Ngaba wakha watyandwa nge-leal pouch? Okanye ngaba kukho umntu omaziyo owake watyandwa? Abantu abatyandwa nge-leal pouch ngamanye amaxesha banokuba nesifo esibizwa ngokuba yi-pouchitis. Nangona kunokuba yinto ecaphukisayo, akukho nto ifanele ixhalabise ngayo. Masithethe ngayo ngendlela elula onokuyiqonda.

Yintoni kanye kanye iPouchitis?

Ngamafutshane, i-pouchitis kukudumba kwesikhwama sakho se-ileal . Makhe sijonge ukuba yintoni isikhwama se-ileal. Umzekelo, abanye abantu baneengxaki zamathumbu ezinzima ezifuna ukuba kususwe i-colon kunye ne-rectum yabo yonke. Sibiza olu tyando ngokuthi yi-proctocolectomy epheleleyo. Emva koko, kufuneka benze indlela entsha yokuba inkunkuma, okanye isitulo, siphume emzimbeni wabo. Kulapho isikhwama se-ileal singena khona. Oogqirha basebenzisa isiphelo samathumbu akho amancinci, i-ileum, ukwenza esi sikhwama, esifana nebhegi encinci. Esi sisikolo sakho samathumbu kunye ne-rectum esisusiweyo, oko kuthetha ukuba siqokelela kwaye sibambe isitulo okwethutyana. Esi sikhwama sidityaniswa apho isitulo siphuma khona. Ngamanye amaxesha sidityaniswa ne-anus yakho, nokuba yi-J-pouch okanye i-S-pouch, okanye njenge-K-pouch, edityaniswe nomnyango okhethekileyo esiswini sakho, obizwa ngokuba yi-stoma. Ngamanye amazwi, inxalenye yamathumbu akho amancinci ngoku isebenza njengekholoni yakho. Ngoko ke, i-pouchitis iyafana ne-colitis – ukudumba kwe-colon – okanye i-proctitis – ukudumba kwe-rectum – kodwa kwenzeka kubantu abane-leal pouch. Iimpawu ziyafana kakhulu. Iimpawu zinokubandakanya iintlungu zesisu kunye nesidingo sokuya kwindlu yangasese ngokukhawuleza nangokuphindaphindiweyo. Uninzi lwabantu luba ne-'acute pouchitis', oku kukudumba okufika kudlule ixesha elifutshane. Nangona kunjalo, kwabanye, kunokuba yimeko ebizwa ngokuba yi-'chronic pouchitis', ehlala ihleli okanye ifike ize idlule.

Ixhaphake kangakanani i-pouchitis?

Kuqikelelwa ukuba phakathi kwama-25% nama-45% abantu abaye benza utyando lwe-ileal pouch baya kuba ne-pouchitis ngaxa lithile ebomini babo . Malunga nama-40% abantu baya kuyihlakulela okokuqala minyaka le. Kwakhona, phakathi kwama-10% nama-20% baya kuyihlakulela kwakhona.

Zithini iimpawu zePouchitis?

Ukuba une -pouchitis, unokufumana iimpawu ezinje.

• Intlungu yesisu esisezantsi kunye nokuqhwalela.
• Kufuneka uye kwindlu yangasese ngokukhawuleza narhoqo.
• Ukufuneka ndivuke ndiye kwindlu yangasese ebusuku.
• Ubunzima bokulawula ukuhamba kwamathumbu (ukungakwazi ukuzibamba), oko kuthetha ukuvuza okuncinci.
• Ubunzima bokuphuma kwendle, ukuxinana (i-dyschezia).
• Ukuziva ngathi ufuna ukuya kwindlu yangasese, kodwa ungakwazi ukuya (tenesmus).
• Igazi elincinci esitulweni.
• Umkhuhlane okanye ukuziva ubanda.

Zithini izizathu ze-pouchitis?

Oogqirha bacinga ukuba imbangela ephambili ye-pouchitis kukutshintsha kweentlobo zeebhaktheriya zamathumbu ezihlala kwisingxobo sakho. Cinga ngayo, xa inxalenye yamathumbu akho amancinci ngoku isebenza njengesisu esikhulu, ivezwa kwiintlobo ezintsha zeebhaktheriya. Ezi bhaktheriya zintsha zikhuphisana neebhaktheriya ezazikho ngaphambili. Oku kubangela ukuba inkqubo yakho yomzimba icinge, "Owu, kukho usulelo apha," ize emva koko iphendule ngokubangela ukudumba. Abanye abantu banentsholongwane. Ezinye iintlobo zeebhaktheriya emathunjini ethu, ukuba zinikwe ithuba, zama ukulawula ezinye kwaye zibe ngukumkani. Ezi zibizwa ngokuba "ziibhaktheriya ezibangela izifo." Ngokwesiqhelo, ukuba nezimbalwa zezi bhaktheriya emathunjini ethu kulungile, kuba ezinye iibhaktheriya ezilungileyo ziyazigcina zilawulekile. Kodwa emva kotyando lwe-ileal pouch, olu lungelelwano luyatshintsha, kwaye ezo bhaktheriya "zimbi" zinethuba elitsha lokusasaza amandla azo. Kuqhelekile ukuba ne-pouchitis ixesha elifutshane emva kotyando lwe-ileal pouchitis. Oku kubizwa ngokuba yi-pouchitis yasekuqaleni, kwaye kuthathwa njengesiphumo esibi sotyando. Ihlala iphucuka ngee-antibiotics. Kodwa inokubuya. Kwabanye abantu, iyaqhubeka ibuya. Oku kungenxa yokuba ezinye iintlobo zeebhaktheriya zihlala zilawula ezinye. Usenokuba neziqendu ezininzi ze-acute pouchitis, kwaye ngalo lonke ixesha unokuphila ngcono ngee-antibiotics. Ingxaki iba nzima ngakumbi xa uneziqendu ezingaphezu kwezimbalwa ngonyaka. Abanye abantu baxhomekeka kwii-antibiotics - oku kubizwa ngokuba yi-chronic antibiotic-dependent pouchitis (CADP). Kwabanye, ii-antibiotics ziyeka ukusebenza kancinci kancinci. Oku kubizwa ngokuba yi-Chronic Antibiotic-Resistant Pouchitis (CARP).

Zeziphi izinto ezichaphazela i-pouchitis (CARP) engapheliyo, engamelaniyo namayeza okubulala iintsholongwane?

Kukho izizathu ezahlukeneyo ezinokubangela le meko 'ye-CARP'. Ezinye zazo zezi:

• Isifo Sokudumba Kwamathumbu ( IBD ): Abantu abaye banqunyulwa i-proctocolectomy ngenxa ye-IBD, njenge-ulcerative colitis okanye isifo sikaCrohn, basengozini enkulu yokufumana i-pouchitis. Izinto ezifanayo ezibangele imeko yabo yokuqala zinokuchaphazela i-pouch.
• Iibhaktheriya ezimelana namayeza okubulala iintsholongwane : EzinyeIintsholongwane ezibangelwa ziintsholongwane , ezifana ne-C. difficile, azikwazi ukumelana neentsholongwane ezibulala iintsholongwane. Ngokusebenzisa amayeza okubulala iintsholongwane rhoqo, iintsholongwane ezingabangeli zifo zinokungakwazi ukumelana neentsholongwane ezibulala iintsholongwane. Oku kunokubangela ukungalingani kweentsholongwane ezikwisingxobo.
• Ezinye izifo: Ngamanye amaxesha usulelo lwentsholongwane, olufana ne-cytomegalovirus, okanye usulelo lwefungus, olufana ne-candidiasis, lunokubangela ukudumba kwesingxobo.
• Ukunciphisa amasosha omzimba: Inkqubo yakho yokuzikhusela yomzimba isenokuba buthathaka ngenxa yeemeko ezithile ezikhoyo okanye amayeza owasebenzisayo, nto leyo ekwenza ungakwazi ukulwa nezifo.
• Ukuqhubeka nokusebenzisa ii-NSAIDs : Ukusela iintlungu ezibizwa ngokuba yi-'NSAIDs' (iziyobisi ezichasene nokuvuvukala ezingezizo ii-steroidal) ezifana ne-'Aspirin' kunye ne- 'Ibuprofen ' rhoqo nangokugqithisileyo kunokonakalisa ulwelo lwamathumbu akho kunye nolwelo 'lwesikhwama'.
• Ukuncipha kokunikezelwa kwegazi (Ischemia): Nangona kungaqhelekanga, ukudumba kunokwenzeka ngenxa yokuncipha kokuhamba kwegazi kwinxalenye yomzimba. Oku kunokubangelwa kukuvaleka kwemithambo yegazi ehambisa igazi.
• I-Primary Sclerosing Cholangitis (PSC): Esi sisifo esibangelwa kukuzikhusela komzimba, oko kuthetha ukuba inkqubo yomzimba yokuzikhusela ihlasela iiseli zayo. Ibangela ukudumba okungapheliyo kwindlela yakho yenyongo. Njenge-IBD, iindlela ezibangela oku kudumba okungapheliyo zinokuchaphazela nesikhwama. Abantu abanesi sifo basengozini enkulu yokuba ne-pouchitis.

Ziziphi iingxaki ezinokubakho ngenxa ye-pouchitis?

I-pouchitis ebukhali ayisoloko ibangela iingxaki ezinkulu. Nangona kunjalo, i-pouchitis engapheliyo nenganyangwanga inokubangela iingxaki. Ezi zingabandakanya:

• Utshintsho kwindlela oziphatha ngayo amathumbu: Ukudumba kwesingxobo kunokwenza kube nzima ukubamba indle ngaphakathi, kwaye ukudumba kungenza kube nzima ukuphuma kwendle. Oku kunokuchaphazela indlela oziphatha ngayo amathumbu ixesha elide.
• Umgangatho wobomi ophantsi: Ukuba neengxaki ezingapheliyo zokuya kwindlu yangasese kunokuba nzima ukuphila nazo. Kunokubangela uxinzelelo lomzimba nolwengqondo, kwaye kunokuphazamisa ukonwabela ubomi bentlalo.
• Ubunzima besikhwama:Ukudumba okungapheliyo kunokubangela amanxeba kwingxowa. Olu xinzelelo lunokubangela ukuba ingxowa ivuleke kancinci. Lunokunciphisa ukuhamba kwegazi kwingxowa, luthintele inkqubo yokuphiliswa.
• Ukukhukuliseka: Ukudumba kwexesha elide kunokubangela ukuba ulwelo lwesingxobo lubole, kwenze izilonda. Ezi zilonda zinokopha. Ezinye iintlobo zeebhaktheriya ezibangela izifo zinokonakalisa udonga lwamathumbu.
• Ukungafunxwa kokutya kunye nokungondleki kakuhle: Xa umaleko ongaphakathi wesingxobo wonakele, amandla okufunxa izondlo ekutyeni okungaphakathi kuwo ayancitshiswa (malabsorption), nto leyo enokubangela ukungondleki kakuhle.
• Ukungasebenzi kakuhle kwesikhwama: Xa iingxaki zesikhwama ziqhubeka, ekugqibeleni zisenokungasebenzi. Oku kunokufuna utyando lokususa isikhwama kunye nokuguqula amathumbu aye kwi-ileostomy.

Ifunyanwa njani iPouchitis?

Ukuchonga i-pouchitis kuqala ngokuthetha ngeempawu zakho kunye nembali yempilo yakho. Emva koko, ugqirha wakho uza kujonga ngaphakathi kwingxowa yakho. Baza kusebenzisa isixhobo esibizwa ngokuba yi-endoscope . Le yityhubhu encinci enekhamera encinci eqhotyoshelwe kuyo. Baza kuyidlulisa kwingxowa ukuze bajonge ukudumba okanye ezinye izinto ezingaqhelekanga. Baza kuthatha nesampulu yezicubu (i-biopsy) nge-endoscope baze bayihlole ukuze bafumane ukuba yintoni enokubangela le meko. Ugqirha wakho angasebenzisa nezinye iimvavanyo zomfanekiso ukujonga ngaphandle kwengxowa kunye nezakhiwo ezidibene nayo. Oku kwenziwa ukuze kufunyanwe ukuba kukho ezinye iimeko ezinokubangela le meko. Ezinye iimvavanyo ezinokwenziwa ziquka:

• I-contrast pouchography (i-pouchogram): Olu luhlobo lwe-X-ray. I-contrast fluid ifakwa kwi-pouch ukuze ibonakale ngakumbi. Ifana ne-barium enema, kodwa oku kwenziwa kwi-ileal pouch.
• Iskeni ye-CT.
• I-MRI scan (i-MRI).

Indlela yokunyanga i-pouchitis?

Unyango lokuqala lwe-acute pouchitis lunyango lwee-antibiotics lweeveki ezimbini . Uninzi lwabantu luyaphola ngale nto. Ukuba awupholi ngale nto, ugqirha wakho uza kuzama enye i-antibiotic, okanye indibaniselwano yee-antibiotics, ixesha elide. Ukuba useneempawu emva kweeveki ezine, usenokuba ne-antibiotic-resistant pouchitis. Ugqirha wakho kuya kufuneka enze uvavanyo oluthe kratya ukuze ajonge ezinye izizathu ezinokubakho ngaphambi kokuba agqibe ngonyango olufanelekileyo.

Ziziphi iindlela zonyango lwe-pouchitis ephindaphindayo?

Ukuba i-acute pouchitis iyaphela ngonyango ize iphinde ivele, ugqirha wakho uya kuqhubeka nonyango olufanayo. Ukuba unyango luyasebenza kwaye iimpawu aziphinde zivele rhoqo, kuya kusetyenziswa unyango olufanayo. Nangona kunjalo, ukuba iphinda ivele ngaphezu kwezihlandlo ezithathu ngonyaka, oogqirha bayijonga njenge-chronic antibiotic-dependent pouchitis. Inyangwa ngonyango lolondolozo lwexesha elide ukuthintela ukuphinda ivele. Unyango lolondolozo lungabandakanya:

• Ii-antibiotics: Ukusela ii-antibiotics ngeedosi eziphantsi kunokunceda ukuthintela ukuphinda kwenzeke kwakhona kwesifo.
• Iiprobiotics: Ezi zizithako ezongezelelweyo ezineebhaktheriya eziluncedo ezihlala emathunjini ethu. Zinokunceda ukubuyisela ibhalansi yeebhaktheriya ezikwisingxobo kwaye zilwe neebhaktheriya ezibangela izifo.

Ziziphi iindlela zonyango lwe-pouchitis engapheliyo, engamelaniyo namayeza okubulala iintsholongwane (i-CARP)?

Ukuba i-pouchitis yakho ayizange iphile kakuhle ngee-antibiotics, okanye ukuba iye yaphila kakuhle ngaphambili kodwa ayiphucuki ngoku, oogqirha bayibiza ngokuba yi-chronic antibiotic-resistant pouchitis (CARP). Kule meko, ugqirha uza kuqala ajonge naziphi na izizathu ezingundoqo, ezinje ngosulelo lwesibini, isifo sokuzikhusela komzimba, okanye isiphene sokwakheka kwesingxobo. Ukuba akukho sizathu sicacileyo sifumanekayo, baza kunyanga i-chronic pouchitis ngendlela efanayo naleyo banyanga ngayo isifo samathumbu esidumbileyo (IBD). Nazi ezinye iindlela zonyango ezinokwenzeka:

• I-Mesalamine enemas: I-Mesalamine, ekwaziwa ngokuba yi-5-aminosalicylic acid (5-ASA), liyeza lokuqala lonyango lwe-ulcerative colitis. Iza njenge-enema oyifaka kwisingxobo.
• I-Bismuth enemas: I-Bismuth subsalicylate, isithako esisebenzayo kwiPepto Bismol®, ikwaza njenge-foam enema (i-bismuth carbomer). Oku kunokunceda ukunciphisa iimpawu zakho.
• IiCorticosteroids: Ezi luhlobo lwamayeza okulwa nokuvuvukala asetyenziselwa ukunyanga ukuvuvukala okungapheliyo.
• Ii-immunosuppressants: La mayeza anciphisa impendulo yomzimba wakho. Oogqirha bawanika la mayeza xa umzimba wakho ubangela ukudumba okungapheliyo.
• Ii-antibodies ze-Monoclonal (i-biologics): Ii-antibodies ze-Monoclonal ziiproteni ezenziwe ngumntu ezisebenza njenge-antibodies zabantu, zikhulisa impendulo yakho yendalo yomzimba yokulwa nosulelo.
• Iimolekyuli ezincinci: La ngamayeza amatsha asebenza njengee-antibodies ze-monoclonal, kodwa zenziwe ngokwenziwa.
• Ukufakelwa kwe-microbiota yendle: Olu nyango luvunyiwe yi-US Food and Drug Administration (FDA) ukunyanga i-C. diff enganyangekiyo kumayeza okubulala iintsholongwane. Nangona kunjalo, ingasetyenziswa ngaphandle kweleyibhile yokunyanga i-pouchitis enganyangekiyo kumayeza okubulala iintsholongwane, nokuba ayibangelwa yi-C. diff. Inceda ukubuyisela i-microbiome yamathumbu esempilweni.

Kuthatha ixesha elingakanani ukuba i-pouchitis iphole?

Iimpawu ze-acute pouchitis zihlala ziqala ukuphucuka kwiintsuku ezimbalwa emva kokuqala unyango lwe-antibiotic. Nangona kunjalo, kubalulekile ukugqiba ikhosi epheleleyo yeeveki ezimbini zee-antibiotics, nokuba uzive ungcono. Kuya kufuneka ubone ugqirha wakho emva kokuba unyango luphelile. Baza kufuna ukujonga ngaphakathi kwingxowa yakho kwakhona ukuqinisekisa ukuba ukudumba kuphelile ngokupheleleyo.

Ngaba iPouchitis ingathintelwa?

Ubungqina obuthile bubonisa ukuba iiprobiotics zinokunceda ukuthintela i-pouchitis ukuba ingakhuli emva kotyando okanye ingabuyi emva konyango oluphumeleleyo. Zisenokungasebenzi rhoqo, kodwa zinokusebenza kuwe. Oogqirha ngamanye amaxesha banika umxube weprobiotic okhethekileyo (njenge-DeSimone formula). Uhlobo lweprobiotic oluthathayo lubalulekile, ngoko ke kubalulekile ukuthetha nogqirha wakho.

Yintoni onokuyilindela ukuba unesifo se-pouchitis?

Ukuba ufumana i-pouchitis emva kotyando lwe-ileal pouch – nokuba iyenzeka amaxesha ambalwa – kukho ithuba elihle lokuba inyangwe ngempumelelo ngee-antibiotics. Abanye abantu banokufuna ikhosi ende yee-antibiotics kunabanye. Ukuba uneziganeko ezixhaphakileyo, unokufuna unyango lwexesha elide ngee-antibiotics okanye ii-probiotics. Kwinani elincinci labantu abane-pouchitis, akukho nanye kwezi ndlela zonyango enokusebenza. Ukuba uqhubeka nokuba ne-pouchitis kwaye ayiphenduli kunyango lwee-antibiotics, ugqirha wakho uya kukhangela izizathu ezisisiseko zokudumba, ezifana ne-ischemia, ukusetyenziswa kwe-NSAID, okanye isifo sokuzikhusela komzimba. Ukuba abanakufumana unobangela wesibini, baya kuyifumanisa njenge-pouchitis engapheliyo ye-antibiotic-resistant (CARP). Oogqirha baya kucebisa iintlobo ngeentlobo zonyango lwe-CARP. Baza kusebenza nawe ukufumana eyona ifanelekileyo kuwe.

Ngamanye amaxesha, ukuba iingxaki zesingxobo zingaphezulu kuneenzuzo, ungagqiba ekubeni usisuse ukuze uphile ubomi obungenazifo. Kwakhona loo nto ikwayindlela onokukhetha kuyo.

Ngaba ukutya neziselo ziyayichaphazela i-pouchitis?

Ewe, ukuya kuthi ga kwinqanaba elithile. Ubungqina obuthile bubonisa ukuba ukuba ukutya kwakho akunazo ii-antioxidants ezininzi , unokuba semngciphekweni omkhulu wokuba ne-pouchitis. Ii-antioxidants zifumaneka ngokwemvelo kwiziqhamo nakwimifuno emininzi. Ezi zinto zinceda ekupheliseni iikhemikhali emizimbeni yethu ezibizwa ngokuba zii-free radicals. Xa ii-free radicals ziqokelelana emzimbeni, zingonakalisa iiseli kwaye zinegalelo ekuvuvukeni. Ii-antioxidants ezivela ekutyeni zisebenza ngakumbi kunezongezo. Kwelinye icala, ukuba unesifo se-pouchitis, ukunciphisa ubungakanani befayibha ekutyeni kwakho kunokunceda. Oogqirha bacebisa ukutya okune-FODMAP ephantsi . Oku kunciphisa inani lokutya iibhaktheriya zakho zamathumbu ezithanda ukukutya, kuquka nefayibha. Ukuyeka oku kutya okwethutyana kunokunceda ukunciphisa iimpawu zamathumbu akho. Kodwa ekuhambeni kwexesha, kufuneka uzame ukongeza iintlobo ezahlukeneyo zokutya kwakhona ekutyeni kwakho.

Ukutya okunceda ukuthintela i-pouchitis:

Qinisekisa ukuba ufumana ii-antioxidants ezaneleyo. Ungazifumana ngokutya iintlobo ngeentlobo zeziqhamo kunye nemifuno. Ezinye zezona zinto zilungileyo zokutya ezinee-antioxidants ezininzi zezi:

• apile
• Amaqunube (afana namaqunube, amaqunube)
• Iidiliya
• Iiplum ezomileyo (iiPrunes)
• Iintlobo zeembotyi
• Ii-artichokes
• Iitapile zeRusset
• Imifuno eluhlaza okwesibhakabhaka (njengespinatshi, ikale)

Ukongeza ukutya okupheleleyo ekutyeni kwakho, ingakumbi ukutya okusekwe kwizityalo, ngumgaqo obalulekileyo wokutya okulwa nokuvuvukala. Ii-antioxidants zesinye sezizathu.

Ukutya okufuneka ungakutyi xa une-pouchitis (ukunciphisa iimpawu):

Ukuze kuncitshiswe iimpawu ze-pouchitis, oogqirha bacebisa ukutya okune-FODMAP ephantsi, ubuncinane ude ufumane ukuba zeziphi ii-FODMAP onayo i-aleji kuzo. Ii-FODMAP eziqhelekileyo ziquka:

• I-Fructose (iswekile kwiziqhamo)
• I-Lactose (iswekile ebisini)
• Itswele
• Itswele elimhlophe
• Iintlobo zeembotyi
• Ingqolowa

Ukutya okungena-FODMAP ininzi kukutya okunciphisa ukutya okwethutyana. Ususa ukutya okuthile ekutyeni kwakho, ufumanise ukuba yintoni ebangela ukuba kutye, uze emva koko ukuphinda ukutye kancinci kancinci phantsi kwesikhokelo sikagqirha.

Ekugqibeleni, umyalezo wokubuyela ekhaya

Ukuba unesikhwama se-ileal, usenokuba ne-pouchitis ngaxa lithile. Asinguye wonke umntu oyifumanayo, kodwa abo banayo banokuyifumana ngaphezu kwesihlandlo esinye. Kunokuba yinto ecaphukisayo ukuba neengxaki zamathumbu eziqhubekayo nangona uninzi lwamathumbu abo lususiwe. Iindaba ezimnandi zezokuba kubantu abaninzi, i-pouchitis yingxaki eyenzeka ngamaxesha athile, kwaye kulula kakhulu ukuyinyanga kuneengxaki zamathumbu ezingapheliyo abasenokuba babenazo ngaphambili. I-pouchitis enganyangekiyo ngamayeza (CARP) inzima kancinci. Ngamanye amaxesha, inokunxulunyaniswa nesifo samathumbu esingapheliyo esele sikhona. Ukuyinyanga kunokuba nzima ngokufanayo. Kodwa ngovavanyo oluncinci, unokufumana indibaniselwano yonyango olusebenza kubantu abaninzi. Khumbula, awuwedwa. Thetha ngokukhululekileyo nogqirha wakho kwaye ubuze nayiphi na imibuzo onayo. Ngolwalathiso olufanelekileyo kunye nonyango, unokuphila kakuhle nale meko.