IBS-D ikhoza kubweretsedwa ndi vuto ndi acids zamatsenga
Madzi otsekula m'mimba (BAD) ndi mkhalidwe umene muli acid acids sungakonzedwe bwino mkati mwa dongosolo la kudya , zomwe zimayambitsa matenda otsekula m'mimba. Matendawa angathenso kutchedwa bile acid malabsorption (BAM). Komabe, kafukufuku akusonyeza kuti matendawa sangakhale nthawi zonse chifukwa cha malabsorption.
Ofufuza m'dera lino amakhulupirira kuti BAD sizowoneka ngati zovuta monga momwe kale zinaganizidwira.
Iwo amakhulupirira kuti BAD ndi matenda osadziwika-omwe ayenera kuganiziridwa kwa aliyense amene ali ndi matenda otsekula m'mimba osadziwika-makamaka, anthu omwe ali ndi zizindikiro za kutsekula m'mimba-matenda aakulu omwe amachititsa kuti thupi likhale lopweteka kwambiri (IBS-D) kapena likugwira ntchito kutsekula m'mimba . Vuto lomwe liri ndi matendawa ndiloti lingalepheretse anthu kupeza chithandizo chabwino.
Mwachidule
Kuti mumvetse bwino BAM, zimathandiza kudziwa momwe chimbudzi chikuyenera kugwira ntchito. Mafuta acidi amapangidwa ndi chiwindi ndi kusungidwa mu ndulu. Mukamadya zakudya zokhudzana ndi mafuta, zidulozi zimatulutsidwa m'matumbo aang'ono kotero kuti mafuta akhoza kuphwanyidwa ndi kulowa m'thupi lanu.
Mitengo ya mitsempha imatha kubwezeretsedwa pamtunda wa m'mimba mwachinyama kubwerera m'chiwindi kuti ikamasulidwe ngati pakufunika. Kawirikawiri pang'ono chabe za zidulozi zimalowa mumatumbo akuluakulu.
Komabe, pamene BAD alipo, kuchuluka kwa mankhwala a bile acid kumathamangira m'matumbo akulu .
Zimenezi zimapangitsa kuti madzi azikhala osakanikirana, zomwe zimachititsa kuti madzi aziwongolera komanso kuthamanga kwa m'mimba mofulumira ndi matenda a kutsekula m'mimba.
Ngakhale kuti ankaganiza kuti vutoli silikuphatikizapo malabsorption, kafukufuku waposachedwapa amasonyeza kuti vutoli lingakhale lopanda mphamvu kwambiri ya bile acid.
Izi zikhoza kukhala chifukwa cholephera kugwira ntchito muzitsulo zomwe ziyenera kulepheretsa kupanga mankhwala a bile.
Zimayambitsa
Matendawa akutsatirako angapangitse chitukuko cha BAD:
- Ileal (matenda aang'ono m'mimba)
- Opaleshoni ya Ileal (nthawi zambiri monga chithandizo cha matenda a Crohns)
- Gallbladder kuchotsedwa (cholecystectomy)
- Mimba yaing'ono ya m'mimba (SIBO)
- Kusakwanira kwapancretic
- Mafunde a khansa
- Microscopic colitis
- Matenda afupipafupi
Zizindikiro
BAD imawonetsa makamaka ngati chithandizo cha matenda otsekula m'mimba. Zina kapena zizindikiro zotsatirazi zingakhalepo:
- Kutsegula m'madzi
- Kutsekula m'mimba mofulumira
- Kutsekula m'mimba pakati pa usiku
- Ngozi zowonongeka
- Kutseka
Kudziwa
Madokotala amasonyeza bile acid malasorption mwa mtundu, malinga ndi chifukwa chake:
- Mtundu 1: Mphindi kwa matenda a leal kapena resection
- Mtundu Wachiwiri: Idiopathic kapena primary (chifukwa sichidziwika)
- Mtundu 3: Mphindi kwa mitundu ina yonse ya mimba
Chifukwa cha kuyang'ana kwatsopano pa udindo wa kulepheretsa kuyankha kwa ndondomeko ya kaphatikizidwe ka kaphatikizidwe ka mankhwala a bile, mawu akuti idiopathic bile acid malabsorption (I-BAM) sangakhale ovomerezeka.
Kuyesedwa
Kuyezetsa kwabwino kwa kukhalapo kwa BAD kumatchedwa 75Se-homocholic acid taurine (75SeHCAT). Iyi ndiyo mankhwala a nyukiliya omwe wodwala amapatsidwa capsule kuti amame pamlomo ndiyeno akuyesa kujambula thupi lonse.
Kuwongolera mobwerezabwereza kukonzedwa masiku asanu ndi awiri kenako.
Kapsule ili ndi SeHCAT, yomwe imagwiritsidwa ntchito kuwonetsa kuti matumbo aang'ono amatha kusungira mavitamini a bile. Chiŵerengero chosungira zosakwana 15 peresenti chimawonedwa kukhala chizindikiro cha kukhalapo kwa BAM.
Mwamwayi, mayeserowa sapezeka ku United States. Amakhulupirira kuti kusowa mwayi kwa mayeso a 75SeHCAT kumapangitsa kuti anthu asadziŵe bwino za BAD.
Madokotala ena amapita ku mayesero a mankhwala kwa BAD monga njira ina yoyezetsa 75SeHCAT. Ngati mankhwalawa amachititsa kuti zizindikiro zikhale bwino, BAD (kapena BAM) imapezeka kuti imapezeka.
Imodzi mwazimenezi ndikuti imodzi mwa mankhwala oyambirira ogwiritsidwa ntchito kwa BAD saloledwa. Kawirikawiri imatha nthawi zambiri pamene anthu sanalandire chithandizo chodziwika bwino chomwe chingathandize mankhwala kutsatira.
Palinso njira yachitatu, yovomerezeka, yomwe siigwiritsidwa ntchito mobwerezabwereza ndipo imafunika maola 24 ogwiritsira ntchito masitepe komanso kupezeka kwa kagulu kakang'ono ka ma laboratori oyenera.
IBS-D kapena Ntchito yotsekula m'mimba
Ofufuza a BAD amakhulupirira kuti anthu ambiri omwe ali ndi IBS-D kapena otsekula m'mimba alidi ndi BAD. Kafukufuku akuwonetsa kuti BAD ikhoza kukhala kumbuyo kwa gawo limodzi mwa magawo atatu a IBS-D ndi 40 mpaka 50 peresenti ya matenda otsegula m'mimba.
Chithandizo
Nthawi zina matendawa amapezeka chifukwa cha matenda ozindikiritsa, chithandizochi chidzayang'ana kuthetsa matendawa. Ngati palibe chifukwa chodziwikiratu, BAD idzachitidwa ndi gulu la mankhwala omwe amatchedwa bile acid sequestrants kapena omanga.
Mankhwalawa amawoneka kuti amagwira ntchito pa zizindikiro za BAD mwa kumangirira mankhwalawa ndipo potero amachepetsa zotsatira zake pamatumbo akuluakulu. Awa ndiwo mamembala omwe alipo m'kalasiyi, zomwe adziwerengera kuti BAD zidzatengedwa ngati chizindikiro:
- Colestyramine (Questran)
- Colesevelam (WelChol)
- Colestipol (Oyang'anira Colestid)
Mankhwalawa amakhala othandiza kuthetsa zizindikiro za BAD. Komabe, mankhwalawa atayikidwa pa mlingo wa chikhalidwe chomwe ali nacho FDA chovomerezeka, mwachitsanzo, mkulu wa cholesterol, kudzimbidwa ndi zizindikiro zina za kugaya zingakhalepo. Ngati mwalangizidwa chimodzi mwa mankhwalawa, nkofunika kuti mugwire ntchito ndi dokotala kuti mupeze mlingo woyenera.
Ndikofunika kudziwa kuti mankhwalawa angakhudze kumwa mankhwala ena omwe mungakhale nawo. Choncho, ayenela kutengedwa maola anayi kapena asanu asanayambe kapena pambuyo pa mankhwala ena onse.
Mawu Ochokera
Ngakhale kuti pakupitiriza kufufuza kumafunika, tsopano ziwoneke kuti BAD ndi yowonjezereka kuposa momwe ankaganizira kale. Ngati mwapezeka kuti muli ndi IBS-D kapena mumakhala ndi zizindikiro za matenda otsekula m'mimba-ndipo dokotala wanu sanatulukepo BAD-mungathe kukambirana nawo nkhaniyi kuti muwone ngati chithandizochi chisanafike za zizindikiro zanu.
> Zotsatira:
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> Pattni S, Walters J. Zomwe Zachitika Posachedwa Kumvetsetsa kwa M'thupi la Maladorption. British Medical Bulletin. 2009 92: 79-93.
> Walter JRF, Pattni SS. Kusamalira Mafuta Akumbudzi. Kupititsa patsogolo kwachipatala mu Gastroenterology. 2010; 3 (6): 349-357.
> Wedlake L, et.al. Kukonzekera Mwatsatanetsatane: Kufala kwa Idiopathic Bile Acid Malabsorption monga Kuzindikiritsidwa ndi SeHCAT Kusintha kwa Odwala Amene Ali ndi Matenda a Kutsekula m'mimba-Amadzimadzi Oopsya Amadzimadzi. Pharmacology and Medical Therapeutics. 2009. 30: 707-717.