Yafunu a ɛyɛ yaw? Wontumi nwe aduan? Bra, momma yɛnka (Prokinetic Agents) ho asɛm!

Ɛtɔ mmere bi a, wote nka sɛ aduan ayɛ wo ma anaasɛ wunnyam aduan yiye bere a woadi awie no? Anaasɛ wowɔ ɔhaw ahorow te sɛ komayare anaa aduan a wonnya nni? Ɛtɔ da bi a, yɛn dwensɔtwaa a ɛnyɛ adwuma yiye no betumi de ɔhaw ahorow yi aba. Ɛnnɛ yɛrebɛka aduru soronko bi a ɛboa wɔ mmere a ɛtete saa mu ho asɛm. Wɔfrɛ eyinom `(Prokinetic Agents)`.

Dɛn ne saa `(Prokinetic Agents)` yi? Sɛ yɛbɛka no tiawa a...

Sɛ yɛbɛka no tiawa a, `(Prokinetic Agents)` yɛ aduru bi a ɛma ahoɔhare a aduan fa wo aduan mu, kyerɛ sɛ, dwensɔtwaa mu no yɛ kɛse. Sɛ yɛmene aduan a, yɛn aduan mu ntini no fi ase twetwe fi soro kɔ fam te sɛ asorɔkye a ɛtoatoa so. Wɔfrɛ eyi `(Peristalsis)`. Ɛte sɛ nea wɔrepia aduan akɔ fam. Eyi ne ɔkwan a aduan fa so fi menewa mu, sian kɔ aduan mu, kɔ yafunu mu, na afei ɛkɔ dwensɔtwaa mu. Ɛyɛ akwantu yi mu na yɛn nipadua no twetwe aduannuru a ehia no.

Nanso, esiane nyarewa bi anaa nneɛma afoforo nti, ebia saa adeyɛ a wɔfrɛ no ``Peristalsis'' yi rennyɛ adwuma yiye. Eyi ne bere a sɛnkyerɛnne ahorow te sɛ akisikuru, komayare, ne te a ɔte nka sɛ obi ayɛ ma a wanyam aduan ba. Ebia aduan bɛtra yafunu no mu akyɛ, na afei nipadua no nnya aduannuru a ɛho hia.

Ɛno na saa nnuru a wɔfrɛ no `(Prokinetic Agents)` yi ba bɛboa. Eyinom ma dwensɔtwaa no kɔ baabiara na ɛboa ma aduan fa aduan mu ntɛmntɛm. Nanso ade a ɛho hia sen biara a ɛsɛ sɛ yɛkae ne sɛ nsunsuanso bɔne atitiriw bi wɔ hɔ a ebetumi de nnuru yi aba. Enti, mpɛn pii no nnuruyɛfo nkyerɛw nnuru yi ntɛm ara. Mpɛn pii no, wɔma `(Proton Pump Inhibitors - PPIs)` anaa `(H2 Blockers)` nnuru afoforo na afei wosusuw `(Prokinetic Agents)` ho sɛ ɛmma ahotɔ nkutoo a. Nanso, egyina w’ayaresa tebea so no, wo duruyɛfo nso betumi akyerɛw saa aduru yi ama wo.

Ɔkwan bɛn so na saa `(Prokinetic Agents)` yi yɛ adwuma?

Ɔkwan a nnuru yi fa so yɛ adwuma no yɛ nea ɛyɛ den kakra, nanso mɛma ayɛ mmerɛw. Ne titiriw no, ɛkanyan ntini a ɛwɔ wo aduan mu no na ɛboa ma ntini no twetwe.

Ɛno kyerɛ sɛ:

• Ɛma wo esophagus (aduan paipu) mu ntini a ɛtwetwe no yɛ kɛse, na ɛboa ma aduan kɔ yafunu no mu ntɛmntɛm.
• Hyɛ Lower Esophageal Sphincter (LES) a ɛwɔ wo esophagus ase no den. LES no te sɛ valve. Ɛyɛ wo menewa no fã a ɛka wo yafunu ne wo menewam no bom. Sɛ ɛntoto yiye na ɛyɛ mmerɛw a, yafunu mu acid betumi asan aba wo menewam ne wo menewam. Ɛno na wunya saa komayare, komayare, ne koko mu yaw no. Wɔsan frɛ eyi sɛ Acid Reflux anaa GERD.
• Ɛma yafunu mu twetwe yɛ kɛse na ɛboa ma aduan kɔ dwensɔtwaa ketewa no mu ntɛmntɛm.
• Ɛtew bere a egye ansa na yafunu no ada mpan no so. Eyi ma hokwan a ɛwɔ hɔ sɛ yafunu no mu nneɛma bɛsan aba soro no so tew, te sɛ nea ɛte wɔ `(Acid Reflux)` ho no.

Fa no sɛ, saa aduru yi yɛ adwuma te sɛ kar akwanhyia, na polisifo ba bɛbue kwan ma kar ahorow no tu ntɛmntɛm.

Tebea bɛn na wɔde `(Prokinetic Agents)` di dwuma?

Wɔde nnuru yi di dwuma titiriw ma tebea horow a edidi so yi:

• Gastroparesis (yafunu mu ntini a ɛnyɛ adwuma yiye/adidi a ɛkyɛ): Wɔ tebea yi mu no, yafunu mu ntini no ntumi ntwetwe yiye, enti aduan a wɔyam no kyɛ. Nnuru a ɛma yafunu no yɛ kɛse ma saa ntini a ɛtwetwe yi yɛ kɛse na ɛma yafunu no mu da mpan ntɛmntɛm. Nnipa a wɔwɔ asikreyare nso betumi anya saa tebea yi a wɔfrɛ no Diabetic Gastroparesis. Metoclopramide nkutoo ne aduru a mprempren FDA apene so wɔ United States ama eyi. Ebia wo duruyɛfo bɛkyerɛw eyi ama wo sɛ ayaresa afoforo mmoa a.

• GERD (Gastroesophageal Reflux Disease): Eyi ne bere a yafunu mu acid san ba aduan no mu kɔ ano no. Eyi ba bere a LES (Lessive Esophageal Suppression System) a madi kan aka ho asɛm no ntumi nto mu yiye no. Prokinetic agents nkutoo rentumi mmoa GERD. Nanso, sɛ wo yafunu mu yɛ brɛoo a, ebia wo duruyɛfo bɛkyerɛw eyinom aka nnuru afoforo ho.

• Functional Dyspepsia: Eyi ne bere a wo yafunu mu yɛ wo yaw bere nyinaa bere a woadi awie no, nanso wontumi nhu nea ɛde ba pefee. Ebia nnipa binom behu sɛ saa nnuru yi betumi aboa ma yare no ho sɛnkyerɛnne so atew. Nhwehwɛmufo ka sɛ saa nnuru yi boa denam yafunu a ɛtwetwe kɔ soro na ɛma yafunu mu yɛ mmerɛw ntɛmntɛm no so.

• Akisikuru ne ɔfe: Oduruyɛfo betumi akyerɛw saa aduru yi ama ɔfe a emu yɛ den anaa nea enni sabea a enni ayaresa afoforo ho dwuma. Ɛtɔ mmere bi nso a wɔde di dwuma ma ɔfe a nnuru a wɔde sa kokoram de ba no.

• Chronic Intestinal Pseudo-obstruction: Eyi ne bere a sɛnkyerɛnne ahorow a ɛkyerɛ sɛ obi asiw dwensɔtwaa no wɔ hɔ ɛwom mpo sɛ biribiara nsiw dwensɔtwaa no mu ankasa . Nhwehwɛmufo da so ara reyɛ nhwehwɛmu sɛ ebia nneɛma bi a ɛma obi nya prokinetic betumi aboa wɔ tebea yi mu anaa.

Dɛn ne `(Prokinetic Agents)` ahorow titiriw?

Wobetumi akyekyɛ saa nnuru yi mu akuw atitiriw abien: `(Agonists)` ne `(Antagonists)`.

• `(Agonists)`: Eyinom yɛ adwuma te sɛ `(Neurotransmitters)` (nnuru ahorow bi a ɛde nkrasɛm kɔ ntini ahorow ntam) wɔ yɛn ntini ahorow mu. Ɛne sɛ, saa `(Agonists)` yi kɔ na wɔde wɔn ho bata ntini bi ho, na wɔka kyerɛ saa ntini no sɛ "ɛnyɛ ntwitwiridii". Sɛnea `(Neurotransmitters)` a ɛfa ho no yɛ ade koro no ara.
• `(Antagonists)`: Eyinom yɛ adwuma denam `(Neurotransmitters)` ahorow bi a wosiw ano sɛ ɛnkyekyere ntini bi so. Titiriw no, sɛ `(Neurotransmitters)` wɔ hɔ a ɛtwetwe `(Peristalsis)` adeyɛ no a, saa `(Antagonists)` yi siw wɔn kwan sɛ wɔbɛkyekyere ntini no.

Wɔakyekyɛ saa ``Prokinetic Agents'' yi mu bio ayɛ no akuw ahorow, a egyina sɛnea aduru biara yɛ adwuma so:

• `(Agonists a Wɔyɛ Cholinergic)`:Eyinom yɛ adwuma te sɛ ``(Neurotransmitter)`` a wɔfrɛ no `(Acetylcholine)`. `(Acetylcholine)` kanyan ntini a ɛwɔ dwensɔtwaa no mu no twetwe. Nhwɛsoɔ: `(Baclofen)`, `(Bethanechol)`, `(Neostigmine)`, `(Pyridostigmine)`.
• `(Motilin Agonists)` (Macrolide Antibiotics): Eyinom yɛ adwuma te sɛ `(Neurotransmitter)` a wɔfrɛ no `(Motilin). `(Motilin)` kanyan dwensɔtwaa ketewa no mu ntini a ɛtwetwe. Nnuru bi a ɛwɔ saa kuw yi mu no yɛ `(Antibiotics)` ankasa a wɔde ma de sa mmoawa a wɔde nyarewa ba. Nhwɛsoɔ: `(Erythromycin)`, `(Azithromycin)`.
• Serotonin Agonists: Eyinom yɛ adwuma te sɛ neurotransmitter serotonin. Te sɛ serotonin no, ɛkanyan dwensɔtwaa no twetwe na ɛboa ma yafunu no da mpan. Nhwɛso ahorow: Cisapride, Prucalopride, Tegaserod.
• `(Dopamine Antagonists)`: Eyinom siw `(Neurotransmitter)` a wɔfrɛ no `(Dopamine)` no kwan sɛ ɛbɛkyekyere ntini mu nkwammoaa. `(Dopamine)` brɛ yafunu ne dwensɔtwaa no kankan ase, na ɛsan nso ma `(LES)` no dwo. Enti, sɛ `(Dopamine)` gyae kyekyere a, saa `(Dopamine Antagonists)` yi dan saa nkɛntɛnso no (i.e. ɛma kankyee kɔ soro). Nhwɛsoɔ: `(Metoclopramide)`, `(Domperidone)`.

Nhwɛsoɔ bi a ɛfa `(Prokinetic Agents)` ho

Mprempren nnuru ahorow bi wɔ hɔ a wɔde ``Prokinetic`` di dwuma de sa yare, a wɔabara ebinom wɔ aman te sɛ United States esiane nea efi mu ba nti, na ebinom nso da so ara wɔ nhwehwɛmu fã.

• Azithromycin (Zithromax®): Aduru a ɛma obi nya motilin. Ɛtɔ mmere bi a nnuruyɛfo kyerɛw ma wɔ off-label sɛ gastroparesis.
• Baclofen (ED baclofen®): Aduru a ɛma mogya tu. Wɔda so ara resua mfaso a ɛwɔ so ma GERD no ho ade.
• `(Bethanechol)` (Urecholine®): Ɛyɛ `(Agonist a ɔyɛ ɔkwasea). Ɛboa wɔ `(Gastroparesis)` ne `(GERD)` sɛnkyerɛnne ahorow ho. Nanso, wɔmfa nni dwuma pii efisɛ ebetumi de ɔhaw ahorow a emu yɛ den te sɛ ntini a ɛyɛ mmerɛw ne aniwa a ɛyɛ mmerɛw aba.
• Cisapride (Propulsid®): Aduru a ɛma serotonin yɛ adwuma. Ɛboa ma yafunu no da mpan ntɛmntɛm. Kan no na wɔde di dwuma ma GERD. Woyii no fii U.S. gua so esiane nea efi koma mu ba nti.
• `(Domperidone)` (Motilium®): Ɛyɛ `(Dopamine a ɛko tia aduru). Wɔ United States no, ɛnyɛ mmerɛw sɛ wobenya bi a wonnyaa kwan titiriw biara. Ebetumi de komayare a emu yɛ den te sɛ koma a ɛbɔ a ɛnteɛ ne komayare aba.
• Erythromycin (EES®): Ɛyɛ Motilin Agonist. Ebia oduruyɛfo bi bɛkyerɛw ama no off-label ama gastroparesis.
• Metoclopramide (Reglan®, Maxeran®, Gimoti®): Aduru a ɛko tia dopamine. Aduru biako pɛ a FDA apene so sɛ wɔde sa gastroparesis. Wɔde sa GERD a ennyaa ayaresa a wɔtaa de di dwuma nso. Nanso, ɛde kɔkɔbɔ bi ba sɛ ebetumi de ɔhaw ahorow a ɛka ntini ahorow no aba.
• `(Prucalopride)` (Nneɛma a Ɛyɛ Fɛ®):A `(Serotonin Agonist)`. Wɔde ma ma akisikuru a enni sabea. Ɛboa nso ma yafunu no da mpan ntɛm.
• Pyridostigmine (Mestinon®): Aduru a ɛma mogya tu. Wɔde sa Myasthenia Gravis titiriw, nanso ɛtɔ mmere bi a wɔde sa Gastroparesis nso.

Dɛn ne nneɛma bɔne a efi saa `(Prokinetic Agents)` yi a wɔde di dwuma mu ba?

Eyi ne ade a ɛho hia sen biara a ɛsɛ sɛ yɛhwɛ yiye. Prokinetic nnuru betumi anya nsunsuanso bɔne a emu yɛ den. Ɛno nti na nnuruyɛfo taa mpɛ sɛ wɔbɛkyerɛw nnuru no. Nanso, sɛ ayaresa a wɔtaa de di dwuma te sɛ PPI ahorow a wɔde sa GERD no ntumi nyɛ adwuma a, oduruyɛfo betumi asi gyinae sɛ ɔbɛkyerɛw aduru bi a ɛma obi nya prokinetic. Anaasɛ, sɛ́ ahwɛyiye no, wobetumi akyerɛw ama obi wɔ dodow a ɛba fam anaasɛ bere tiaa bi mu.

Sɛ oduruyɛfo bi kyerɛw aduru bi a ɛma wo ho yɛ hyew ma wo a, hwɛ hu sɛ wubebisa saa aduru no ho nsunsuanso pɔtee bi.

Nneɛma bɔne a ɛtaa ba no bi ne:

• Yafunu mu yaw
• Akisikuru ne ɔfe
• Atiridiinini (akisikuru) .
• Anisoadehu a ɛyɛ kusuu
• Tiyɛ (tiyɛ) .
• Ɔbrɛ
• Dae, ɔbrɛ a ɛboro so, nna a wɔtaa da (Lethargy) .
• Hahaahayɔ
• Brɛ
• Ntini a ɛtwetwe a wontumi nni so (Dystonia) .
• Anim ntini a ɛkeka ne ho a wontumi nni so (Tardive Dyskinesia) .

Woyii nnuru te sɛ `(Cisapride)`, `(Domperidone)` ne `(Tegaserod)` fii gua so esiane asiane a ɛwɔ hɔ sɛ wobenya komayare a emu yɛ den nti. Ɛyɛ:

• Koma a ɛbɔ brɛoo (Bradycardia) .
• Koma a ɛbɔ daa (Arrhythmia) .
• Koma mu yare

Mprempren nhwehwɛmu a wɔyɛ wɔ nnuru foforo a ɛma nipadua no yɛ adwuma ho no twe adwene si nnuru a wɔbɛyɛ a ɛma wonya mfaso a ɛne sɛ ɛbɛkanyan dwensɔtwaa no mu ntini a ɛtwetwe bere a ɛtew asiane a ɛwɔ hɔ sɛ ebefi mu aba a ɛte saa no so.

Dɛn ne `(Prokinetic Agents)` a wɔtaa de di dwuma?

Nnuru a wɔtaa kyerɛw ma prokinetic ne Metoclopramide ne Domperidone. Wɔ United States no, Metoclopramide nkutoo ne aduru a FDA apene so sɛ wɔde sa yafunu mu yare. Nanso, oduruyɛfo betumi akyerɛw Domperidone ama obi bere a FDA apene so.

Ɛsono sɛnea nneɛma a ɛma nipadua no yɛ adwuma no yɛ adwuma yiye na ahobammɔ wom wɔ aduan mu haw ahorow a wɔsa mu. Esiane asiane a ɛwɔ hɔ sɛ ebefi mu aba nti, oduruyɛfo betumi asɔ nnuru afoforo ahwɛ ansa na wakyerɛw nnuru a ɛma obi nya prokinetic. Nanso, sɛ wowɔ sɛnkyerɛnne ahorow a emu yɛ den esiane sɛ wo dwensɔtwaa ntumi nkɔ yiye nti a, ebia prokinetic aduru bi bɛma woanya ahotɔ a wuhia kɛse. Sɛ woresusuw ho sɛ wobɛnom aduru bi a ɛma obi nya prokinetic a, ɛho hia sɛ wo ne wo duruyɛfo susuw mfaso ne asiane ahorow a ɛwom ho.

Nneɛma a ɛho hia sen biara a ɛsɛ sɛ wokae (Take-Home Message) .

Enti, mewɔ anidaso sɛ woasua biribi afi nea yɛaka ho asɛm afa `(Prokinetic Agents)` ho. Sɛ yɛbɛbɔ no mua a:

• Prokinetic agents yɛ nnuru bi a ɛma aduan mu ntini no tu kɔ soro na ɛboa ma aduan no di dwuma.
• Wɔde eyinom di dwuma ma tebea horow te sɛ `(Gastroparesis)` ne `(GERD)`, ne nneɛma te sɛ akisikuru ne ɔfe nso.
• Saa aduru yi yɛ adwuma denam ntini a ɛwɔ dwensɔtwaa mu a ɛkanyan no na ɛma ntini no twetwe no so.
• Nea ɛho hia sen biara ne sɛ ɛtɔ mmere bi a nnuru yi betumi de ɔhaw ahorow a emu yɛ den aba. Ɛno nti na oduruyɛfo de ahwɛyiye kɛse bɛkyerɛw wɔn.
• Mfa aduru yi nni dwuma da a wonkɔ oduruyɛfo nkyɛn. Ɛsɛ sɛ oduruyɛfo si aduru a ɛfata wo ne bere tenten a ɛsɛ sɛ wonom ho gyinae.

Sɛ wo yafunu mu yɛ wo yaw anaasɛ wowɔ aduan mu haw te sɛ eyi a, ade a eye sen biara a ɛsɛ sɛ woyɛ ne sɛ wobɛkɔ oduruyɛfo nkyɛn na woaka ho asɛm. Afei wubetumi anya ayaresa a ɛfata.

` prokinetic nnuru, yafunu a ɛyɛ yaw, aduan a ɛnyɛ yiye, yafunu mu yare, GERD, yafunu mu yare, metoclopramide