Matenda a celeacac angakhale ochititsa mantha: mwakutanthauzira, amatanthawuza chithandizo choyenera cha matenda a celiac - zakudya zopanda thanzi - zalephera kugwira ntchito, ndipo tsopano mukufuna kupeza njira zina.
Uthenga wabwino, komabe, ndikuti choliac chotsutsa ndi chosowa kwambiri. Nthaŵi zambiri, vuto lanu silikutsutsa matenda a leliac - mmalo mwake, kuchuluka kwa zakudya zamagudeni m'thupi lanu kapena matenda ena amachititsa kuti mukhale ndi zizindikiro.
Komabe, ngati dokotala atulutsa zifukwa zina ndipo potsirizira pake amapezeka ndi matenda ochotsera matendawa, muyenera kudziwa kuti madokotala amatha kupambana bwino maulendo ambiri; chithandizo chidzadalira mtundu wina wamakono amene mukukumana nawo, komanso zina mwa mbiri yanu ya mankhwala ndi chikhalidwe.
Mtundu Wotsutsa Matenda Odwala Matendawa Amadziwitsa Njira Zochizira, Zochita
Pali mitundu iwiri ya matenda a celeacac: Opanga I ndi mtundu wachiwiri. Mukapezeka, dokotala wanu adzakuuzani mtundu umene muli nawo. Kawirikawiri, Mtundu Woyamba ndi wofala komanso wochiritsidwa mosavuta, koma kafukufuku wam'mbuyo wapereka zotsatira zowonjezereka zothandizira mtundu wachiwiri.
Pansi pazifukwa zambiri, mutha kuchiritsidwa ku matenda opatsirana amtundu wa coliac pa malo akuluakulu omwe muli ndi zochitika zowonongeka ndi kuyang'anira matendawa; chifukwa chosokoneza celiac ndi chosowa kwambiri, ambiri a gastroenterologists sanasamalire milandu.
Kuchiza Kungayambe ndi Thandizo Labwino
Matenda otsekemera oterewa angayambitse kulemera kwakukulu ndi kusowa kwa zakudya m'thupi , ngakhale mutakhala kudya zakudya zopanda thanzi zowonjezera. Ndicho chifukwa kuwonongeka kwa m'matumbo anu aang'ono, otchedwa villous atrophy , sanachiritse - ngakhale mukudya bwino.
Kotero dokotala wanu angayambe kulandira chithandizo mwa kuunika thupi lanu la mavitamini, mchere, ndi zina zowonjezera, ndikupatsanso chithandizo chothandizira kuti musinthe matenda anu osowa zakudya. Kwa odwala makumi asanu ndi limodzi (60%), thandizo la zakudyali limaphatikizapo zomwe zimatchedwa Total Parenteral Nutrition, yomwe imakhala ndi njira yothetsera zakudya m'thupi, kupyolera m'matumbo anu.
Dokotala wanu angayesenso kuyesa zomwe zimatchedwa zovuta zenizeni zakudya - zakudya zamadzimadzi zomwe zimapereka zakudya mu fomu ya hypo-allergenic yomwe yathyoledwa kumalo awo oyamba a amino acid. Phunziro limodzi laling'ono linapeza kuti odwala asanu ndi atatu (8) omwe ali ndi matenda a mtundu wa I I amatsitsimutsa m'mimba mwawo. asanu ndi mmodzi mwa iwo adakumananso ndi kusintha kwa zizindikiro zawo.
M'maganizo angapo okhudza matenda a mtundu wa I, chithandizo cha zakudya komanso zakudya zopanda thanzi zowonjezereka zingakhale zonse zomwe mukufunikira kuyamba kuyamba kuchiritsa. Koma anthu ambiri amalandira mankhwala osokoneza bongo.
Mankhwala Osokoneza Bongo kwa Mtundu Woyamba Ndikuphatikizapo Steroids
Pakalipano, mankhwala osokoneza bongo a matenda opatsiranawa amachititsa kuti chitetezo chanu chiteteze chitetezo chanu kuti chiteteze matumbo anu kuchitapo kanthu.
(Kumbukirani kuti si gluteni yokha yomwe imayambitsa matumbo m'mimba mwachangu - ndi momwe chitetezo chanu cha mthupi chimakhudzidwira ndi gluten. Mu matenda osokoneza bongo a chitetezo, chitetezo chanu cha mthupi chikupitirizabe kugunda matumbo anu, ngakhale kuti mulibe gluten mu zakudya zanu.)
Mu mitundu yonse ya mtundu Woyamba I ndi Mtundu Wachiwiri wa mankhwala ochotsera mankhwalawa, njira yoyamba mankhwala osokoneza bongo ndi mawonekedwe a mankhwala a steroid otchedwa glucocorticoids. Glucocorticoids amagwiritsidwa ntchito nthawi zambiri pochiza matenda ena omwe amachititsa kuti munthu azidwala matenda a nyamakazi komanso matenda opweteka.
Mankhwala ena omwe angagwiritsidwe ntchito pa mankhwalawa ndi azathioprine, omwe amagwiranso ntchito poletsa chitetezo cha mthupi lanu.
Anthu omwe ali ndi nyamakazi yambiri yamtunduwu komanso omwe amakhala ndi mankhwala otchedwa azathioprine.
Kafukufuku amasonyeza kuti anthu ambiri omwe ali ndi mtundu wa mtundu Woyamba wodwala matendawa amatha kukhululukidwa -, mwa kuyankhula kwina, awone zizindikiro zawo zithetsa ndipo matumbo awo ayamba kuchiritsa - pogwiritsira ntchito steroids, mwinamwake kuphatikiza ndi azathioprine.
Mtundu Wachiwiri Wosakaniza Matenda Omwe Amakhala Ovuta Kwambiri Kuchitira
Odwala omwe ali ndi kachilombo kawiri kawiri kawiri kawiri amawona mpumulo ku zizindikiro zawo za mankhwalawa, koma mwatsoka, matumbo awo amatha kuchepetsa, ndipo sawoneka kuti amawateteza ku mtundu wakupha wa anthu omwe si a Hodgkin Lymphoma yomwe ili ndi matenda a celiac .
Mayesero ena a chipatala ayesa mankhwala omwe amatchedwa Cladribine - mankhwala amphamvu omwe amagwiritsa ntchito mankhwala a khansa ya m'magazi - mu odwala a mtundu wa II omwe amatsutsa. Mlandu wina, womwe unachitikira ku Netherlands, unapeza kuti Cladribine inaletsa matendawa kuti athetsere odwala 18 pa 32. Koma ngakhale kuti mankhwalawa amachititsa odwala ena kukhala okhululukidwa, pali mantha ena kuti sangalepheretse kugonana kwa-T-cell lymphoma (EATL): yosawerengeka, yoopsa ya mtundu wa lymphoma. EATL imayambitsa matenda a mtundu wachiwiri mosiyana.
Ngakhale zili choncho, madokotala ena ayamba kugwiritsa ntchito Cladribine ngati njira yoyamba yothandizira matenda a mtundu wa mtundu wachiwiri wa matendawa, ndipo amapeza kuti amatha kuika odwala theka la odwalawo ndi mankhwala. Pa mulandu womwewo, odwala omwe ali ndi mtundu wachiwiri wazaka zisanu adakhalapo kwa zaka zisanu ndi zisanu ndi zitatu, poyerekeza ndi 22 peresenti mwa iwo omwe sanaone zotsatira zabwino ndi chithandizo. Chofunika koposa, sizinkawoneka kuti akuwonjezeka ku ma lymphoma. Komabe, zotsatira za mankhwalawa sizinayambe zowerengedwa.
Pomalizira, kwa omwe ali ndi mtundu wachiwiri wotsutsa matendawa omwe amalephera kulabadira mankhwala ena onse, kuphatikizapo Cladribine, malo osachepera amodzi - omwewo omwe adafalitsa zotsatira zoyesedwa za Cladribine - adayesa kuyendetsa maselo otchedwa autologous stem, Maselo amachokera ku fupa lanu, amakula mu labata ndikubwereranso m'mbuyo mwa mankhwalawa. Imeneyi ndi njira yowopsa ndi mavuto ambiri, kuphatikizapo imfa.
Mu mayesero amodzi omwe amachititsa matenda a mtundu wa II omwe amagwidwa ndi matendawa komanso mavitamini otchedwa autologous stem cell transplant, zizindikiro za odwala khumi ndi zisanu ndi ziŵiri (13) mwa khumi ndi zisanu ndi zitatu (13) zimakhala bwino kwambiri m'kati mwa chaka. Munthu mmodzi anamwalira chifukwa chokhazikitsa njirayo, ndipo awiri mwa atatu aliwonse adakali ndi moyo zaka zinayi pambuyo pake. Wodwala wina adayamba EATL.
Chithandizo Chake Chokhalitsa Chokhazikika Pitirizani Pitirizani Kutalika Kwambiri
Pofuna kupewa kuchepa kwa matenda osokoneza bongo, muyenera kutenga steroid kosatha. Koma kugwiritsidwa ntchito kwa nthawi yaitali kwa steroid kumayambitsa zoopsa zake (kuphatikizapo shuga wamagazi, kupopetsa mafupa ndi chiopsezo chachikulu cha matenda). Kuwonjezera apo, kugwiritsa ntchito mankhwala otchedwa steroids kwa nthawi yaitali kumawonjezera chiopsezo chanu cha lymphoma - ndipo ndithudi, odwala okhaokha omwe ali ndi kachilomboka amakhala kale kwambiri kuposa chiopsezo cha khansa iyi.
Akatswiri ofufuza akufufuza njira zina zothandizira mankhwala osokoneza bongo chifukwa cha matendawa, kuphatikizapo mankhwala omwe amatchedwa mesalazine, mankhwala odana ndi kutupa omwe akugwiritsidwa ntchito pochiza matenda opatsirana omwe ayesedwa odwala a mtundu wa I. Kafukufuku wochuluka pa mtundu wosawoneka wa matenda a celiac adzatulutsidwa posachedwa.
Pakadali pano, mosasamala kanthu za chithandizo cham'tsogolo chomwe chikulangizidwa kwa inu, muyenera kuyandikana kwambiri ndi dokotala wanu ndikuyang'anitsitsa zizindikiro zilizonse (monga kuwonjezereka kwa kulemera kwa thupi ndi kutsegula m'mimba) kuti matenda anu osakanikirana akuchoka ku chikhululuko.
Zotsatira:
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Malamut G. et al. Matenda osakanikirana otchedwa Celiac disease. Mapatala a Endoscopy Clinic a North America. 2012 Oct; 22 (4): 759-72. do: 10.1016 / j.giec.2012.07.007. Epub 2012 Aug 24.
Mauriño E. et al. Azathioprine mumakono opangira: zotsatira za phunziro lofunira, lotsegula. American Journal of Gastroenterology. 2002 Oct; 97 (10): 2595-602.
Mooney PD et al. Kuchepetsa kuperewera kwa matenda a celiac: chithandizo chothandizira kufufuza ndi chithandizo cha matenda osachiritsika omwe amatsutsa. Journal za M'mimba ndi Matenda a Chiwindi. 2012 Jun; 21 (2): 197-203.
Roshan B. et al. Zomwe zimachitika ndi matenda enaake omwe amachititsa kuti matendawa asapitirire. American Journal of Gastroenterology. 2011 May; 106 (5): 923-8. do: 10.1038 / ajg.2011.104. Epub 2011 Apr 5.
GJ et al. Kufufuza kwa chithandizo cha Cladribine mu kukana matenda a mtundu wa IIli. World Journal of Gastroenterology. 2011 Jan 28; 17 (4): 506-13. do: 10.3748 / wjg.v17.i4.506.
GJ et al. SCT-Auto m'thupi lachilendo lachilendo lachiwiri lachilendo sagwirizana ndi mankhwala. Matenda a Marrow Opaleshoni. 2011 Jun; 46 (6): 840-6. lembani: 10.1038 / bmt.2010.199. Epub 2010 Sep 6.