Ingabe nawe unesifo sokuvuvukala 'esikhwameni' sakho? Ake sixoxe nge-pouchitis!

Wake wahlinzwa ngesikhwama se-ileal? Noma ingabe kukhona umuntu omaziyo owake wahlinzwa? Abantu abahlinzwa ngesikhwama se-ileal ngezinye izikhathi bangaba nesifo esibizwa ngokuthi i-pouchitis. Nakuba kungaba yinto ecasulayo kancane, akukho okufanele ukhathazeke ngakho. Ake sixoxe ngakho ngendlela elula ongayiqonda.

Iyini ngempela i-Pouchitis?

Kalula nje, i-pouchitis ukuvuvukala kwesikhwama sakho se-ileal . Ake sibheke ukuthi siyini isikhwama se-ileal. Isibonelo, abanye abantu banenkinga enkulu yamathumbu edinga ukususwa kwekholoni labo lonke kanye ne-rectum. Lokhu kuhlinzwa sikubiza ngokuthi i-proctocolectomy ephelele. Bese, badinga ukudala indlela entsha yokuthi imfucuza, noma indle, iphume emzimbeni wabo. Yilapho isikhwama se-ileal singena khona. Odokotela abahlinzayo basebenzisa ukuphela kwamathumbu akho amancane, i-ileum, ukudala lesi sikhwama, esifana nesikhwama esincane. Lesi yikholoni yakho esusiwe kanye ne-rectum, okusho ukuthi iqoqa futhi ibambe indle isikhashana. Lesi sikhwama sibe sesixhunywa lapho indle iphuma khona. Ngezinye izikhathi sixhunywa endunu yakho, kungaba njengesikhwama se-J noma isikhwama se-S, noma njengesikhwama se-K, esixhunywe embobeni ekhethekile esiswini sakho, ebizwa ngokuthi i-stoma. Ngamanye amazwi, ingxenye yamathumbu akho amancane manje isebenza njengekholoni yakho. Ngakho-ke, i-pouchitis ifana ne-colitis – ukuvuvukala kwekholoni – noma i-proctitis – ukuvuvukala kwe-rectum – kodwa kwenzeka kubantu abanesikhwama se-ileal. Izimpawu zifana kakhulu. Izimpawu zingase zihlanganise ubuhlungu besisu kanye nesidingo sokuya endlini yangasese ngokushesha futhi njalo. Iningi labantu liba ne-'acute pouchitis', okuwukuvuvukala okufika kudlule isikhathi esifushane. Kodwa-ke, kwabanye, kungaba yisimo esibizwa ngokuthi 'i-chronic pouchitis', esiqhubekayo noma esifika sidlule.

Ivame kangakanani i-pouchitis?

Kulinganiselwa ukuthi phakathi kuka-25% no-45% wabantu abaye bahlinzwa ngesikhwama se-ileal bazoba ne-pouchitis ngesikhathi esithile empilweni yabo . Cishe abantu abangu-40% bazoba nayo okokuqala minyaka yonke. Futhi, phakathi kuka-10% no-20% bazophinde bayithole.

Ziyini izimpawu ze-Pouchitis?

Uma une -pouchitis, ungase ube nezimpawu ezinjengalezi.

• Ubuhlungu besisu esingezansi kanye nokuxhuga.
• Kudingeka uye endlini yangasese ngokushesha futhi njalo.
• Kudingeka ngivuke ngiye endlini yangasese ebusuku.
• Ubunzima bokulawula ukuhamba kwamathumbu (ukungakwazi ukuzibamba), okusho ukuvuza okuncane.
• Ubunzima bokukhipha indle, ukukhama (i-dyschezia).
• Ukuzizwa sengathi udinga ukuya endlini yangasese, kodwa ungakwazi ukuya (tenesmus).
• Igazi elincane esitulweni.
• Umkhuhlane noma ukuzizwa ubanda.

Ziyini izimbangela ze-pouchitis?

Odokotela bacabanga ukuthi imbangela eyinhloko ye-pouchitis ushintsho ezinhlotsheni zamagciwane asemathunjini ahlala esikhwameni sakho. Cabanga ngakho, lapho ingxenye yamathumbu akho amancane manje isebenza njengethumbu elikhulu, ivezwa ezinhlotsheni ezintsha zamagciwane. Lawa magciwane amasha ancintisana namagciwane ayekhona ngaphambili. Lokhu kubangela ukuthi amasosha omzimba wakho acabange ukuthi, "O, kukhona ukutheleleka lapha," bese esabela ngokubangela ukuvuvukala. Abanye abantu empeleni banegciwane. Ezinye izinhlobo zamagciwane emathunjini ethu, uma zinikezwa ithuba, zama ukulawula ezinye futhi zibe yinkosi. Lawa abizwa ngokuthi "amagciwane abangela izifo." Ngokuvamile, ukuba nalawa magciwane ambalwa emathunjini ethu kulungile, ngoba amanye amagciwane amahle ayawagcina elawulwa. Kodwa ngemva kokuhlinzwa kwesikhwama se-ileal, lokhu kulinganisela kuyashintsha, futhi lawo magciwane "amabi" anethuba elisha lokusabalalisa amandla awo. Kuvamile ukuba ne-pouchitis isikhathi esifushane ngemva kokuhlinzwa kwesikhwama se-ileal. Lokhu kubizwa ngokuthi i-pouchitis yokuqala, futhi kubhekwa njengomphumela ongemuhle wokuhlinzwa. Ngokuvamile kuba ngcono ngama-antibiotic. Kodwa kungabuya. Kwabanye abantu, kuqhubeka kubuya. Lokhu kungenxa yokuthi ezinye izinhlobo zamagciwane ziyaqhubeka zibusa ezinye. Ungase ube neziqephu eziningana ze-acute pouchitis, futhi isikhathi ngasinye ungalulama ngama-antibiotic. Inkinga iba yinkimbinkimbi kakhulu uma uneziqephu ezingaphezu kwezimbalwa ngonyaka. Abanye abantu bathembela kuma-antibiotic - lokhu kubizwa ngokuthi i-chronic antibiotic-dependent pouchitis (CADP). Kwabanye, ama-antibiotic ayayeka ukusebenza kancane kancane. Lokhu kubizwa ngokuthi i-Chronic Antibiotic-Resistant Pouchitis (CARP).

Yiziphi izici ezithonya i-pouchitis (CARP) engapheli, engamelani namagciwane?

Kunezizathu eziningana ezingaba nomthelela kulesi simo se-'CARP'. Ezinye zazo yilezi:

• Isifo Sokuvuvukala Kwamathumbu ( IBD ): Abantu abaye bahlinzwa i-proctocolectomy ngenxa ye-IBD, njenge-ulcerative colitis noma isifo sikaCrohn, basengozini enkulu yokuthola i-pouchitis. Izici ezifanayo ezibangele isimo sabo sokuqala zingathinta isikhwama.
• Amabhaktheriya amelana nama-antibiotic : AmanyeUkutheleleka ngamagciwane , njenge-C. difficile, kuyamelana nama-antibiotic. Ngokusebenzisa ama-antibiotic njalo, amabhaktheriya angavamile ukubangela izifo angaba namandla okumelana nama-antibiotic. Lokhu kungabangela nokungalingani kwamabhaktheriya esikhwameni.
• Ezinye izifo: Ngezinye izikhathi ukutheleleka ngegciwane, njenge-cytomegalovirus, noma ukutheleleka ngefungus, njenge-candidiasis, nakho kungabangela ukuvuvukala kwesikhwama.
• Ukucindezeleka Kwamasosha omzimba: Amasosha omzimba wakho angase abe buthaka ngenxa yezimo ezithile noma imithi oyiphuzayo, okwenza ungakwazi ukulwa nezifo.
• Ukusetshenziswa okuqhubekayo kwama -NSAID : Ukuphuza imithi yobuhlungu ebizwa ngokuthi 'ama-NSAID' (imithi elwa nokuvuvukala engeyona eye-steroidal) njenge-'Aspirin' kanye ne- 'Ibuprofen ' njalo futhi ngokweqile kungalimaza ulwelwesi lwamathumbu akho kanye nolwelwesi 'lwesikhwama'.
• Ukuncipha kokunikezwa kwegazi (i-Ischemia): Nakuba kungavamile, ukuvuvukala kungenzeka futhi ngenxa yokuncipha kokugeleza kwegazi engxenyeni yomzimba. Lokhu kungaba ngenxa yokuvaleka kwemithambo yegazi ehlinzeka ngegazi.
• I-Primary Sclerosing Cholangitis (PSC): Lesi yisifo esibangelwa ukuzivikela komzimba, okusho ukuthi amasosha omzimba ahlasela amangqamuzana awo. Sibangela ukuvuvukala okungapheli endleleni yakho yenyongo. Njenge-IBD, izindlela ezibangela lokhu kuvuvukala okungapheli zingathinta nesikhwama. Abantu abanalesi sifo basengozini enkulu yokuthola i-pouchitis.

Yiziphi izinkinga ezingaba khona ngenxa ye-pouchitis?

I-pouchitis ebukhali ayivamile ukubangela izinkinga ezinkulu. Kodwa-ke, i-pouchitis engapheli, engalashwanga ingabangela izinkinga. Lokhu kungafaka:

• Izinguquko emikhubeni yamathumbu: Ukuvuvukala kwesikhwama kungenza kube nzima ukubamba indle, kanti ukuvuvukala kungenza kube nzima ukuphuma kwendle. Lokhu kungathinta imikhuba yakho yamathumbu yesikhathi eside.
• Ukwehla kwezinga lempilo: Ukuba nezinkinga eziqhubekayo zokuya endlini yangasese kungaba nzima ukuphila nazo. Kungabangela ukucindezeleka ngokomzimba nangokwengqondo, futhi kungaphazamisa ukujabulela impilo yokuxhumana nabantu.
• Ukuqina kwesikhwama:Ukuvuvukala okungapheli kungabangela izibazi esikhwameni. Lokhu kuzibazi kunganciphisa ukuvuleka kwesikhwama. Kunganciphisa nokugeleza kwegazi esikhwameni, kuvimbele inqubo yokuphulukiswa.
• Ukuguguleka: Ukuvuvukala kwesikhathi eside kungabangela ukuthi ulwelwesi lwesikhwama luguguleke, kwakheke izilonda. Lezi zilonda zingaphinde zophe. Ezinye izinhlobo zamagciwane abangela izifo zingalimaza nodonga lwamathumbu.
• Ukungamuncwa kokudla kanye nokungondleki kahle: Uma ungqimba lwangaphakathi lwesikhwama lonakele, ikhono lokumunca izakhamzimba ekudleni okungaphakathi kwalo liyancishiswa (i-malabsorption), okungaholela ekungondleki kahle.
• Ukwehluleka kwesikhwama: Uma izinkinga ngesikhwama ziqhubeka, singagcina singasakwazi ukusetshenziswa. Lokhu kungadinga ukuhlinzwa ukuze kususwe isikhwama futhi kuphambukiswe amathumbu aye ku-ileostomy.

Itholakala kanjani i-Pouchitis?

Ukuxilonga i-pouchitis kuqala ngokukhuluma ngezimpawu zakho kanye nomlando wempilo. Ngemuva kwalokho, udokotela wakho uzobheka ngaphakathi kwesikhwama sakho. Bazosebenzisa ithuluzi elibizwa ngokuthi i-endoscope . Leli yipayipi elincane elinekhamera encane enamathiselwe kulo. Bazolidlulisa esikhwameni ukuze babheke ukuvuvukala noma ezinye izinkinga. Bazophinde bathathe isampula yezicubu (i-biopsy) nge-endoscope bese beyihlola ukuze bathole ukuthi yini engabangela lesi simo. Udokotela wakho angasebenzisa nezinye izivivinyo zesithombe ukuze abheke ingaphandle lesikhwama kanye nezakhiwo ezixhunywe kuso. Lokhu kwenziwa ukuze kutholakale ukuthi zikhona yini ezinye izimo ezingase zibangele lesi simo. Izivivinyo ezengeziwe ezingenziwa zifaka:

• I-contrast pouchography (i-pouchogram): Lolu uhlobo lwe-X-ray. Kufakwa uketshezi oluhlukile esikhwameni ukuze lubonakale kakhulu. Lufana ne-barium enema, kodwa lokhu kwenziwa esikhwameni se-ileal.
• I-CT scan.
• I-MRI scan (i-MRI).

Indlela yokwelapha i-pouchitis?

Ukwelashwa kokuqala kwe-acute pouchitis yinkambo yama-antibiotic yamasonto amabili . Iningi labantu liba ngcono ngalokhu. Uma ungalulami ngalokhu, udokotela wakho uzozama i-antibiotic ehlukile, noma inhlanganisela yama-antibiotic, isikhathi eside. Uma usenezimpawu ngemva kwamasonto amane, ungase ube ne-pouchitis engamelani nama-antibiotic. Udokotela wakho kuzodingeka enze izivivinyo ezengeziwe ukuze abheke ezinye izimbangela ezingaba khona ngaphambi kokunquma ukwelashwa okungcono kakhulu.

Yiziphi izindlela zokwelapha i-pouchitis ephindaphindayo?

Uma i-pouchitis ebukhali iphela ngokwelashwa bese ibuyelela, udokotela wakho uzoqhubeka nokwelashwa okufanayo. Uma ukwelashwa kusebenza futhi izimpawu zingabuyeli njalo, kusetshenziswa ukwelashwa okufanayo. Kodwa-ke, uma ibuyelela izikhathi ezingaphezu kwezintathu ngonyaka, odokotela bayibheka njenge-pouchitis engapheli encike kuma-antibiotic. Yelashwa ngokwelashwa kokunakekelwa kwesikhathi eside ukuze kuvinjelwe ukuphinda ibuyelela. Ukwelashwa kokunakekelwa kungafaka:

• Ama-antibiotic: Ukuthatha ama-antibiotic ngemithamo ephansi kungasiza ekuvimbeleni ukuphinda kuvele isifo.
• Ama-probiotic: Lezi izithasiselo eziqukethe amabhaktheriya awusizo ahlala emathunjini ethu. Zingasiza ekubuyiseleni ibhalansi yamabhaktheriya esikhwameni futhi zilwe namabhaktheriya abangela izifo.

Yiziphi izindlela zokwelapha i-pouchitis (CARP) engapheli, engamelani namagciwane?

Uma i-pouchitis yakho ingakaze ibe ngcono ngama-antibiotic, noma uma iye yaba ngcono esikhathini esidlule kodwa ingakabi ngcono manje, odokotela bayibiza ngokuthi i-pouchitis engamelana namagciwane (CARP). Kulesi simo, udokotela uzoqala abheke noma yiziphi izimbangela eziyisisekelo, njengokutheleleka kwesibili, isifo sokuzivikela komzimba, noma isici sesakhiwo esikhwameni. Uma kungatholakali imbangela ecacile, bazophatha i-pouchitis engapheli ngendlela efanayo naleyo abaphatha ngayo isifo samathumbu esivuvukalayo (IBD). Nazi ezinye izindlela zokwelapha ezingaba khona:

• I-Mesalamine enemas: I-Mesalamine, eyaziwa nangokuthi i-5-aminosalicylic acid (5-ASA), umuthi wokuqala we-ulcerative colitis. Iza njenge-enema oyifaka esikhwameni.
• I-Bismuth enemas: I-Bismuth subsalicylate, isithako esisebenzayo ku-Pepto Bismol®, nayo iza njenge-foam enema (i-bismuth carbomer). Lokhu kungasiza ekunciphiseni izimpawu zakho.
• Ama-Corticosteroids: Lawa uhlobo lwemithi yokulwa nokuvuvukala esetshenziselwa ukwelapha ukuvuvukala okungapheli.
• Ama-immunosuppressants: Le mithi inciphisa ukusabela kwesimiso sakho somzimba. Odokotela bayinikeza le mithi uma isimiso sakho somzimba sibangela ukuvuvukala okungapheli.
• Ama-antibodies e-Monoclonal (i-biologics): Ama-antibodies e-Monoclonal amaprotheni enziwe ngabantu asebenza njengama-antibodies abantu, akhulisa impendulo yakho yemvelo yokuzivikela komzimba ngokumelene nokutheleleka.
• Ama-molecule amancane: Lezi yimithi emisha esebenza njengama-antibodies e-monoclonal, kodwa yenziwe ngokwenziwa.
• Ukufakelwa kwe-fecal microbiota: Lokhu kwelashwa kuvunyiwe yi-US Food and Drug Administration (FDA) ukwelapha i-C. diff engamelani namagciwane. Kodwa-ke, ingasetshenziswa ngaphandle kwelebula ukwelapha i-pouchitis engamelana namagciwane, noma ngabe ayibangelwa yi-C. diff. Kusiza ukubuyisela i-microbiome yamathumbu enempilo.

Kuthatha isikhathi esingakanani ukuthi i-pouchitis iphole?

Izimpawu ze-acute pouchitis zivame ukuqala ukuthuthuka zingakapheli izinsuku ezimbalwa kusukela ekuqaleni kokwelashwa ngama-antibiotic. Kodwa-ke, kubalulekile ukuqeda inkambo ephelele yama-antibiotic yamasonto amabili, noma ngabe uzizwa ungcono. Kufanele ubone udokotela wakho ngemva kokuphela kokwelashwa. Bazofuna ukubheka ngaphakathi kwesikhwama sakho futhi ukuqinisekisa ukuthi ukuvuvukala sekuphelile ngokuphelele.

Ingabe i-Pouchitis ingavinjelwa?

Ubufakazi obuthile busikisela ukuthi ama-probiotic angasiza ekuvimbeleni i-pouchitis ukuthi ingakhuli ngemva kokuhlinzwa noma ingabuyi ngemva kokwelashwa okuphumelelayo. Angase angasebenzi ngaso sonke isikhathi, kodwa angakusebenzela. Odokotela ngezinye izikhathi banikeza ingxube ekhethekile yama-probiotic (njengefomula ye-DeSimone). Uhlobo lwe-probiotic oluthathayo lubalulekile, ngakho-ke kubalulekile ukukhuluma nodokotela wakho.

Yini ongayilindela uma unesifo se-pouchitis?

Uma uba ne-pouchitis ngemuva kokuhlinzwa kwe-ileal pouch – noma ngabe kwenzeka izikhathi ezimbalwa – kunethuba elihle lokuthi izokwelashwa ngempumelelo ngama-antibiotic. Abanye abantu bangadinga inkambo ende yama-antibiotic kunabanye. Uma uneziqephu ezivamile, ungadinga ukwelashwa kwesikhathi eside ngama-antibiotic noma ama-probiotic. Kwabambalwa abantu abane-pouchitis, akukho noyedwa walaba belashwayo ongasebenza. Uma uqhubeka nokuba ne-pouchitis futhi ingaphenduli ekwelashweni ngama-antibiotic, udokotela wakho uzobheka izimbangela eziyisisekelo zokuvuvukala, njenge-ischemia, ukusetshenziswa kwe-NSAID, noma isifo sokuzivikela komzimba. Uma bengakwazi ukuthola imbangela yesibili, bazoyixilonga njenge-pouchitis engamelana nama-antibiotic (CARP) engapheli. Odokotela bazophakamisa izinhlobo ezahlukene zokwelapha ze-CARP. Bazosebenza nawe ukuthola okulungele wena.

Ngezinye izikhathi, uma izinkinga ngesikhwama zingaphezu kwezinzuzo, ungase unqume ukususa isikhwama ukuze uphile impilo engenazifo. Lokho futhi kuyindlela ongakhetha kuyo.

Ingabe ukudla neziphuzo kuyayithinta i-pouchitis?

Yebo, ngezinga elithile. Ubufakazi obuthile busikisela ukuthi uma ukudla kwakho kunamafutha amancane okulwa ne-antioxidant , ungase ube sengozini enkulu yokuthola i-pouchitis. Ama-antioxidants atholakala ngokwemvelo ezithelweni nasemifino eminingi. Lawa makhemikhali asiza ekunciphiseni amakhemikhali emizimbeni yethu abizwa ngokuthi ama-free radicals. Lapho ama-free radicals eqoqana emzimbeni, angalimaza amangqamuzana futhi afake isandla ekuvuvukeni. Ama-antioxidants avela ekudleni asebenza kangcono kunezithasiselo. Ngakolunye uhlangothi, uma unesifo se-pouchitis, ukunciphisa inani le-fiber ekudleni kwakho kungasiza. Odokotela batusa ukudla okune-FODMAP ephansi . Lokhu kunciphisa inani lokudla amabhaktheriya akho amathumbu athanda ukukudla, kufaka phakathi i-fiber. Ukuyeka lokhu kudla okwesikhashana kungasiza ekunciphiseni izimpawu zamathumbu akho. Kodwa ngokuhamba kwesikhathi, kufanele uzame ukwengeza ukudla okuhlukahlukene ekudleni kwakho.

Ukudla okusiza ukuvimbela i-pouchitis:

Qiniseka ukuthi uthola ama-antioxidants anele. Ungawathola ngokudla izithelo nemifino ehlukahlukene. Okunye kokudla okuhle kakhulu okunama-antioxidants amaningi yile:

• i-apula
• Amajikijolo (njengama-strawberry, ama-blueberries)
• Amagilebhisi
• Ama-plum omisiwe (ama-Prunes)
• Izinhlobo zobhontshisi
• Ama-artichokes
• Amazambane e-Russet
• Imifino eluhlaza okwesibhakabhaka (njengesipinashi, i-kale)

Ukwengeza ukudla okuphelele ekudleni kwakho, ikakhulukazi ukudla okusekelwe ezitshalweni, kuyisimiso esiyinhloko sokudla okulwa nokuvuvukala. Ama-antioxidants ayisizathu esisodwa nje.

Ukudla okungafanele ukudle uma une-pouchitis (ukunciphisa izimpawu):

Ukuze kuncishiswe izimpawu ze-pouchitis, odokotela batusa ukudla okune-FODMAP ephansi, okungenani uze uthole ukuthi yimaphi ama-FODMAP onayo. Ama-FODMAP avamile afaka:

• I-Fructose (ushukela ezithelweni)
• I-Lactose (ushukela obisini)
• U-anyanini
• U-anyanisi omhlophe
• Izinhlobo zobhontshisi
• Ukolweni

Ukudla okune-FODMAP ephansi kuyindlela yokudla yokuqeda ukudla okwesikhashana. Ususa ukudla okuthile ekudleni kwakho, uthole ukuthi yini ekubangelayo, bese ukuphinda ukubuyisele kancane kancane ngaphansi kwesiqondiso sikadokotela.

Ekugcineni, umyalezo okufanele uthathwe ekhaya

Uma unesikhwama se-ileal, ungase ube ne-pouchitis ngesinye isikhathi. Akuwona wonke umuntu oyitholayo, kodwa labo abayitholayo bangase bayithole izikhathi ezingaphezu kwesisodwa. Kungaba yinto ecasulayo ukuba nezinkinga zamathumbu eziqhubekayo ngisho nangemva kokususwa kwenqwaba yamathumbu abo. Izindaba ezinhle ukuthi kubantu abaningi, i-pouchitis iyinkinga eyenzeka ngezikhathi ezithile, futhi kulula kakhulu ukwelapha kunezinkinga zamathumbu ezingamahlalakhona okungenzeka ukuthi babenazo ngaphambili. I-pouchitis engamelana nama-antibiotic (CARP) engamahlalakhona iyinkimbinkimbi kancane. Ngezinye izikhathi, ingahlotshaniswa nesimo samathumbu esingamahlalakhona esivele sikhona. Ukuyelapha kungaba nzima ngendlela efanayo. Kodwa ngokuhlola okuncane, ungathola inhlanganisela yezindlela zokwelapha ezisebenzela abantu abaningi. Khumbula, awuwedwa. Khuluma ngokukhululekile nodokotela wakho bese ubuza noma yimiphi imibuzo onayo. Ngesiqondiso nokwelashwa okufanele, ungaphila kahle nalesi simo.