Ingabe nawe uvame ukuhlushwa yisisu? Kungaba yi-bile acid malabsorption!

Ingabe nawe uhlushwa ukunyakaza kwamathumbu njalo, okungukuthi, isifo sohudo? Ingabe nawe uhlushwa isifo sohudo okunzima ukusiyeka, ngezinye izikhathi esinamanzi, izikhathi eziningana ngosuku? Khona-ke lokhu kuyinto engabaluleka kuwe. Namuhla, sizokhuluma ngesimo esibizwa ngokuthi i-Bile Acid Malabsorption (BAM) . Nakuba igama lingase lizwakale liyinkimbinkimbi kancane, ake silichaze kalula.

Kuyini i-Bile Acid Malabsorption?

Kalula nje, lesi yisifo esithinta uhlelo lwethu lokugaya ukudla . Ikakhulukazi, kungaba imbangela enkulu yohudo olungapheli , okungukuthi, uhudo oluqhubekayo. Uma ama-bile acid emathunjini ethu engamuncwa kahle ngumzimba, aqoqana emathunjini. Bese ibhalansi yamakhemikhali ngaphakathi iyaphazamiseka. Ngenxa yala ma-bile acid amaningi, ikholoni yethu ithunyelwa umlayezo wokukhipha amanzi engeziwe. Yingakho uhudo olunamanzi luvela. Cabanga ngakho njengamanzi ahamba ngepayipi, kodwa yilokhu okwenzekayo lapho lawo manzi engalawuleki.

Ayini ama-bile acid?

Manje ungase uzibuze, "Ayini lawa ma-bile acid?" I-Bile iyinto ekhiqizwa yisibindi sethu . Lapho isibindi sihlanza igazi lethu, sihlukanisa udoti onjenge-toxins, amangqamuzana egazi afile, kanye ne-cholesterol eningi bese sakha i-bile. Izinhlobo ezahlukene zama-acids kule bile ziyahlangana ukuze zakhe ama-bile acids . Lawa ma-acid asiza ukugcina ama-lipids oketshezini lwe-bile.

Le nyongo evela esibindini ithunyelwa ngemigudu yenyongo iye emathunjini ethu amancane ukuze isize ekugayeni ukudla. Emathunjini amancane, lawa ma-bile acid asiza umzimba ukugaya amafutha ekudleni esikudlayo futhi awamunce. Uma lowo msebenzi usuqediwe, lawa ma-bile acid aphinde amuncwe emzimbeni wethu, ahambe ngegazi aye esibindini, bese esetshenziswa futhi ukwenza inyongo. Lokhu kufana nenqubo yokuvuselela .

Kuyini "i-Malabsorption"?

"Ukungamuncwa kahle" kusho ukuthi amathumbu ethu awakwazi ukumunca kahle amakhemikhali okudingeka siwamunce. Lokhu kungaba ngenxa yenkinga ngamathumbu ngokwawo, noma kungaba ngenxa yokungalingani kwamakhemikhali. Isibonelo, uma kunekhemikhali ethile eningi kakhulu noma encane kakhulu, amathumbu angase angakwazi ukuyimunca kahle.

Ubani othinteka kakhulu yilesi simo?

Esikhathini esidlule, i-bile acid malabsorption (BAM) yayingabonwa kubantu abaningi ngoba zazingekho izindlela zokuyixilonga ngokunembile. Kodwa-ke, ucwaningo lwamuva lubonisa ukuthi izifo zohudo ezisebenzayo (ama-FDD)Kulinganiselwa ukuthi okungenani abantu abangu-30% abane-BAM bangaba nayo. Izifo ezisebenzayo yizimo ezingenayo imbangela ecacile futhi ezingatholakali kalula ngokuhlolwa kwezokwelapha. Isibonelo, isimo esibizwa ngokuthi (Irritable Bowel Syndrome - IBS) .

I-BAM ingabonakala kubantu abanezimo zezokwelapha ezilandelayo:

• I-Microscopic colitis
• Isifo sikaCrohn
• I-enteritis ehlobene ne-HIV
• Uhudo oluqhubekayo ngemva kokutheleleka ngamagciwane
• Ukuntuleka kwe-pancreatic exocrine

Futhi, lesi simo singavela kubantu abathola ukwelashwa okuthile:

• Ukususwa noma ukuguqulwa kwe-ileum ngokuhlinzwa, ingxenye yokugcina yamathumbu amancane.
• Ukuhlinzwa kokususwa kwenyongo (i-cholecystectomy) .
• Ukwelashwa ngemisebe , ikakhulukazi esiswini nasesinqeni.
• Ukwelashwa ngamakhemikhali .
• Ukusetshenziswa kwe -Metformin, umuthi osetshenziselwa isifo sikashukela sohlobo 2.

Ziyini izimpawu zalokhu?

Izimpawu ezivame ukubonakala yilezi:

• Uhudo olunamanzi
• Isidingo sokuya endlini yangasese njalo
• Ubuhlungu esiswini
• Isifiso sokuya endlini yokugezela ngokushesha kanye nobunzima bokubambelela esitulweni

Abanye abantu bangase babe nezimpawu ezilandelayo:

• Ukuqunjelwa kwesisu
• Igesi kanye nobuhlungu obuyibangelayo
• Indle enamafutha (i-Steatorrhea)
• Ukungagayeki kahle kokudla

Imiphumela yesikhathi eside ingafaka:

• Ukuphelelwa amanzi emzimbeni
• Ukukhathala okukhulu naphezu kokuphumula okwanele
• Ikhanda elibuhlungu
• Isiyezi
• Isicanucanu
• Abanye abantu bayakhuluphala, abanye bayancipha.

Ngokuvamile, cishe ingxenye yalabo abahlushwa yilezi zimpawu iba nezimpawu ngaso sonke isikhathi . Ingxenye yesibili ibhekana nezimpawu ngezikhathi ezithile kuphela.

Kungani kwenzeka uhudo lwe-bile acid?

Uphawu oluyinhloko lokungamuncwa kwe-bile acid yisifo sohudo se-bile acid (BAD) . Lokhu kubangelwa ama-bile acid aqoqana emathunjini ethu amakhulu (ikholoni) , lapho imfucuza yokudla iguqulwa ibe yindle. Ngokuvamile, ama-95% ama-bile acid emathunjini ethu amancane aphinde amuncwe engxenyeni yokugcina yamathumbu amancane, i-ileum, ngaphambi kokuba afike emathunjini amakhulu.

Kodwa-ke, uma ama-bile acid amaningi engamuncwa ngale ndlela, adlula kanye neminye imikhiqizo yokungcola iye emathunjini amakhulu. Emathunjini amakhulu, lawa ma-bile acid acasula ulwelwesi lwamathumbu. Lokhu kubangela ukuthi akhiphe uketshezi oluningi, futhi imisipha esunduza indle phambili iba namandla kakhulu. Yingakho uhudo luvela njalo futhi ngokuzumayo, futhi kuvela ubuhlungu besisu.

Yiziphi izimbangela zokuncipha kokumuncwa kwe-bile acid?

Manje umbuzo uwukuthi, kungani lawa ma-bile acid eqongelela emathunjini? Abacwaningi bahlukanise i-BAM ngezimbangela ezine ezingaba khona. Ngezinye izikhathi lezi zihlukaniswa njengezimbangela eziyinhloko nezesibili .

• I-BAM Eyinhloko: Lokhu kubangelwa ukuthi isibindi sethu sikhiqiza ama-bile acid amaningi kakhulu (izinhlobo 2 no-4).
• I-BAM yesibili: Lokhu kwenzeka lapho amathumbu ethu amancane onakele ngenxa yesifo, ukuhlinzwa, noma ukwelashwa ngemisebe (izinhlobo 1 no-3).

I-Hlobo 1 BAM: Lokhu kubangelwa inkinga ku-ileum, ingxenye yokugcina yamathumbu amancane. Lokhu kubizwa ngokuthi i-malabsorption yangempela ngoba inkinga iqala esigabeni sokumuncwa komjikelezo we-bile acid. Ungase futhi ube ne-Hlobo 1 BAM uma ingxenye yokugcina yamathumbu amancane isusiwe ngokuhlinzwa, yashintshwa, noma yadlulwa njengengxenye yesinye isimo sezokwelapha. I-ileum ingalimala nangezimo ezifana nesifo sikaCrohn kanye nokwelashwa ngemisebe. Uma kukhona umonakalo omkhulu, ukumuncwa kuyaphazamiseka.

I-Hlobo 2 BAM: Lokhu ngezinye izikhathi kubizwa ngokuthi "i-idiopathic." Lokhu kusho ukuthi kwenzeka ngokuzumayo, ngaphandle kwesizathu. Kodwa-ke, ucwaningo lwamanje lubonisa ukuthi kubangelwa inkinga ngohlelo lokubonisana kwamakhemikhali phakathi kwamathumbu ethu nesibindi. Lolu hlelo lokubonisana luvame ukulawula ukujikeleza kwegazi okubangelwa yi-enterohepatic. Lezi zimpawu zitshela isibindi ukuthi senze nini futhi sithumele ama-bile acid amaningi, nokuthi siwamise nini, siwamunce futhi siwasebenzise kabusha. Kodwa ku-Hlobo 2 BAM, umyalezo othi "yeka" awufiki kahle. Ngakho-ke, isibindi siqhubeka sithumela ama-bile acid—okungaphezu kwalokho i-ileum engamunca.

Uhlobo 3 lwe-BAM: Lokhu kubangelwa yizifo ezithinta i-ileum kanye nezinye izingxenye zesimiso sethu sokugaya ukudla. Isibonelo, izimo ezifana nesifo se-celiac , i-pancreatitis engamahlalakhona , kanye nokukhula ngokweqile kwamagciwane emathunjini amancane (i-SIBO) .

Uhlobo 4 lwe-BAM: Lokhu kwenzeka njengomphumela ongemuhle wokuthatha umuthi wesifo sikashukela i-metformin , obangela ukukhiqizwa kwe-bile acid ngokweqile.

Iyini imiphumela yesikhathi eside yalesi simo?

Uma kukhona ukungakwazi ukumuncwa kahle kwe-bile acid, ukuntuleka kwe-bile acid kungase kukhule ngokuhamba kwesikhathi.Lokhu kungenzeka. Okusho ukuthi, uma i-bile acid eningi kakhulu ikhishwa esitulweni futhi ingaphindi ibuyiselwe esibindini, isibindi asinayo i-bile acid eyanele yokwenza i-bile. Uma kune-bile encane emathunjini amancane, kuthinta ukugaya kwakho kanye nokudla okunempilo.

Ukuntuleka kwama-bile acid emathunjini amancane kunciphisa ukumuncwa kwamafutha namavithamini ancibilikayo emafutheni (A, D, E, kanye no-K). Lokhu kungaholela ekungondleki kahle kanye nezinkinga ezithile ezihambisana nokuntuleka kwamavithamini ancibilikayo emafutheni. Isibonelo, ukuntuleka kwevithamini D kuthinta amathambo, kanti ukuntuleka kwevithamini A kuthinta umbono.

Abantu abane-Hlobo 1 BAM, ikakhulukazi, bangase babe nokuntuleka kwe-vitamin B12 . Lokhu kungenxa yokuthi i-vitamin B12 imuncwa yi-ileum. Kulesi simo, ukuntuleka kwayo akubangelwa yi-BAM ngokwayo, kodwa yisimo esibangela i-Hlobo 1 BAM - okungukuthi, ukungasebenzi kahle kwe-ileum. Izimpawu ezifana nesicanucanu, isiyezi, nokukhathala zingase zihambisane nalokhu.

Uma unesifo sokuntuleka kwe-bile acid, okunciphisa ukumuncwa kwamafutha futhi kukuvimbele ekushiseni amakhalori anele, ungase wehlise isisindo. Kodwa-ke, kwezinye izimo, ukumuncwa kabi kwe-bile acid kungaholela ekuzuzeni isisindo. Lokhu kubonakala kuhlobene nokusetshenziswa kwe-metabolism. I-BAM, noma izimo ezibangela lokhu, ingathinta indlela umzimba wakho osebenzisa ngayo amakhalori futhi uwagcine njengamafutha.

Lesi sifo sitholakala kanjani?

Iziqondiso zezokwelapha zamanje zincoma ukuthi noma ubani onesifo sohudo esiqhubekayo ngaphandle kwesizathu esicacile kufanele ahlolwe i-bile acid malabsorption. Kodwa lezi zivivinyo azitholakali yonke indawo. Abanye odokotela bazohlola lokhu futhi banikeze imithi ebizwa ngokuthi i-bile acid sequestrants ukuze babone ukuthi iyasiza yini.

Kunezivivinyo eziningana ezingasetshenziswa ukuxilonga i-bile acid malabsorption:

• Ukuhlolwa kwe-SeHCAT: Lokhu kubhekwa njengokuhlolwa okungcono kakhulu kokuxilonga i-BAM, kodwa amazwe amaningi, okuhlanganisa neSri Lanka, awanazo izinsiza zokwenza lokhu. Lokhu ukuhlolwa kokuthatha izithombe zemithi yenuzi . Okusho ukuthi, into enomsebe ephansi ifakwa emzimbeni, bese ikhompyutha iqapha ukuthi ihamba kanjani emzimbeni bese ithatha izithombe. Kulokhu kuhlolwa, ugwinya i-capsule equkethe i-bile acid yokwenziwa ebizwa ngokuthi i-SeHCAT kanye nale nto enomsebe. Le capsule iya emathunjini amancane futhi imuncwa ngokushesha ngangokunokwenzeka yi-bile acid emzimbeni wakho. Ikhamera ye-gamma ilinganisa izinga le-SeHCAT emzimbeni wakho ngosuku lokuqala nangemva kwezinsuku eziyisikhombisa. Uma kusele ngaphansi kuka-85% we-SeHCAT ngemva kwezinsuku eziyisikhombisa, ingatholakala ukuthi ine-BAM.

• Ukuhlolwa kwe-Serum C4:Lokhu ukuhlolwa kwegazi. Kubhekwa njengokhetho olulandelayo olungcono kakhulu ngemva kokuhlolwa kwe-SeHCAT. Kukala izinga le-enzyme ebizwa ngokuthi i-C4 egazini. Amazinga e-C4 ahlobene nokuthi isibindi sakho sikhiqiza ama-bile acid angakanani. Uma amazinga akho e-C4 ephezulu, kuyisibonakaliso esihle sokuthi une-BAM eyinhloko (izinhlobo 2 no-4). Kubantu abane-BAM yesibili (izinhlobo 1 no-3), amazinga e-C4 angaba phezulu uma isibindi siqala ukukhiqiza ama-bile acid amaningi ukuze kulungiswe ukumuncwa okunciphile. Ngakho-ke, lokhu kuhlolwa kuyasiza kubantu abaningi. Kodwa-ke, kunganikeza imiphumela engamanga kubantu abanezimo ezithile, njenge-cholesterol ephezulu kanye nesifo sesibindi esinamafutha esingadakwanga .

• Ukuhlolwa kwe-Fecal Bile Acid (Ukuhlolwa kwe-Fecal BA): Lokhu kulinganisa inani lama-bile acid esithweni sakho. Lena yindlela eqondile kakhulu yokukala ukumuncwa kwe-bile acid. Kodwa-ke, kuyinkimbinkimbi kakhulu futhi kungenziwa kuphela ezikhungweni zezempilo ezikhethiwe. Lokhu kuhlolwa kudinga ukulungiswa okukhethekile. Kuzodingeka ulandele ukudla okukhethekile izinsuku ezimbalwa ngaphambi kwesikhathi, bese uqoqa amasampula esithweni amahora angu-48. Ochwepheshe bazohlola indle yakho ukuthola ama-bile acid elabhorethri. Uma amazinga akho e-bile acid ephezulu, kusho ukuthi i-bile acid eningi kakhulu iyamuncwa emathunjini amancane futhi idluliselwa emathunjini amakhulu, okubangela uhudo lwe-bile acid.

Yiziphi izindlela zokwelapha ezingcono kakhulu?

Ukwelashwa kokuqala kwe-bile acid malabsorption uhlobo lwemithi ebizwa ngokuthi i-bile acid sequestrants noma i-bile acid binders . I-Cholestyramine ne -colestipol yizona ezivame kakhulu ukunikezwa. I-Colesevelam iyindlela engenalayisensi, kodwa abanye abantu bakuthola kulula ukuyisebenzisa.

Lezi zinhlayiya ze-bile acid ziyizinhlayiya ezishajelwe kahle ezibopha kuma-bile acid ashajelwe kabi emathunjini, zivimbele ukuthi aqhekeke abe yizicucu ezincane ezingamuncwa. Lokhu kubopha kuvimbela nama-bile acid ukuthi angasebenzi emathunjini amakhulu futhi kubangele uhudo. Lokhu kusiza ukunciphisa izimpawu ze-BAM.

Ingabe ikhona imiphumela emibi yokwelashwa?

Le mithi ivame ukuza ngesimo sempuphu. Kudingeka ixutshwe noketshezi bese ithathwa. Abanye abantu bathola ukunambitheka nokuthungwa kunzima ukugwinya. Abanye bathola izimpawu ze-BAM kanye nemiphumela emibi engathandeki. Lokhu kufaka phakathi ukuqunjelwa , isicanucanu, ukuqunjelwa, kanye negesi.

Futhi, ama-bile acid sequestrants angabopha amavithamini ancibilikayo emathunjini amancane. Lokhu kungavimbela amathumbu amancane ukuthi awamunce. Abanye abantu abathatha ama-bile acid sequestrants bangadinga ukuthatha izithasiselo zamavithamini. Kungadingeka futhi ukuthi athathwe ngendlela evimbela uhlelo lokugaya ukudla, njengokufaka umjovo .

Ingabe lesi simo singalapheka ngokuphelele?

Ukuthi i-bile acid malabsorption ingelapheka yini kuncike embangela. Ezinye izimbangela zingelapheka, kanti ezinye azikwazi. Uma imbangela eyisisekelo yelashwa ngqo, ngezinye izikhathi isimo se-BAM singathuthuka. Kwezinye izimo, noma ngabe imbangela ingelapheka, kunethuba elihle lokuthi izimpawu zingelapheka ngempumelelo.

Okubalulekile: Ungesabi! I-BAM ingalawulwa. Into ebaluleke kakhulu ukulandela imiyalelo kadokotela wakho.

Yini eyenza izimpawu zibe zimbi kakhulu?

Umjikelezo we-bile acid ubangelwa inani lamafutha ekudleni kwakho. Uma kunamafutha amaningi kakhulu emathunjini amancane, isibindi sithola isignali yamakhemikhali esitshela ukuthi "sithumele i-bile eningi." I-bile eningi isho ukuthi ama-bile acid amaningi aya emathunjini amakhulu. Yingakho odokotela bencoma ukudla okunamafutha aphansi ukusiza ekuphatheni i-BAM.

Kufanele ubonane nini nodokotela?

Uma unesifo sohudo esiqhubekayo ngaphandle kwesizathu esibonakalayo, buza udokotela wakho mayelana nokumuncwa kwe-bile acid. Lesi yisimo esingaqondwa kahle futhi esingaxilongwa kahle, ngakho akubona bonke odokotela abazocabanga ngaso ngokushesha. Ngakho-ke cela udokotela wakho ukuthi akuhlolele sona, noma akuthumele kuchwepheshe owaziyo ngaso.

Abantu abaningi bachitha iminyaka bezama ukuthola ukuxilongwa okufanele kanye nokwelashwa okusebenzayo kohudo lwabo olungachazeki. Kulabo abane-bile acid malabsorption, kunethemba lokuthi lezo zinsuku zizophela. Ngokuqwashisa okukhulu ngalesi simo kanye nezindlela ezilula zokusithola, ukuxilongwa kuzothuthuka.

Nakuba kunezimbangela eziningi zokungamuncwa kahle kwe-bile acid, ukwelashwa kuyafana kuzo zonke izimo. Udokotela osola i-BAM angase anikeze ukwelashwa, mhlawumbe njengendlela yokuqinisekisa lokho. Abantu abaningi abane-BAM bangakwazi ukuphatha izimpawu zabo ngempumelelo ngemithi yokwelapha i-bile acid kanye nokushintsha kokudla.

Izinto ezibaluleke kakhulu okufanele uzikhumbule (Umyalezo Wokuya Ekhaya)

Kulungile, ake sifingqe lokho esikhulume ngakho namuhla:

• Ukungamuncwa kwe-bile acid (BAM) yisimo esingaba imbangela enkulu yohudo olungapheli.
• Lokhu kwenzeka ngoba ama-bile acid awamuncwa kahle amathumbu, kodwa aqoqana emathunjini amakhulu, okubangela uhudo olumanzi.
• Izimo zezokwelapha ezahlukahlukene, ukuhlinzwa, kanye neminye imithi kungabangela lokhu.
• Izimpawu zingase zihlanganise uhudo oluvame ukuvela, ubuhlungu besisu, kanye nokuqunjelwa.
• Lesi sifo singatholakala ngokuhlolwa okufana nokuhlolwa kwe-SeHCAT, ukuhlolwa kwe-serum C4, kanye nokuhlolwa kwe-fecal bile acid .
• Izindlela zokwelapha eziyinhloko imithi ebizwa ngokuthi ama-bile acid sequestrants kanye nokudla okunamafutha aphansi .
• Kuye ngembangela, kungenzeka ukuthi yelapheke ngokuphelele noma cha, kodwa izimpawu zingalawulwa kahle.
• Uma unesifo sohudo esingapheli, esingachazeki, qiniseka ukuthi ufuna iseluleko sezokwelapha.Futhi ubuze nge-BAM.

Ungakhathazeki, uma uqonda lesi simo futhi usiphatha kahle, nawe ungathola impumuzo. Yiba nempilo enhle!

Ama - asidi e-bile, isifo sohudo, amathumbu, ukumuncwa, isibindi, izimpawu, ukwelashwa