% u'tu+ %e'-etahui e'/e3a3 ari isesia /a'-

i+eluh+a' asie'(

Terapi#

Mei+a%e't2sa &

A'ti3i2ti+ &?e:ar28il ta3let )00 %- $81!

A'ti se+ret2ri 4PPI5 & la'2era2l

O3at +u%ur 

KIE & %e'-ura'-i %a+a'a' atau %i'u%a' /a'- 3er%i'/a+! eas! i'-i'! a' a'as( ila

 asie' %erasa+a' e%a% /a'- tia+ terlalu ti'--i! aat i +2%res e'-a' air ha'-at

a' %e'i'-+at+a' i'ta+e 9aira'(

Pro&nosis # u3ia a 32'a%

TIN*AUAN PUSTAKA

I. Farin&itis Kronis

De(inisi

"ari'-itis %erua+a' eraa'-a' i'i'- :ari'- /a'- aat ise3a3+a' 2leh ;irus

4B0,60C5! 3a+teri 4),B0C5! aler-i! trau%a a' t2+si'(#irus a' 3a+teri %ela+u+a' i';asi +e

:ari'- a' %e'i%3ul+a' rea+si i':la%asi l2+al(I':e+si 3a+teri -ru A Stret29299us

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he%2liti+us 3a'/a+ %e'/era'- a'a+ usia se+2lah a' 2ra'- ewasa( Pe'ulara' i':e+si

%elalui se+ret hiu'- a' luah(

"ari'-itis +r2'is aalah +2'isi i':la%asi ala% wa+tu /a'- la%a aa %u+2sa :ari'-

a' .ari'-a' se+itar'/a("ari'-itis +r2'is ter3a-i %e'.ai :ari'-itis +r2'is hierlasti+ 

4-ra'ular5 a' :ari'-itis +r2'is atr2i atau +ataralis(

Etio!o&i

"ari'-itis +r2'is 3isa ise3a3+a' +are'a i'u+si /a'- 3erula'-,ula'- :ari'-itis a+ut

atau +are'a iritasi :ari'- a+i3at %er2+2+ 3erle3iha' a' e'/alah-u'aa' al92h2l! seri'-

+2'su%si %i'u%a' atauu' %a+a'a' /a'- a'as! a' 3atu+ +r2'is +are'a aler-i("ari'-itis

+r2'is a+i3at -a'--ua' e'9er'aa' aa la%3u'- .u-a %u'-+i' ter.ai 'a%u' %erua+a'

 e'/e3a3 /a'- .ara'- ite%u+a'(Pe'/e3a3 lai' /a'- tia+ ter%asu+ irita' aalah e%a+aia'

suara 3erle3iha' %isal'/a aa 2rat2r! si'usitis! rhi'itis! i'halasi a+i3at ua /a'- %era'-sa'-

%u+2sa :ari'-! e3u! serta +e3iasaa' 3er'a:as %elalui %ulut +are'a hiu'- tersu%3at(

Ge+a!a

Ge.ala su3.e+ti: /a'- irasa+a' aat 3erua rasa -atal i te'--2r2+a'! rasa aa /a'-

%e'--a'.al i te'--2r2+a'! 3atu+ iritati: a' 3atu+ /a'- 3eraha+(Pe'erita :ari'-itis +r2'is

 .u-a aat %e'erita -a'--ua' aa lari'- /aitu suara sera+(

Paa staiu% i'i! %e%3ra' %u+2sa a+a' ta%a+ %erah +are'a e%3uluh arah /a'-

%e'-ala%i +2'-esti! 3e'-+a+ a' ilaisi %u9us( Paa taha sela'.ut'/a war'a %e%3ra'e

%u+2sa :ari'- a+a' le3ih -ela a' seerti itutui 2leh :2li+el,:2li+el /a'- %e%3esar!

ter.ai e'e3ala' %u+2sa! serta se9ret 3er+ura'- a' +e'tal(

Dia-'2sis :ari'-itis +r2'is ite-a++a' e'-a' a'a%'esis a' i'se+si %u+2sa

:ari'-(Pasie' :ari'-itis harus %e'-hi'ari su%3er,su%3er irita'(Ke3iasaa' %er2+2+!

%e'-+2'su%si al92h2l! %a+a'a' a'as! a' +2'ta+ la'-su'- e'-a' uara ter3u+a harus

i3atasi u'tu+ %e'-ura'-i -e.ala :ari'-itis(

Terdapat dua 'entuk (arin&itis kronis %aitu #

• "ari'-itis +r2'is hierlasti+ 

• "ari'-itis +r2'is atr2:i

a. Farin&itis kronis "iperp!astik 

Faktor predisposisi #

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, Ri'itis +r2'is a' si'usitis

, I':lasi +r2'i+ /a'- iala%i er2+2+ a' e%i'u% al92h2l

, I'halasi ua /a'- %era'-sa'-

, I':e+si

, Daerah 3ere3u

, Ke3iasaa' 3er'a:as %elalui %ulut

,ani(estasi k!inis #

, Rasa -atal! +eri'- a' 3erle'ir /a'- su+ar i+eluar+a' ari te'--2r2+a'

, atu+ serta erasaa' %e'--a'.al i te'--2r2+a'

Peeriksaan (isik #

, Pe'e3ala' %u+2sa i i'i'- 2steri2r :ari'-

, Hiertr2:i +ele'.ar li%:e i 3awah %u+2sa

, Mu+2sa i'i'- :ari'- 2steri2r tia+ rata 4-ra'uler5

, Lateral 3a' %e'e3al

Penata!aksanaan #

, Di9ari a' i23ati e'/a+it +r2'is i hiu'- a' si'us ara'asal

, L29al aat ila+u+a' +austi+ e'-a' at +i%ia 4'itras ar-e'ti! al32th/l5 atau e'-a'

listri+ 4ele+tr2+auter5

, Se3a-ai si%t2%ati+ i3eri+a' 23at +u%ur atau isa! 23at 3atu+ 4a'titusi: atau

e+se+t2ra'5

'. Farin&itis kronis atro(i

Aalah :ari'-itis /a'- ti%3ul a+i3at ra'-sa'-a' a' i':e+si aa lari'- +are'a ter.ai

rhi'itis atr2:i! sehi'--a uara er'a:asa' tia+ iatur suhu a' +ele%3a3a''/a sehi'--a

%e'i%3ul+a' ra'-sa'-a' i':e+si aa :ari'-(

,ani(estasi k!inis #

, Te'--2r2+a' terasa +eri'- a' te3al

, Mulut 3er3au

Peeriksaan (isik #

Paa %u+2sa :ari'- teraat le'ir /a'- %ele+at! a' 3ila le'ir itu ia'-+at a+a'

ta%a+ %u+2sa i3awah'/a +eri'-(

Penata!aksanaan #

Terai sa%a e'-a' rhi'itis atr2:i! ita%3ah 23at +u%ur! 23at si%t2%ati+ a'

%e'.a-a h/-ie'e %ulut(

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II. Pen%akit Re(!uks Gastro Eso(a&ea!

De(inisi

Gastr2es2ha-eal Re:lu8 Disease aalah suatu +eaaa' at2l2-is se3a-ai a+i3at

re:lu+s +a'u'-a' la%3u'- +e ala% es2ha-us! e'-a' 3er3a-ai -e.ala /a'- ti%3ul a+i3at

ari +eterli3ata' es2ha-us! :ari'-! lari'-! a' salura' 'a:as(

Etio!o&i

Pe'/a+it -astr2es2:a-eal re:lu+s 3ersi:at %ulti:a+t2rial(Hal i'i aat ter.ai 2leh

+are'a eru3aha' /a'- si:at'/a se%e'tara atauu' er%a'e' aa 3arrier ia'tara es2ha-us

a' la%3u'-(Selai' itu .u-a! aat ise3a3+a' 2leh +are'a s:i'-ter es2ha-us 3a-ia' 3awah

/a'- i'+2%ete'! rela+sasi ari s:i'-ter es2ha-us 3a-ia' 3awah /a'- 3ersi:at se%e'tara!

terr-a'--u'/a e+sulsi ari re:lu+s la%3u'- ari es2ha-us! atauu' her'ia hiatus(

Pato&enesis

Es2:a-us a' -aster iisah+a' 2leh suatu 2'a te+a'a' ti'--i 4hi-h ressure 2'e5 /a'-

ihasil+a' 2leh +2'tra+si l2wer es2ha-eal shi'9ter 4LES5( Paa i'i;iu '2r%al! e%isah

i'i a+a' iertaha'+a' +e9uali aa saat ter.ai'/a alira' a'te-ra /a'- ter.ai aa saat

%e'ela'! atau alira' retr2-ra /a'- ter.ai aa saat se'awa atau %u'tah( Alira' 3ali+ ari

-aster +e es2ha-us %elalui LES ha'/a ter.ai aa3ila t2'us LES tia+ aa atau sa'-at

re'ah 4 %%H-5( Re:lu+s -astr2es2:a-eal aa asie' GERD ter.ai %elalui

%e+a'is%e&

• Re:lu+s s2'ta' aa saat rela+sasi LES /a'- tia+ ae+uat

• Alira' retr2-rae /a'- %e'ahului +e%3ali'/a t2'us LES setelah %e'ela'

• Me'i'-+at'/a te+a'a' i'traa32%i'al

De'-a' e%i+ia' aat itera'-+a' 3ahwa at2-e'esis ter.ai'/a GERD %e'/a'-+ut

+esei%3a'-a' a'tara :a+t2r e:e'si: ari es2ha-us a' :a+t2r 2:e'si: ari 3aha'

re:lu+sat(Ya'- ter%asu+ :a+t2r e:e'si: es2ha-us! aalah e%isah a'tire:lu+s 4li'i erta%a5!

 3ersiha' asa% ari lu%e' es2ha-us 4li'i +eua5! a' +etaha'a' eithelial es2ha-us 4li'i

+eti-a5(Sea'-+a' /a'- ter%asu+ :a+t2r 2:e'si: aalah se+resi -astri+ a' a/a il2ri+(

,ani(estasi K!inik 

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Ge.ala +li'i+ /a'- +has ari GERD aalah '/eri<rasa tia+ e'a+ i ei-astriu% atau

retr2ster'al 3a-ia' 3awah(Rasa '/eri 3iasa'/a ies+risi+a' se3a-ai rasa ter3a+ar 

4heart3ur'5! +aa'-,+aa'- 3er9a%ur e'-a' -e.ala is:a-ia 4+esulita' %e'ela' %a+a'a'5!

%ual atau re-ur-itasi a' rasa ahit i liah(@alau e%i+ia'! era.at 3erat ri'-a''/a +eluha'

heart3ur' ter'/ata tia+ 3er+2relasi e'-a' te%ua' e'2s+2i+(Kaa'-,+aa'- ti%3ul rasa

tia+ e'a+ retr2ster'al /a'- %iri e'-a' +eluha' aa sera'-a' a'-i'a e9t2ris(Dis:a-ia

/a'- ti%3ul saat %a+a' %a+a'a' aat %u'-+i' ter.ai +are'a stri+tur atau +e-a'asa' /a'-

 3er+e%3a'- ari arrettFs es2ha-us(Oi'2:a-ia 4rasa sa+it saat %e'ela' %a+a'a'5 3isa

ti%3ul .i+a suah ter.ai ulserasi es2ha-us /a'- 3erat(

GERD aat .u-a %e'i%3ul+a' %a'i:estasi -e.ala e+stra es2ha-eal /a'- atii+ a' sa'-at

 3er;ariasi %ulai ari '/eri aa '2',+aria+ 4'2',9aria9 9hest ai'<N??P5! suara sera+!

lar/'-itis! 3atu+ +are'a asirasi sa%ai ti%3ul'/a 3r2'+ie+tasis atau as%a(

Di lai' iha+! 3e3eraa e'/a+it aru aat %e'.ai :a+t2r reis2sisi u'tu+ ti%3ul'/a

GERD +are'a ti%3ul'/a eru3aha' a'at2%is i aerah -astr2es2ha-eal hi-h ressure 2'e

a+i3at e'--u'aa' 23at,23ata' /a'- %e'uru'+a' t2'us LES 4%isal'/a te2:ili'5(

Ge.ala GERD 3iasa'/a 3er.ala' erlaha',laha'! sa'-at .ara'- ter.ai eis2e a+ut atau

+eaaa' /a'- 3ersi:at %e'-a'9a% '/awa(Oleh se3a3 itu! u%u%'/a asie' e'-a' GERD

%e%erlu+a' e'atala+sa'aa' se9ara %ei+(

Dia&nosis

Disa%i'- a'a%'esis a' e%eri+saa' :isi+ /a'- se+sa%a! 3e3eraa e%eri+saa' e'u'.a'-

aat ila+u+a' u'tu+ %e'e-a++a' ia-'2sis GERD! /aitu &

• E'2s+2i salura' 9er'a 3a-ia' atas

Pe%eri+saa' e'2s+2i salura' 9er'a 3a-ia' atas %erua+a' sta'ar 3a+u u'tu+ 

ia-'2sis GERD e'-a' ite%u+a''/a %u92sal 3rea+ i es2ha-us 4es2:a-itis re:lu+s5(

De'-a' %ela+u+a' e%eri+saa' e'2s+2i aat i'ilai eru3aha' %a+r2s+2i+ ari

%u+2sa es2ha-us! serta aat %e'/i'-+ir+a' +eaaa' at2l2-is lai' /a'- aat

%e'i%3ul+a' -e.ala GERD( *i+a tia+ ite%u+a' %u92sal 3rea+ aa e%eri+saa'

e'2s+2i salura' 9er'a 3a-ia' atas aa asie' e'-a' -e.ala +has GERD! +eaaa' i'i

ise3ut '2',er2si;e re:lu8 isease 4NERD5(

Dite%u+a''/a +elai'a' es2:a-itis aa e%eri+saa' e'2s+2i /a'- iasti+a' e'-a'

 e%eri+saa' hist2at2l2-i 43i2si5! aat %e'-+2':ir%asi+a' 3ahwa -e.ala heart3ur'

atau re-ur-itasi terse3ut ise3a3+a' 2leh GERD(

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• Es2:a-2-ra:i e'-a' 3ariu%

Di3a'i'-+a' e'-a' e'2s+2i! e%eri+saa' i'i +ura'- e+a a' seri'-+ali tia+ 

%e'u'.u++a' +elai'a'! teruta%a aa +asus es2:a-itis ri'-a'(Paa +eaaa' /a'- le3ih

 3erat! -a%3ar rai2l2-/ aat 3erua e'e3ala' i'i'- a' liata' %u+2sa! ul+us! atau e'/e%ita' lu%e'(@alauu' e%eri+saa' i'i sa'-at tia+ se'siti;e u'tu+ ia-'2sis

GERD! 'a%u' aa +eaaa' terte'tu e%eri+saa' i'i %e%u'/ai 'ilai le3ih ari

e'2s+2i! /aitu aa ste'2sis es2ha-us era.at ri'-a' a+i3at es2:a-itis eti9 e'-a'

-e.ala is:a-ia! a' aa hiatus her'ia(

• Pe%a'taua' H $B .a%

Eis2e re:lu+s -astr2es2:a-eal %e'i%3ul+a' asii:i+asi 3a-ia' istal

es2ha-us(Eis2e i'i aat i%2'it2r a' ire+a% e'-a' %e'e%at+a'%i+r2ele+tr2a H aa 3a-ia' istal es2ha-us(Pe'-u+ura' H aa es2ha-us 3a-ia'

istal aat %e%asti+a' aa tia+'/a re:lu+s -astr2es2:a-eal(H i3awah B aa .ara+ )

9% i atas LES ia'--a ia-'2sti+ u'tu+ re:lu+s -astr2es2:a-eal(

• Tes er'stei'

Tes i'i %e'-u+ur se'siti;itas %u+2sa e'-a' %e%asa'- sela'- tra's'asal a'

%ela+u+a' er:usi 3a-ia' istal es2ha-us e'-a' H?l 0!1 M ala% wa+tu +ura'- ari 1

 .a%( Tes i'i 3ersi:at ele'-+a terhaa %2'it2ri'- H $B .a% aa asie',asie'e'-a' -e.ala /a'- tia+ +has(ila laruta' i'i %e'i%3ul+a' rasa '/eri aa seerti /a'-

 3iasa'/a iala%i asie'! sea'-+a' laruta' Na?l tia+ %e'i%3ul+a' rasa '/eri! %a+a

test i'i ia'--a 2siti:( Test er'stei' /a'- 'e-ati;e tia+ %e'/i'-+ir+a' aa'/a '/eri

/a'- 3erasal ari es2ha-us(

Penata!aksanaan

@alauu' +eaaa' i'i .ara'- se3a-ai e'/e3a3 +e%atia'! %e'-i'-at +e%u'-+i'a'

ti%3ul'/a +2%li+asi .a'-+a a'.a'- 3erua ulserasi! stri+tur es2ha-us atauu' es2ha-us

 3arrett /a'- %erua+a' +eaaa' re%ali-'a! %a+a se/2-/a'/a e'/a+it i'i %e'aat

 e'atala+sa'aa' /a'- ae+uat(

Paa ri'si'/a! e'atala+sa'aa' GERD teriri ari %2i:i+asi -a/a hiu! terai

%ei+a%e't2sa! terai 3eah serta a+hir,a+hir i'i %ulai ila+u+a' terai e'2s+2i+(Tar-et

 e'atala+sa'aa' GERD aalah %e'/e%3uh+a' lesi es2ha-us! %e'-hila'-+a'

-e.ala<+eluha'! %e'9e-ah +e+a%3uha'! %e%er3ai+i +ualitas hiu! a' %e'9e-ah

ti%3ul'/a +2%li+asi(

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• M2i:i+asi -a/a hiu

M2i:i+asi -a/a hiu %erua+a' salah satu 3a-ia' ari e'atala+sa'aa' GERD! 'a%u'

 3u+a' %erua+a' e'-23ata' ri%er( @alauu' 3elu% aa stui /a'- aat%e%erlihat+a' +e%a+'aa''/a! 'a%u' aa asar'/a usaha i'i 3ertu.ua' u'tu+ 

%e'-ura'-i :re+ue'si re:lu+s serta %e'9e-ah +e+a%3uha'(

Hal,hal /a'- erlu ila+u+a' ala% %2i:i+asi -a/a hiu aalah %e'i'--i+a' 2sisi

+eala aa saat tiur serta %e'-hi'ari %a+a' se3elu% tiur e'-a' tu.ua' u'tu+ 

%e'i'-+at+a' 3ersiha' asa% sela%a tiur serta %e'9e-ah re:lu+s asa% ari la%3u'- +e

es2ha-us! 3erhe'ti %er2+2+ a' %e'-+2'su%si al+2h2l +are'a +eua'/a aat

%e'uru'+a' t2'us LES sehi'--a se9ara la'-su'- %e%e'-aruhi sel,sel eitel!

%e'-ura'-i +2'su%si le%a+ serta %e'-ura'-i .u%lah %a+a'a' /a'- i%a+a' +are'a

+eua'/a aat %e'i%3ul+a' iste'si la%3u'-! %e'uru'+a' 3erat 3aa' aa asie'

+e-e%u+a' serta %e'-hi'ari a+aia' +etat sehi'--a aat %e'-ura'-i te+a'a'

i'traa32%e'! %e'-hi'ari %a+a'a'<%i'u%a' seerti 92+lat! teh! eer%i't! +2i a'

%i'u%a' 3ers2a +are'a aat %e'sti%ulasi se+resi asa%! .i+a' %e%u'-+i'+a'

%e'-hi'ari 23at,23at /a'- aat %e'uru'+a' t2'us LES seerti a'ti+2li'er-i+! te2:ili'!

iaea%! 2iate! a'ta-2'is +alsiu%! a-2'is 3eta are'er-i9! r2-ester2'e(

• Terai %ei+a%e't2sa

Teraat 3er3a-ai taha er+e%3a'-a' terai %ei+a%e't2sa aa e'atala+sa'aa'

GERD i'i(Di%ulai e'-a' asar 2la i+ir 3ahwa sa%ai saat i'i GERD %erua+a' atau

ter%asu+ ala% +ate-2ri -a'--ua' %2tilitas salura' 9er'a 3a-ia' atas(Na%u' ala%

 er+e%3a'-a''/a sa%ai saat i'i ter3u+ti 3ahwa terai suresi asa% le3ih e:e+ti: 

ariaa e%3eria' 23at,23at r2+i'eti+ u'tu+ %e%er3ai+i -a'--ua' %2tilitas(

Teraat ua alur e'e+ata' terai %ei+a%e't2sa! /aitu ste u a' ste 2w'( Paa

 e'e+ata' ste u e'-23ata' i%ulai e'-a' 23at,23at /a'- ter-2l2'- +ura'- +uat

ala% %e'e+a' se+resi asa% 4a'ta-2'is reset2r H$5 atau -2l2'-a' r2+i'eti+! 3ila

-a-al i3eri+a' 23at -2l2'-a' e'e+a' se+resi asa% /a'- le3ih +uat e'-a' %asa terai

le3ih la%a 4e'-ha%3at 2%a r2t2'<PPI5(Sea'-+a' aa e'e+ata' ste 2w'

 e'-23ata' i%ulai e'-a' PPI a' setelah 3erhasil aat ila'.ut+a' e'-a' terai

 e%eliharaa' e'-a' %e'--u'a+a' 2sis /a'- le3ih re'ah atau a'ta-2'is reset2r H$

atau r2+i'eti+ atau 3ah+a' a'ta9i(

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Dari 3er3a-ai stui! ila2r+a' 3ahwa e'e+ata' terai ste 2w' ter'/ata le3ih

e+2'2%is 4ala% se-i 3ia/a /a'- i+eluar+a' 2leh asie'5 i3a'i'-+a' e'-a'

 e'e+ata' terai ste u(

Me'urut Ge';al State%e't 41>>>5 serta K2'se'sus Asia Pasi:i+ te'ta'- e'atala+sa'aa'

GERD 4$005 telah isea+ati 3ahwa terai li'i erta%a u'tu+ GERD aalah -2l2'-a'

PPI a' i-u'a+a' e'e+ata' terai ste 2w'(

Paa u%u%'/a stui e'-23ata' %e%erlihat+a' hasil ti'-+at +ese%3uha' iatas 0C

ala% wa+tu 6, %i'--u(U'tu+ sela'.ut'/a aat iterus+a' e'-a' terai e%eliharaa'

4%ai'te'a'9e thera/5 atau 3ah+a' terai 3ila erlu 42',e%a' thera/5 /aitu

 e%3eria' 23at,23ata' sela%a 3e3eraa hari sa%ai ua %i'--u .i+a aa +e+a%3uha'

sa%ai -e.ala hila'-(

Paa 3er3a-ai e'elitia' ter3u+ti 3ahwa res2's er3ai+a' -e.ala %e'a'a+a' aa'/a

res2's er3ai+a' lesi 2r-a'i+'/a 4er3ai+a' es2:a-itis'/a5(Hal i'i ta%a+'/a le3ih

 ra+tis 3a-i asie' a' 9u+u e:e+ti: ala% %e'-atasi -e.ala aa tatala+sa'a GERD(

eri+ut aalah 23at,23ata' /a'- aat i-u'a+a' ala% terai %ei+a%e't2sa GERD &

• A'tasi

G2l2'-a' 23at i'i 9u+u e:e+ti: a' a%a' ala% %e'-hila'-+a' -e.ala GERD tetai

tia+ %e'/e%3uh+a' lesi es2:a-itis(Selai' se3a-ai 3u::er terhaa H?l! 23at i'i aat

%e%er+uat te+a'a' s:i'-ter es2ha-us 3a-ia' 3awah(Kele%aha' 23at -2l2'-a' i'i

aalah rasa'/a +ura'- %e'/e'a'-+a'! aat %e'i%3ul+a' iare teruta%a /a'-

%e'-a'u'- %a-'esiu% serta +2'stiasi teruta%a a'tasi /a'- %e'-a'u'-

alu%i'iu%! e'--u'aa''/a sa'-at ter3atas aa asie' e'-a' -a'--ua' :u'-si

-i'.al(

• A'ta-2'is reset2r H$

Ya'- ter%asu+ ala% -2l2'-a' 23at i'i aalah si%etii'! ra'itii'e! :a%2tii'! a'

'iatii'(Se3a-ai e'e+a' se+resi asa%! -2l2'-a' 23at i'i e:e+ti: ala% e'-23ata'

 e'/a+it re:lu+s -astr2es2:a-eal .i+a i3eri+a' 2sis $ +ali le3ih ti'--i a' 2sis

u'tu+ terai ul+us(G2l2'-a' 23at i'i ha'/a e:e+ti: aa e'-23ata' es2:a-itis era.at

ri'-a' sa%ai sea'- serta ta'a +2%li+asi(

• O3at,23ata' r2+i'eti+ 

Se9ara te2ritis! 23at i'i ali'- sesuai u'tu+ e'-23ata' GERD +are'a e'/a+it i'i

le3ih 92'2'- +earah -a'--ua' %2tilitas(Na%u'! aa ra+te+'/a! e'-23ata'

GERD sa'-at 3er-a'tu'- aa e'e+a'a' se+resi asa%(

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• Met2+l2ra%i

O3at i'i 3e+er.a se3a-ai a'ta-2'is reset2r 2a%i'e(E:e+ti;itas'/a re'ah ala%

%e'-ura'-i -e.ala serta tia+ 3erera' ala% e'/e%3uha' lesi i es2ha-us +e9uali

ala% +2%3i'asi e'-a' a'ta-2'is reset2r H$ atau e'-ha%3at 2%a r2t2'(Kare'a %elalui sawar arah 2ta+! %a+a aat ti%3ul e:e+ terhaa susu'a'

sara: usat 3erua %e'-a'tu+! usi'-! a-itasi! tre%2r! a' is+i'esia(

• D2%eri2'

G2l2'-a' 23at i'i aalah a'ta-2'is reset2r 2a%i'e e'-a' e:e+ sa%i'- /a'-

le3ih .ara'- is3a'i'- %et2+l2ra%i +are'a tia+ %elalui sawar arah 2ta+(

@alauu' e:e+ti;itas'/a ala% %e'-ura'-i +eluha' a' e'/e%3uha' lesi

es2ha-eal 3elu% 3a'/a+ ila2r+a'! -2l2'-a' 23at i'i i+etahui aat %e'i'-+at+a't2'us LES serta %e%er9eat e'-2s2'-a' la%3u'-(

• ?isarie

Se3a-ai suatu a'ta-2'is reset2r ) HTB! 23at i'i aat %e%er9eat e'-2s2'-a'

la%3u'- serta %e'i'-+at+a' te+a'a' t2'us LES(E:e+ti;itas'/a ala% %e'-hila'-+a'

-e.ala serta e'/e%3uha' lesi es2ha-us le3ih 3ai+ i3a'i'-+a' e'-a'

2%eri2'(

Su+ral:at 4Alu%i'iu% hir2+sia 7 su+r2sa 2+tasul:at5er3ea e'-a' a'tasi a' e'e+a' se+resi asa%! 23at i'i tia+ %e%ili+i e:e+ 

la'-su'- terhaa asa% la%3u'-( O3at i'i 3e+er.a e'-a' 9ara %e'i'-+at+a'

 ertaha'a' %u+2sa es2ha-us! se3a-ai 3u::er terhaa H?l i ees2:a-us serta aat

%e'-i+at esi' a' -ara% e%eu( G2l2'-a' 23at i'i 9u+u a%a' i3eri+a' +are'a

 3e+er.a se9ara t2i+al 4sit2r2te+si5(

• Pe'-ha%3at 2%a r2t2' 4Pr2t2' Pu% I'hhi3it2r<PPI5

G2l2'-a' 23at i'i %erua+a' ru- 2: 9h2i9e ala% e'-23ata' GERD( G2l2'-a'23at,23ata' i'i 3e+er.a la'-su'- aa 2%a r2t2' sel arietal e'-a'

%e%e'-aruhi e'i% H! K ATP,ase /a'- ia'--a se3a-ai taha a+hir r2ses

 e%3e'tu+a' asa% la%3u'-(

O3at,23ata' i'i sa'-at e:e+ti: ala% %e'-hila'-+a' +eluha' serta e'/e%3uha' lesi

es2ha-us! 3ah+a' aa es2:a-itis er2si;e era.at 3erat serta /a'- re:ra+ter e'-a'

-2l2'-a' a'ta-2'is reset2r H$(

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U%u%'/a e'-23ata' i3eri+a' sela%a 6, %i'--u 4terai i'isial5 /a'- aat

ila'.ut+a' e'-a' 2sis e%eliharaa' 4%ai'te'a'9e thera/5 sela%a B 3ula' atau 2',

e%a' thera/! ter-a'tu'- ari era.at es2:a-itis'/a(

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PE,BA)ASAN

Pasie' i'i i ia-'2sis e'-a' :ari'-itis +r2'is e+saser3asi a+ut et 9ausa suse+ 

GERD 3erasar+a' a'a%'esis a' e%eri+saa' /a'- ila+u+a'( Dari a'a%'esis iaat+a'

 3ahwa +eluha' '/eri te'--2r2+a' /a'- i ala%i asie' i'i 3erula'- a' suah i3eri+a'

terai e'-a' a%28i9illi' a' a'ti i':la%asi a+a' tetai tia+ %e'-hila'-+a' +eluha' asie'

se9ara %e'/eluruh( Ge.ala ari :ari'-itis +r2'is /a'- iaat+a' aa a'a%'esis ari asie'

i'i aalah asie' seri'- %erasa+a' te'--2r2++a''/a terasa +eri'- a' %e'--a'.al( Paa

a'a%'esis iaat+a' asie' %e%ili+i riwa/at sa+it %aa-! e'-a' -e.ala rasa ter3a+ar i

 3a-ia' aa! %ual a' seri'- %erasa+a' '/eri ei-astriu%( Hal i'i /a'- %e'u'.a'-

ia-'2sis re:lu+s -atr2es2:a-eal aa asie' i'i( Me'urut literatur! re:lu+s -astr2es2:a-eal

%eru+a' salah satu e'/e3a3 ter.ai'/a :ari'-its +r2'is( Sehi'--a 3erasar+a' a'a%'esis

aat i3uat ia-'2sis aa asie' i'i aalah :ari'-itis +r2'is /a'- ise3a3+a' 2leh re:lu+s

-astr2 es2:a-eal(

U'tu+ %e%asti+a' ia-'2sis :ari'-itis a+ut aa asie' i'i ila+u+a' e%eri+saa'

:isi+ aa aerah te'--2r2+a'! i%a'a ite%u+a' aa 3a-ia' 2steri2r ari i'i'- :ari'-

teraat 3a'/a+ -ra'ul a' teraat 'e2;as+ularisasi /a'- %e'a'a+a' aa'/a r2ses

i':la%asi /a'- +r2'is aa 3a-ia' terse3ut( Paa e%eri+saa' ite%u+a' %u+2sa :ari'-

hiere%is /a'- %e'a'a+a' sea'- ter.ai rea+si i':la%asi a+ut isa'a( Dari hasil

 e%eri+saa' i'i aat itari+ suatu ia-'2sis 3ahwa aa asie' i'i ter.ai :ari'-itis +r2'is

e'-a' e+saser3ai a+ut( erasar+a' e%eri+saa' :isi+! 3elu% aat iasti+a' e'/e3a3

ari :ari'-itis +r2'is aa asie' i'i! 2leh +are'a itu asie' i ia-'2sis e'-a' suse+ 

GERD 3erasar+a' a'a%'esis( U'tu+ %e%asti+a ia-'2sis GERD /a'- i ala%i asie'

ierlu+a' e%ari+saa' e'u'.a'- le3ih la'.ut seerti e'-u+ura' PH es2:a-us /a'-

%erua+a' -2l sta'ar u'tu+ %e'ia-'2sis GERD a' %ela+u+a' e'2s+2i u'tu %elihat

+eaaa' %u+2sa ari es2:a-us( Paa asie' i'i +e%u'-+i'a' e'/e3a3 ari :ari'-itis

+r2'is'/a le'ih %e'-arah +eaa GERD hal i'i i+are'a+a' asie' %e'-a+u suah 3er23at

 3erula'- +ali a' %e'aat+a' terai a't23i2ti+ a+a' tetai +eluha' asie' tia+ +u'.u'-

%e%3ai+! 2leh +are'a itu le3ih i 9uri-ai +e arah GERD(

Terai /a'- i 3eri+a' aa aa asie' i'i aalah selai' %e%e3ri+a' a'ti3i2ti+! .u-a

i3eri+a' a'ti se+ret2ri+ u'tu+ %e'-ura'-i +eluha' ari GERD( Pe%3eria' terai a'ti

se+ret2ri+ .u-a aat ila+u+a' se3a-ai e'u'.a'- ia-'2sis i%a'a 3ila +eluha' asie'

%e%3ai+ e'-a' e%3eria' a'ti se+ret2ri+ %a+a aat iasti+a' :ari'-itis +r2'is /a'-

i+eluha+a' asie' 3erasal ari GERD( A'ti3i2ti+ /a'- i3eri+a' aalah 9e:ar28il /a'-

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%erua+a' -2l2'-a' se:al2s2ri'( Hal i'i i erti%3a'-+a' +are'a asie' suah seri'-

%e'--u'a+a' a%28i9illi' a+a' tetai +eluha''/a tia+ %e%3ai+( Pe%3eria' Pr2t2' Pu%

I'hi3it2r aa asie' i'i u'tu+ %e'-ura'-i r2u+si asa% la%3u'- sehi'--a +eluha' aat

%e'-hila'-( Pr2t2' u% i'hi3it2r %erua+a' iliha' uta%a aa GERD! i%a'a aa3ila

+eluha' tia+ %e%3ai+ 3arulah ila+ua+' e'2s+2i( Pe%e3eria' 23at +u%ur aa asie' i'i

i%a+su+a' u'tu %e'.a-a h/-ie'e %ulut u'tu %e'9e-ah i':e+si /a'- le3ih 3erat ter.ai(

Pasie' .u-a i3eri+a' e'.elasa' u'tu+ %e'-atur 2la %a+a' a-ar tia+ ter.ai :ari'-itis

+r2'is e'-a' e+saser3asi a+ut /a'- 3erula'-( Pr2-'2sis aa asie' i'i aalah 3ai+!

 3iasa'/a e'-a' 23at asie' suah %erasa+a' +eluha''/a %e'-hila'-! a+a' tetai asie'

harus teta %e'.a-a 2la %a+a''/a a-ar tia+ %u'9ul la-i -e.ala /a'- serua(

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