Kuchiza kwa Matenda Opatsirana Opatsirana

Matenda Opatsirana Opatsirana (IBD)

Matenda opweteka a m'magazi (IBD) , monga Crohn's disease, ulcerative colitis, ndi indeterminate colitis, ndi matenda aakulu a dongosolo lakumagazi. Panopa palibe mankhwala a mtundu uliwonse wa IBD, koma pali njira zothandizira mankhwala. Pano tikukambirana za mankhwala ovomerezeka pa mitundu iwiri ya IBD: Matenda a Crohn ndi ulcerative colitis. Odwala omwe ali ndi indeterminate colitis (omwe amawerengedwa pafupifupi 10 peresenti ya odwala omwe ali ndi IBD) amapatsidwa mankhwala omwe amavomerezedwa kuti azidwala matenda a ulcerative.

> Yang'anirani momwe ulcerative utitiri umakhudzira colon.

Pali mankhwala ambiri omwe amavomerezedwa kuti agwiritsidwe ntchito kwa anthu omwe ali ndi matenda a Crohn ndi matenda a zilonda zam'mimba. Ena, komabe, amavomerezedwa kwa wina kapena mzake. Mankhwalawa ali ndi njira zosiyana zogwirira ntchito ndi kupatsidwa, kotero odwala ndi gastroenterologists angagwirane ntchito kuti apeze njira yomwe silingathe bwino zizindikiro zawo, koma zimalowa m'moyo wa wodwala.

• Kukhala Wodzitetezera pa Zilonda N'kofunika kwa Anthu Omwe Ali ndi IBD

• Kodi Kusiyanasiyana Kwapakati pa Zamoyo 6 za IBD?

Nkhani yabwino ndi yakuti ngati mankhwala amodzi kapena mtundu umodzi wa mankhwala sakugwira ntchito, pali mankhwala ena m'kalasi lomwelo, kapena m'kalasi ina, yomwe ingayesedwe yotsatira. Ngakhale nkhani yabwino kwambiri ndi yakuti pali mankhwala ambiri omwe amapangidwa kuti athetse matenda a IBD, ndipo pali chiyembekezo chachikulu kuposa kale lonse kuti apeze chithandizo chomwe chimagwira ntchito bwino poyang'anira zizindikiro za IBD ndi kutupa kwa IBD.

Kuchita opaleshoni ndi njira yothandizira IBD, komanso matenda a Crohn ndi matenda a zilonda zam'mimba, opaleshoni zosiyanasiyana amagwiritsidwa ntchito monga chithandizo. Komabe, mtundu wa opaleshoni yogwiritsidwa ntchito udzakhala wosiyana malinga ndi kuti watha kuchiza matenda a Crohn kapena ulcerative colitis.

Ichi ndi chifukwa cha njira zosiyanasiyana zomwe matendawa amakhudzira dongosolo lakumagwiridwe ndi momwe opaleshoni imathandizira zizindikiro komanso umoyo wa odwala. Pamene lingaliro la opaleshoni likuwopsya, limagwiritsidwa ntchito pokhapokha ngati mankhwala ena ayesedwa ndipo sakugwiranso ntchito.

Zolinga za mankhwala a IBD

Pali mankhwala osiyanasiyana omwe amagwiritsidwa ntchito popanga IBD. Mankhwalawa amatchulidwa kawirikawiri, ndipo amaphatikizapo maantibayotiki, biologics, corticosteroids, ndi ma immunomodulator. Chithandizo ndi mankhwala chili ndi cholinga chokwanira: kuti awonongeke ndi kukhululukidwa, ndiyeno kusunga chikhululukiro ndikupita ndi kupewa zowonjezereka. Mankhwala ena amagwiritsidwa ntchito pa imodzi mwa zolingazo kapena zina, ndipo zina zimagwiritsidwa ntchito zonse.

Palibe mlingo umodzi wa mankhwala omwe amagwiritsidwa ntchito kwa munthu aliyense ndi IBD. Pali malangizo omwe amaperekedwa ndi mabungwe azachipatala, koma chithandizo sichinali chofanana. Chithandizo chamankhwala chiyenera kukhala chosinthidwa kuti chigwirizane ndi zosowa za wodwala aliyense.

Izi zikunenedwa, komabe zisankho zokhudzana ndi chithandizo zimachokera pa umboni wofukufuku.

Matenda a Crohn's Disease

Mankhwala a Matenda a Crohn

Mankhwala omwe amagwiritsidwa ntchito pochiza matenda a Crohn ndi awa:

Maantibayotiki

• Cipro (ciprofloxacin)
• Flagyl (metronidazole)

Odzidzidzimadzi

• 6-mercaptopurine (Purinethol, 6-MP)
• Azathioprine (Imuran ndi Azasani)
• Folex, Rheumatrex (methotrexate)
• Prograf (Tacrolimus)
• Mchenga, Neoral (cyclosporine A)

Corticosteroids

• Cortenema (hydrocortisone)
• Deltasone ( prednisone )
• Entocort (budesonide)
• Medrol (methylprednisolone)
• Proctofoam-HC (hydrocortisone acetate, thovu lamadzimadzi)

Zochiritsira Zamoyo

• Cimzia (certolizumab pegol)
• Entyvio (vedolizumab)
• Humira (adalimumab)
• Inflectra (infliximab-dyyb)
• Remicade (infliximab)
• Stelara (ustekinumab)
• Tysabri (natalizumab)

Opaleshoni ya Matenda a Crohn

Kuchita opaleshoni kawirikawiri kumachitika pambuyo pa mankhwala osathandiza ndi kutupa kapena pali mavuto. Mtundu wa opaleshoni wapangidwa udzakhazikitsidwa pa malo omwe kutupa kwa Crohn's disease kukuyambitsa komanso kutalika kwake.

Kuchita opaleshoni sikungakhale mankhwala a Crohn's disease ndipo, mwa anthu ena, kutupa kwa Crohn kukhoza kubwerera kwinakwake.

Kuchita opaleshoni ya matenda a Crohn nthawi zonse kumawongolera, ndipo nthawi zina zimatha kuchitidwa ndi njira zochepa zomwe zimawonongeka (monga opaleshoni ya laparoscopic ) yomwe imadula nthawi nthawi kuchipatala komanso nthawi yobwezeretsa. Nazi zochepa mwa mitundu yowonjezereka ya opaleshoni yomwe yachitidwa pofuna kuchiza matenda a Crohn:

• Kuyanjanitsa : Njira yowonjezereka ya opaleshoni yochitidwa pofuna kuchiza matenda a Crohn ndi resection. A resection ndi pamene gawo la chifuwa chowopsa kapena matenda amachotsedwa, ndipo malekezero awiri a minofu yathanzi amatsindikizidwanso pamodzi (wotchedwanso anastomosis). Izi zikhoza kuchitika m'matumbo aang'ono kapena matumbo akuluakulu .
• Strictureplasty : Matenda a Crohn angayambitse minofu yomwe imamanga ndipo ingayambitse kupweteka m'mimba. Pamene gawo la m'matumbo limakhala lochepa kwambiri, likhoza kutsegulidwa kachiwiri pa opaleshoni ya strictureplasty.
• Proctocolectomy : Kwa anthu ena omwe ali ndi matenda a Crohn komwe kulibe matenda mumtengowo, proctocolectomy amatha kubwezeretsa. Matumbo akuluakulu amachotsedwa ndipo mapeto a intestine amatha kulumikizana ndi anus. Izi zikutanthauza kuti stoma sichifunika ndipo chitsime chikhoza kuperekedwa pansi. Kuchita opaleshoni imeneyi kumachitika kokha mwa gulu linalake la odwala. Kuchita opaleshoniyi kumatchedwanso leoanal anastomosis (kuwongolera molunjika).

• Chotsogolera Chanu Chotsatira Njira ya Prednisone

• Zimene Anthu Omwe Amakhala ndi IBD Ayenera Kudziwa Zokhudza Cipro

• Kuchita opaleshoni ya abambo : Anthu ena omwe ali ndi matenda a Crohn omwe amakhudza chithokomiro adzachita opaleshoni kuti apange leostomy. Apa ndi pamene coloni imachotsedwa ndipo stoma imapangidwa pamimba. Chotupa chimachoka kunja kwa thupi kupyola pansi, ndipo chovala cha ostomy chimavala pamimba kuti chigwire. Anthu ambiri omwe ali ndi matenda a Crohn sadzasowa opaleshoni ya ostomy.

Kuchiza kwa ulitisative Colitis

Mankhwala a Ulcerative Colitis

Mankhwala omwe amagwiritsidwa ntchito pochizira zilonda zam'mimba ndi awa:

Aminosalicylates (5-ASA)

• Azulfidine (sulfasalazine)
• Asacol , Pentasa, Lialda, Apriso , Delzicol (mesalamine)
• Mankhwala a Canasa (mesamine suppositories)
• Colazal (balsalazide)
• Dipentum (olsazine)
• Rowasa (mesamine enemas)

Odzidzidzimadzi

• 6-mercaptopurine (Purinethol, 6-MP)
• Azathioprine (Imuran ndi Azasani)
• Mchenga, Neoral (cyclosporine A)
• Tacrolimus (Prograf)

Corticosteroids

• Cortenema (hydrocortisone enema)
• Deltasone ( prednisone )
• Entocort (budesonide)
• Medrol (methylprednisolone)
• Proctofoam-HC (hydrocortisone acetate, thovu lamadzimadzi)
• Uceris (budesonide)

Zochiritsira Zamoyo

• Entyvio (vedolizumab)
• Humira (adalimumab)
• Inflectra (infliximab-dyyb)
• Remicade (infliximab)
• Simponi (golimumab)

Opaleshoni ya Ulcerative Colitis

Crohn's ndi Colitis Foundation ya America amaganiza kuti paliponse pakati pa 23 peresenti ndi 45 peresenti ya odwala ulcerative colitis ochita opaleshoni. Zochita za opaleshoni ya ulcerative colitis nthawi zonse zimachotsa kuchotsa matumbo akuluakulu (colectomy), pogwiritsa ntchito stoma kapena mkati mwa thumba kuti asonkhanitse chopondapo. Kuchita opaleshoni ya ulcerative colitis kumaphatikizapo:

• Protocolectomy pogwiritsa ntchito thumba lachitsulo : Pambuyo pa chidebecho chitachotsedwa kuti chiteteze zilonda zam'mimba, mkati mwake mumatumba amapangidwa kuchokera ku gawo lotsiriza la matumbo aang'ono (the ileum). Ndi thumba ili, palibe thumba lakunja la ostomy kapena stoma chifukwa thumba limakhala ngati rectum. Mabokosi opanga mavitamini angapangidwe mu mawonekedwe osiyana, koma omwe amagwiritsidwa ntchito nthawi zambiri ndi j-poch. Kuchita opaleshoniyi kumatchedwanso koal-pouch anastomosis, kapena IPAA.
• Protocolectomy ndi kulengedwa kwa ileostomy : Pambuyo pa colectomy, odwala ena omwe ali ndi zilonda zam'mimba amakhala ndi leostomy yomaliza. A stoma imapangidwa pamimba pa gawo la chitseko ndi chovala cha ostomy chavala pa stoma. Malingaliro akuti kukhala ndi stoma amawopsyeza, koma odwala ambiri omwe ali ndi zilonda zam'mimba amakhala ndi moyo wapamwamba atatha opaleshoni ya leostomy ndipo amachita bwino ndi stoma yawo.

Mawu Ochokera

Pali njira zambiri zamankhwala ndi zopaleshoni zomwe zilipo lero kuti zithetse matenda a Crohn ndi matenda a zilonda zam'mimba kuposa kale lonse. Mankhwala omwe asandukapo m'zaka zaposachedwa ndi othandiza, ndipo pali zambiri zomwe zikuphunziridwa.

Mbali yofunika kwambiri yothandizira IBD bwino ndi kuigwiritsa ntchito kukhululukidwa ndikuwona gastroenterologist nthawi zonse ndi kumwa mankhwala nthawi. Ndi mankhwala osiyanasiyana omwe alipo, odwala ambiri akhoza kuchepetsa kutupa, kuteteza mavuto, komanso kusintha moyo wawo.

> Zotsatira:

> Bhandari BM, Kroser JA. "Matenda Opatsirana Opunduka." American College of Gastroenterology. March 2010, March 2011. Cleveland Clinic Foundation. 26 Sep 2013.

> Braegger CP, Nicholls S, Murch SH, Stephens S, MacDonald TT. "Tumorous necrosis factor alpha mu chopondera ngati chizindikiro cha kutupa kwa m'mimba." Lancet. 1992; 339: 89.

> Crohns & Colitis Foundation ya America. "Opaleshoni ya Matenda a Crohn & Ulcerative Colitis." CCFA.org. 31 Aug 2010.

> Terdiman JP, Gruss CB, Heidelbaugh JJ, Sultan S, Falck Ytter YT, Komiti ya AGA Institute Clinical Practice ndi Quality Management Committee. "American Gastroenterological Association Institute Guideline pa Kugwiritsa Ntchito Thiopurines, Methotrexate, ndi Anti-TNF-Biologic Mankhwala Osokoneza Bongo ndi Kukonzekera Kwa Kukhululukidwa kwa Matenda a Crohn's Inflammatory." Gastro. 2013; 145: 1459-1463.