Ngaba ukhe wadumba 'ngesikhwama'? Masithethe ngePouchitis kunye neNirogi Lanka!

Ngaba ukhe watyandwa nge-'ileal pouch', okanye mhlawumbi kukho umntu omaziyo okhe watyandwa? Kwabanye, le nkqubo inokukhokelela kwimeko eyaziwa ngokuba yi-'Pouchitis.' Nangona inokuba yingxaki kakhulu, akukho mfuneko yokoyika. Apha eNirogi Lanka, sifuna ukukunceda uqonde le meko ngokulula nangokucacileyo.

Yintoni kanye kanye iPouchitis?

Ngamafutshane, iPouchitis kukudumba ngaphakathi kwingxowa yakho ye-ileal. Ukuze sikuqonde oku, makhe sijonge ukuba yintoni ingxowa ye-ileal. Kwabanye abaguli, iimeko ezinzima zamathumbu zifuna ukuba kususwe ikholoni yonke kunye ne-rectum, inkqubo ebizwa ngokuba yi-'total proctocolectomy.' Emva kolu tyando, umzimba udinga indlela entsha yokugcina nokususa inkunkuma. Kulapho ke 'ingxowa ye-ileal' ingena khona.

Oogqirha benza esi sikhwama—ngokuyintloko isitya esincinci sangaphakathi—besebenzisa isiphelo samathumbu akho amancinci, i-'ileum.' Silinganisa umsebenzi wekholoni yakho yokuqala kunye ne-rectum ngokubamba inkunkuma ude ulungele ukuyikhupha. Emva koko esi sikhwama siqhagamshelwa kwi-anus yakho, edla ngokumila njengesikhwama 'J' okanye 'S', okanye kwezinye iimeko, siqhagamshelwe kwindawo yotyando esiswini eyaziwa ngokuba yi-'stoma' (isikhwama se-K). Ngokwenyani, inxalenye yamathumbu akho amancinci ngoku yenza umsebenzi wekholoni yakho.

I-Pouchitis ifana ne-'colitis' (ukudumba kwamathumbu amakhulu) okanye 'i-proctitis' (ukudumba kwe-rectum), kodwa iyenzeka ngokukodwa kwabo bane-leal pouch. Iimpawu ziyafana kakhulu, kubandakanya ukuqaqamba kwesisu kunye nomnqweno oqhelekileyo wokusebenzisa indlu yangasese ngequbuliso. Uninzi lwabantu lufumana 'i-acute pouchitis,' okukudumba okwethutyana okuphelayo. Nangona kunjalo, kwabanye, inokuba yimeko eqhubekayo okanye ephindaphindayo eyaziwa ngokuba yi-'chronic pouchitis.'

Ixhaphake kangakanani iPouchitis?

Kuqikelelwa ukuba ama-25% ukuya kuma-45% abantu abenza utyando lwe-ileal pouchitis baya kuba nePouchitis ngaxa lithile ebomini babo. Malunga nama-40% ezigulana zinokuba nayo kunyaka wokuqala, kwaye ama-10% ukuya kuma-20% afumana iziqendu eziphindaphindayo.

Zithini iimpawu zePouchitis?

Ukuba unePouchitis , ungabona ezi mpawu zilandelayo:

• Intlungu yesisu esisezantsi kunye nokuqaqamba.
• Isidingo sokusebenzisa indlu yangasese ngequbuliso nangokuphindaphindiweyo.
• Ukuvuka ebusuku ukuze ulale phantsi.
• Ubunzima bokulawula ukuhamba kwamathumbu (ukungakwazi ukuzibamba) okanye ukuvuza okuncinci.
• Ubunzima bokuphuma kwendle okanye ukutsala nzima (i-dyschezia).
• Ukuziva ungaphelelanga ekuphumeni okanye umnqweno ongapheliyo wokuhamba (tenesmus).
• Igazi esitulweni sakho.
• Umkhuhlane okanye ukubanda.

Yintoni ebangela iPouchitis?

Iingcali zonyango zikholelwa ukuba iPouchitis ibangelwa kakhulu lutshintsho kumlinganiselo weebhaktheriya zamathumbu ngaphakathi kwingxowa yakho. Ekubeni icandelo lamathumbu akho amancinci ngoku lisebenza njengekholoni, livezwa kwiintlobo ezahlukeneyo zeebhaktheriya. Ezi bhaktheriya zintsha zinokukhuphisana nezo zikhoyo, zibangele ukuba inkqubo yakho yomzimba ibangele impendulo yokudumba, iphosisa utshintsho njengosulelo.

Kwezinye iimeko, usulelo lokwenyani lunokwenzeka. Iibhaktheriya ezithile ezibangela izifo ezihlala emathunjini ngamanani amancinci, alawulwayo zinokuqala ukwanda xa ibhalansi ebuthathaka iphazamiseka emva kotyando. Oku kuvumela iibhaktheriya 'ezimbi' ukuba zikhule, nto leyo ekhokelela ekuvuvukeni.

I-pouchitis eqala kwangoko, eyenzeka emva nje kotyando, ithathwa njengesiphumo esiqhelekileyo emva kotyando kwaye idla ngokuphendula kakuhle kwii-antibiotics. Nangona kunjalo, inokubuya. Ukuba iyaqhubeka nokuphinda ivele, idla ngokuba kukwanda kweentsholongwane ezithile. Ngelixa abantu abaninzi bephumelela ekulawuleni i-'pouchitis ebukhali' ngeekhosi ezimfutshane zee-antibiotics, imeko iba nzima ngakumbi xa isenzeka amaxesha amaninzi ngonyaka. Abanye abaguli baxhomekeke kwii-antibiotics, imeko eyaziwa ngokuba yi-'Chronic Antibiotic-Dependent Pouchitis' (CADP). Abanye banokufumanisa ukuba ii-antibiotics ziyeka ukusebenza, ebizwa ngokuba yi-'Chronic Antibiotic-Resistant Pouchitis' (CARP).

Izinto ezibangela iPouchitis engapheliyo nenganyangekiyo kwiintsholongwane (i-CARP):

Ziliqela izinto ezinokubangela uphuhliso lwe-'CARP'. Phakathi kwezi zinto kukho:

• Isifo Sokudumba Kwamathumbu ( IBD ): Ukuba ukhe wenziwa i-proctocolectomy ukuze unyange iimeko ezifana ne-Ulcerative Colitis okanye isifo sikaCrohn , usemngciphekweni omkhulu wokuba ne-pouchitis. Izinto ezingundoqo ezinegalelo kwimeko yakho yokuqala zinokuchaphazela impilo ye-pouch yakho.
• Iibhaktheriya ezimelana neentsholongwane : Ezinye izifo zebhaktheriya , ezifana nezo zibangelwa yi-'C. difficile,' azimelani neentsholongwane eziqhelekileyo. Ukusetyenziswa kwexesha elide kweentsholongwane kunokuvumela iibhaktheriya ezihlala zingenabungozi ukuba zivelise ukuxhathisa, ziphazamise ibhalansi ethambileyo yebhaktheriya ebhegini yakho.
• Ezinye izifo: Ngamanye amaxesha, ukudumba okukwingxowa yakho kunokubangelwa zizifo ezibangelwa ziintsholongwane ezifana neCytomegalovirus okanye izifo ezibangelwa yifungus ezifana neCandidiasis.
• Ukunciphisa amasosha omzimba: Ukuba amasosha omzimba wakho abuthathaka ngenxa yeemeko ezikhoyo okanye amayeza athile, ukuqina komzimba wakho ngokwemvelo kwizifo kunokuphazamiseka.
• Ukusetyenziswa kwe -NSAID ixesha elide: Ukusetyenziswa rhoqo okanye ngokugqithisileyo kwamayeza angengo-steroidal anti-inflammatory (NSAIDs) afana ne-Aspirin okanye i-Ibuprofen kunokonakalisa ulwelo olukhuselayo lomgudu wakho wokugaya ukutya, kuquka nolwelo lwesikhwama sakho.
• I-Ischemia (Ukunikezelwa kwegazi okunciphileyo): Nangona kunqabile, ukudumba kunokwenzeka ukuba ukuhamba kwegazi kwindawo ethile kuthintelwe, rhoqo ngenxa yokuvaleka kwemithambo yegazi ehambisa loo ndawo.
• I-Primary Sclerosing Cholangitis (PSC): Le yimeko yokuzikhusela komzimba apho amajoni akho omzimba ahlasela iiseli zakho eziphilileyo, nto leyo ebangela ukudumba okungapheliyo kwimibhobho yenyongo. Njenge-IBD, iindlela zebhayoloji ezibangela ukudumba okungapheliyo nazo zinokuchaphazela isikhwama sakho, zinyuse umngcipheko wakho wokuba ne-pouchitis.

Ziziphi iingxaki ezinokubakho ngenxa ye-pouchitis?

I-pouchitis ebukhali ayisoloko ikhokelele kwiingxaki ezinkulu. Nangona kunjalo, i-pouchitis engapheliyo okanye enganyangekiyo kunyango inokuba yingxaki. Iingxaki ezinokubakho ziquka:

• Utshintsho kwindlela oziphatha ngayo xa uthulula isisu: Ukudumba kwisikhwama kunokwenza kube nzima ukulawula ukuhamba kwamathumbu, ngelixa ukudumba kunokwenza kube nzima ukukhupha amathumbu akho ngokufanelekileyo, nto leyo echaphazela imisebenzi yakho yemihla ngemihla.
• Umgangatho wobomi obuphantsi: Ukuphila neengxaki zamathumbu ezingapheliyo kunokuba nzima ngokwasemzimbeni nangokweemvakalelo, okuphazamisa ubomi bakho bentlalo kunye nempilo-ntle iyonke.
• Ubunzima besikhwama:Ukudumba okungapheliyo kunokukhokelela ekuqhekekeni kwamanxeba, okunokubangela ukuba isithuba sokukhupha ingxowa sinciphe. Oku kunokuphazamisa ukujikeleza kwegazi kwindawo leyo, kuthintele inkqubo yendalo yokuphiliswa.
• Ukuguguleka kwengaphakathi lengxowa: Ukudumba kwexesha elide kunokonakalisa ingaphakathi lengxowa, okunokubangela izilonda ezinokuphuma igazi. Iintsholongwane ezibangela izifo zingonakalisa ngakumbi udonga lwamathumbu.
• Ukungafunxwa kokutya kunye nokungondleki kakuhle: Xa ingaphakathi lesikhwama lonakele, amandla omzimba wakho okufunxa izondlo ekutyeni ayancipha, nto leyo enokubangela ukungondleki kakuhle.
• Ukungasebenzi kakuhle kwesikhwama: Kwiimeko ezinzima neziqhubekayo apho unyango lungasebenzi, isikhwama sisenokungasebenzi. Oku kunokufuna utyando olongezelelweyo ukususa isikhwama kunye nokubuyisela amathumbu endaweni yawo nge-ileostomy.

Ifunyanwa njani i-pouchitis?

Uxilongo luqala ngengxoxo enzulu ngeempawu zakho kunye nembali yezonyango. Ugqirha wakho uya kuhlola ingaphakathi lesikhwama sakho esebenzisa i -endoscope —ityhubhu encinci, eguquguqukayo enekhamera encinci. Oku kubavumela ukuba babone ukudumba okanye naziphi na izinto ezingaqhelekanga. Ngexesha lale nkqubo, banokwenza i -biopsy (ukuqokelela isampuli encinci yezicubu) ukufumanisa unobangela weempawu zakho.

Ugqirha wakho angasebenzisa iimvavanyo zomfanekiso ukuvavanya ulwakhiwo lwangaphandle lwesikhwama kunye neendawo ezisingqongileyo, nto leyo enceda ekuthinteleni ezinye iimeko ezikhoyo.

Uvavanyo olongezelelweyo lokuxilonga lungabandakanya:

• I-contrast pouchography (i-pouchogram): I-X-ray ekhethekileyo apho kusetyenziswa khona ulwelo lokungafani ukuchaza isikhwama ngokucacileyo, njenge-barium enema, kodwa ngokukodwa kwisikhwama se-ileal.
• Iskeni ye-CT.
• Iskeni ye-MRI.

Iphathwa njani i-pouchitis?

Unyango lokuqala lwe-acute pouchitis lunyango lwee-antibiotics lweeveki ezimbini , olusombulula ngempumelelo iimpawu zezigulane ezininzi. Ukuba imeko yakho ayiphucuki, ugqirha wakho unokulungisa amayeza akho, adibanise ii-antibiotics ezahlukeneyo, okanye andise ixesha lonyango. Ukuba iimpawu ziyaqhubeka ngaphaya kweeveki ezine, unokufunyanwa une-pouchitis engamelaniyo namayeza, nto leyo efuna uphando olongezelelweyo lokuxilongwa ukuze kuchongwe indlela engcono yokuqhubeka.

Kuthekani nge-pouchitis ephindaphindayo?

Ukuba uyachacha kwi-acute pouchitis kodwa iimpawu zibuya, ugqirha wakho uya kuphinda unyango lokuqala olusebenzayo. Ukuba nje unyango lusebenza kwaye ukudumba kwesisu kungenzeki rhoqo, le ndlela ihlala iyindlela eqhelekileyo. Nangona kunjalo, ukuba ufumana iziqendu ezingaphezu kwezintathu ngonyaka, ihlelwa njenge-'chronic antibiotic-dependent pouchitis', kwaye ugqirha wakho uya kutshintshela kunyango lolondolozo lwexesha elide ukuthintela ukudumba kwesisu okungakumbi.

Unyango lokulungisa lungabandakanya:

• Ii-antibiotics: Ukusetyenziswa ixesha elide kwee-antibiotics ezisebenzisa idosi ephantsi kunokunceda ukugcina isikhwama sisempilweni kwaye kuthintele ukuphinda kuvele isifo.
• Iiprobiotics: Ezi zizinto ezongezelelweyo ezineebhaktheriya eziluncedo ezinceda ukubuyisela ibhalansi esempilweni kwingxowa yakho kwaye zilwe neebhaktheriya ezibangela izifo.

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

Ukuba i-pouchitis yakho ayizange iphendule kwii-antibiotics, okanye ukuba ngaphambili yayisabela kodwa ayisaphenduli, oogqirha bayibiza ngokuba yi- Chronic Antibiotic-Resistant Pouchitis (CARP) . Kwiimeko ezinjalo, ugqirha wakho uza kuqala aphande izinto ezisisiseko onokuba uziphosile, njengosulelo lwesibini, imeko yokuzikhusela komzimba, okanye ingxaki yesakhiwo se-pouch. Ukuba akukho sizathu sicacileyo sichongiweyo, baya kuyilawula i-pouchitis engapheliyo ngendlela esiphatha ngayo i-Inflammatory Bowel Disease (IBD).

Ezinye iindlela zonyango ezinokubakho ziquka:

• Ii-enema zeMesalamine:I-Mesalamine, okanye i-5-aminosalicylic acid (5-ASA), lunyango lokuqala lwe-ulcerative colitis. Iza ngohlobo lwe-enema, onokuyinika ngqo kwisingxobo sakho.
• I-Bismuth enemas: I-Bismuth subsalicylate, isithako esisebenzayo kwiPepto-Bismol®, siyafumaneka njenge-foam enema (bismuth carbomer), enokukunceda uthomalalise iimpawu zakho.
• IiCorticosteroids: La ngamayeza okulwa nokuvuvukala asetyenziselwa ukunyanga ukuvuvukala okungapheliyo.
• Ii-immunosuppressants: La mayeza anciphisa impendulo yomzimba wakho, enikwa ngoogqirha xa umzimba wakho uqhuba ukudumba okungapheliyo.
• Ii-antibodies ze-Monoclonal (Biologics): Ezi ziiproteni ezenziwe ngumntu ezisebenza njengee-antibodies zendalo zomzimba wakho, zikhulisa impendulo yenkqubo yakho yomzimba yokulwa nokudumba.
• Iimolekyuli ezincinci: La ngamayeza amatsha, aqulunqiweyo asebenza ngendlela efanayo nee-antibodies ze-monoclonal.
• Ukufakelwa kweFecal Microbiota (FMT): Nangona ivunyiwe yi-US FDA ukunyanga usulelo lwe-C. diff olumelana namayeza okubulala iintsholongwane, ngamanye amaxesha isetyenziswa ngaphandle kwelebheli kwi-pouchitis engamelana namayeza okubulala iintsholongwane ukunceda ukubuyisela i-microbiome yamathumbu esempilweni.

Kuthatha ixesha elingakanani ukuba i-pouchitis iphole?

Iimpawu ze-acute pouchitis zihlala ziqala ukuphela kwiintsuku ezimbalwa emva kokuba uqalise ukusebenzisa amayeza okubulala iintsholongwane. Nangona kunjalo, nokuba uzive ungcono, kubalulekile ukugqiba ikhosi epheleleyo yamayeza okubulala iintsholongwane yeeveki ezimbini.

Kufuneka ulandele ugqirha wakho emva kokugqiba unyango. Kusenokufuneka benze uvavanyo lwe-endoscopic kwisingxobo sakho ukuqinisekisa ukuba ukudumba kuphelile ngokupheleleyo.

Ngaba i-pouchitis ingathintelwa?

Ubungqina obuthile bubonisa ukuba iiprobiotics zinokunceda ukuthintela ukuqala kwe-pouchitis emva kotyando okanye ukuthintela ukuphinda kwenzeke emva konyango oluphumeleleyo. Nangona zingasebenzi kuye wonke umntu, zinokuba luncedo kuwe. Oogqirha ngamanye amaxesha banika umxube othile weprobiotic (umz., ifomula yeDeSimone). Ngenxa yokuba uhlobo oluthile loxinzelelo lubalulekile, kubalulekile ukuxoxa ngale nto nogqirha wakho.

Yintoni onokuyilindela ukuba unesifo se-pouchitis?

Ukuba ufumana i-pouchitis emva kotyando lwakho lwe-ileal pouch—nokuba iyenzeka amaxesha amaninzi—kunokwenzeka ukuba iya kuphendula ngempumelelo kwii-antibiotics. Abanye abantu banokufuna ikhosi ende yee-antibiotics kunabanye. Ukuba ufumana ukuphinda-phinda rhoqo, unokufuna unyango oluhlala ixesha elide olune-antibiotics okanye ii-probiotics. Kwipesenti encinci yabantu abane-pouchitis, olu nyango lusenokungasebenzi.

Ukuba uqhubeka unesifo sokudumba esingapheliyo esingaphenduliyo kwii-antibiotics, ugqirha wakho uya kujonga izizathu ezifihlakeleyo zokudumba, ezifana ne-ischemia, ukusetyenziswa kwe-NSAID, okanye isifo esibangelwa kukuzikhusela komzimba. Ukuba akukho sizathu sesibini esifunyenweyo, siya kuhlelwa njenge-CARP. Oogqirha baya kucebisa iindlela ezahlukeneyo zonyango lwe-CARP, besebenza ngokusondeleyo nawe ukufumana ukuba yintoni esebenza kakuhle kwimeko yakho ethile.

Kwezinye iimeko, ukuba umthwalo wokuphatha isikhwama ungaphezulu kuneenzuzo, ungakhetha ukusisusa ukuze uphile ungenazo iimpawu. Leyo yindlela efanelekileyo.

Ngaba ukutya kuyayichaphazela i-pouchitis?

Ewe, inokudlala indima.

Ubungqina obuthile bubonisa ukuba ukuba ukutya kwakho akunazo ii-antioxidants ezininzi, umngcipheko wakho wokuba ne-pouchitis unokwanda. Ii-antioxidants, ezifumaneka ngokwendalo kwiziqhamo nakwimifuno emininzi, zinceda ekunciphiseni iikhemikhali emzimbeni wakho ezibizwa ngokuba yi-'free radicals'. Xa ii-free radicals ziqokelelana, zingonakalisa iiseli kwaye zinegalelo ekuvuvukeni. Ii-antioxidants ezivela ekutyeni zisebenza ngakumbi kunezo zivela kwizongezo.

Kwelinye icala, ukuba okwangoku uneempawu ze-pouchitis, ukunciphisa i-fiber yokutya kunokunceda. Oogqirha badla ngokucebisa ukutya okungena-FODMAP ininziOku kunciphisa ukutya okuthile—kuquka iifayibha ezithile—ezithandwa ziibhaktheriya zakho zamathumbu. Ukunciphisa oku kutya okwethutyana kunokunceda ekunciphiseni iimpawu zakho zesisu. Nangona kunjalo, ixesha elide, kufuneka ujonge ukuphinda uvelise ukutya okwahlukeneyo kancinci kancinci.

Ukutya okunokunceda ukuxhasa impilo yesikhwama sakho:

Qinisekisa ukuba ufumana ii-antioxidants ezaneleyo ngokutya iintlobo ngeentlobo zeziqhamo nemifuno. Imithombo emihle ibandakanya:

• Iiapile
• Amaqunube (umz., amaqunube, amaqunube)
• Iidiliya
• IiPrunes
• Iimbotyi
• Ii-artichokes
• Iitapile zeRusset
• Imifuno eluhlaza emnyama (umz., ispinatshi)

Ukufaka ukutya okupheleleyo, ingakumbi ukutya okusekwe kwizityalo, kukutya kwakho ngumgaqo osisiseko wendlela yokuphila yokulwa nokuvuvukala. Ii-antioxidants zesinye sezizathu zokuba kutheni.

Ukutya ekufuneka ukuphephe xa kukho i-pouchitis flare (ukunciphisa iimpawu):

Ukuze kuncedwe ekusombululeni iimpawu zakho, oogqirha banokucebisa ukutya okune-FODMAP ephantsi, ubuncinane ude uchonge ukuba zeziphi ii-FODMAP ezibangela iingxaki zakho ezithile. Ii-FODMAP eziqhelekileyo ziquka:

• I-Fructose (iswekile yeziqhamo)
• I-Lactose (iswekile yobisi)
• U-anyanisi
• Igalikhi
• Iimbotyi
• Ingqolowa

Ukutya okungena-FODMAP ininzi yindlela yokususa ukutya okwethutyana. Ususa amaqela athile okutya okwethutyana ukuze uchonge izinto ezikubangelayo, uze emva koko, phantsi kwesikhokelo sezonyango, uwabuyisele ngokucwangcisiweyo.

Ukuthatha kokugqibela

Ukuba unesikhwama se-ileal, kusenokwenzeka ukuba unokuba ne-pouchitis ngaxa lithile. Nangona ingachaphazeli wonke umntu, abo bayihlakulelayo banokujamelana neziganeko eziphindaphindiweyo. Kuyaqondakala ngokupheleleyo ukuziva ukhathazekile xa iingxaki zokugaya ukutya ziqhubeka nokuba ikholoni yakho isusiwe. Nangona kunjalo, iindaba ezimnandi zezokuba kubantu abaninzi, i-pouchitis ngumqobo onzima ngamanye amaxesha okulula ukuwulawula kuneengxaki zamathumbu ezingapheliyo osenokuba uzinyamezele ngaphambili.

I-pouchitis enganyangekiyo ngama-antibiotic (i-CARP) iyavunywa ukuba yimeko enzima ngakumbi. Kwezinye iimeko, inokunxulunyaniswa nesifo sakho samathumbu esinganyangekiyo, nto leyo eyenza indlela yonyango ibe nzima ngakumbi. Nangona kunjalo, ngonyango oluqhubekayo kunye necebo elilungiselelwe wena, iqela lakho lezonyango linokufumana indibaniselwano esebenzayo yonyango olusebenzayo kuwe.

Nceda ukhumbule ukuba awuwedwa kolu hambo. Siyakukhuthaza ukuba uthethe ngokukhululekileyo nogqirha wakho kwaye ubuze nayiphi na imibuzo onokuba nayo. Ngolwalathiso olufanelekileyo kunye nonyango, iNirogi Lanka ilapha ukukunceda ekugcineni ubomi bakho busemgangathweni ophezulu.