Uke wahlinzwa ngesikhwama se-ileal, noma mhlawumbe wazi othile oke wahlinzwa? Kwabanye, le nqubo ingaholela esimweni esaziwa ngokuthi 'i-Pouchitis.' Nakuba kungaba nzima kakhulu, asikho isidingo sokwesaba. Kwa-Nirogi Lanka, sifuna ukukusiza uqonde lesi simo ngamagama alula nacacile.
Iyini ngempela i-Pouchitis?
Kalula nje, i-Pouchitis ukuvuvukala ngaphakathi kwesikhwama sakho se-ileal. Ukuze siqonde lokhu, ake sibheke ukuthi siyini isikhwama se-ileal. Kwabanye abantu, izimo ezimbi zamathumbu zidinga ukususwa kwekholoni lonke kanye ne-rectum, inqubo ebizwa ngokuthi 'i-total proctocolectomy.' Ngemva kwalokhu kuhlinzwa, umzimba udinga indlela entsha yokugcina nokususa imfucuza. Yilapho-ke 'isikhwama se-ileal' singena khona.
Odokotela abahlinzayo bakha lesi sikhwama—empeleni idamu elincane langaphakathi—besebenzisa ukuphela kwamathumbu akho amancane, i-'ileum.' Silingisa umsebenzi wekholoni lakho lokuqala kanye ne-rectum ngokubamba imfucuza uze ulungele ukuyikhipha. Lesi sikhwama sibe sesixhunywa endunu yakho, ngokuvamile esime njengesikhwama sika-'J' noma sika-'S', noma kwezinye izimo, sixhunywe embotsheni yokuhlinzwa esiswini eyaziwa ngokuthi 'i-stoma' (isikhwama sika-K). Empeleni, ingxenye yamathumbu akho amancane manje yenza umsebenzi wekholoni lakho.
I-Pouchitis ifana ne-'colitis' (ukuvuvukala kwekholoni) noma i-'proctitis' (ukuvuvukala kwe-rectum), kodwa kwenzeka ikakhulukazi kulabo abanesikhwama se-ileal. Izimpawu ziyafana kakhulu, okuhlanganisa ukuqaqamba kwesisu kanye nesifiso sokusebenzisa indlu yangasese ngokuzumayo. Iningi labantu liba ne-'acute pouchitis,' okuwukuvuvukala kwesikhashana okuphelayo. Kodwa-ke, kwabanye, kungaba yisimo esiqhubekayo noma esiphindaphindayo esaziwa ngokuthi 'i-chronic pouchitis.'
Ivame kangakanani i-Pouchitis?
Kulinganiselwa ukuthi abantu abangu-25% kuya ku-45% abahlinzwa ngesikhwama se-ileal bazobhekana ne-Pouchitis ngesikhathi esithile empilweni yabo. Cishe iziguli ezingu-40% zingase zibe nayo phakathi nonyaka wokuqala, kanti u-10% kuya ku-20% uhlangabezana nezigameko eziphindaphindayo.
Ziyini izimpawu ze-Pouchitis?
Uma une -Pouchitis , ungase uqaphele lezi zimpawu ezilandelayo:
- Ubuhlungu besisu esingezansi kanye nokuqaqamba kwesisu.
- Isidingo esiphuthumayo nesivame ukusetshenziswa endlini yangasese.
- Ukuvuka ebusuku ukuze ulale indle.
- Ubunzima bokulawula ukunyakaza kwamathumbu (ukungakwazi ukuzibamba) noma ukuvuza okuncane.
- Ubunzima bokukhipha indle noma ukukhama (i-dyschezia).
- Umuzwa wokuphuma okungaphelele noma isifiso esiqhubekayo sokuhamba (tenesmus).
- Igazi esitulweni sakho.
- Umkhuhlane noma ukubanda.
Yini ebangela i-Pouchitis?
Ochwepheshe bezokwelapha bakholelwa ukuthi i-Pouchitis ibangelwa kakhulu izinguquko ekulinganisweni kwamagciwane amathumbu ngaphakathi kwesikhwama sakho. Njengoba ingxenye yamathumbu akho amancane manje isebenza njengekholoni, ivezwa ezinhlotsheni ezahlukene zamagciwane. Lawa magciwane amasha angase ancintisane nalawo akhona, okwenza amasosha omzimba wakho aqale ukusabela kokuvuvukala, enze iphutha lokushintsha libe ukutheleleka.
Kwezinye izimo, ukutheleleka kwangempela kungavela. Amabhaktheriya athile abangela izifo avame ukuhlala emathunjini ngamanani amancane, alawulwayo angase aqale ukwanda kakhulu lapho ibhalansi ebucayi iphazamiseka ngemva kokuhlinzwa. Lokhu kuvumela amabhaktheriya 'amabi' ukuba achume, okuholela ekuvuvukeni.
I-pouchitis eqala ekuqaleni, eyenzeka ngokushesha ngemva kokuhlinzwa, ibhekwa njengomphumela ovamile wesikhathi sokuhlinzwa futhi ivame ukusabela kahle kuma-antibiotic. Kodwa-ke, ingabuya. Uma iqhubeka nokubuya, ngokuvamile kungenxa yokuthi amabhaktheriya athile ahlala ekhona. Nakuba abantu abaningi bephumelela ekuphatheni 'i-pouchitis ebukhali' ngezifundo ezimfushane zama-antibiotic, isimo siba nzima kakhulu uma senzeka izikhathi eziningi ngonyaka. Ezinye iziguli zithembela kuma-antibiotic, isimo esaziwa ngokuthi 'i-Chronic Antibiotic-Dependent Pouchitis' (CADP). Abanye bangathola ukuthi ama-antibiotic ayayeka ukusebenza, okubizwa ngokuthi 'i-Chronic Antibiotic-Resistant Pouchitis' (CARP).
Izici ezibangela i-Pouchitis Engapheli, Engamelani Namagciwane (i-CARP):
Kunezici eziningana ezingasiza ekuthuthukiseni 'i-CARP.' Phakathi kwalezi zinto:
- Isifo Sokuvuvukala Kwamathumbu ( IBD ): Uma uke wahlinzwa i-proctocolectomy ukuze welaphe izimo ezifana ne-Ulcerative Colitis noma isifo sikaCrohn , usengozini enkulu yokuthola i-pouchitis. Izici eziyisisekelo ezibangele isimo sakho sokuqala zingathinta impilo yesikhwama sakho.
- Amabhaktheriya amelana nama-antibiotic : Ukutheleleka okuthile kwamagciwane , njengalokho okubangelwa yi-'C. difficile,' kuyamelana nama-antibiotic ajwayelekile. Ukusetshenziswa isikhathi eside kwama-antibiotic kungavumela amabhaktheriya avame ukuba yingozi ukuba akhiqize ukumelana, okuphazamisa ibhalansi ethambile yamabhaktheriya esikhwameni sakho.
- Ezinye izifo: Ngezinye izikhathi, ukuvuvukala esikhwameni sakho kungabangelwa izifo ezibangelwa amagciwane njenge-Cytomegalovirus noma izifo ezibangelwa amagciwane njenge-Candidiasis.
- Ukucindezeleka Kwamasosha omzimba: Uma amasosha omzimba wakho ebuthakathaka ngenxa yezimo ezikhona noma imithi ethile, ukuqina komzimba wakho ngokwemvelo ekulweni nezifo kungase kube sengozini.
- Ukusetshenziswa isikhathi eside kwe-NSAID : Ukusetshenziswa njalo noma ngokweqile kwemithi engeyona eye-steroidal yokulwa nokuvuvukala (ama-NSAID) njenge-Aspirin noma i-Ibuprofen kungalimaza ulwelwesi oluvikelayo lomgudu wakho wokugaya ukudla, okuhlanganisa nolwelwesi lwesikhwama sakho.
- I-Ischemia (Ukunikezwa kwegazi okunciphile): Nakuba kungavamile, ukuvuvukala kungenzeka uma ukugeleza kwegazi endaweni ethile kuvinjelwe, ngokuvamile ngenxa yokuvinjelwa kwemithambo yegazi ehlinzeka ngaleyo ndawo.
- I-Primary Sclerosing Cholangitis (PSC): Lesi yisimo sokuzivikela komzimba lapho amasosha omzimba wakho ehlasela khona amangqamuzana akho aphilile, okubangela ukuvuvukala okungapheli kwemigudu ye-bile. Njenge-IBD, izindlela eziphilayo ezibangela lokhu kuvuvukala okungapheli nazo zingathinta isikhwama sakho, zandise ingozi yakho yokuthola i-pouchitis.
Yiziphi izinkinga ezingaba khona ngenxa ye-pouchitis?
I-pouchitis ebukhali ayivamile ukuholela ezinkingeni ezinkulu. Kodwa-ke, i-pouchitis eqhubekayo noma engamelani nokwelashwa ingaba yinselele. Izinkinga ezingaba khona zifaka:
- Izinguquko emikhubeni yokuthulula: Ukuvuvukala esikhwameni kungenza kube nzima ukulawula ukunyakaza kwamathumbu, kanti ukuvuvukala kungenza kube nzima ukukhipha amathumbu akho ngempumelelo, kuthinte imisebenzi yakho yansuku zonke.
- Ukwehla kwezinga lempilo: Ukuphila nezinkinga zamathumbu ezingamahlalakhona kungaba nzima ngokomzimba nangokomzwelo, okuvame ukuphazamisa impilo yakho yokuxhumana nabantu kanye nenhlalakahle yakho iyonke.
- Ukuqina kwesikhwama:Ukuvuvukala okungapheli kungaholela ekuqhekekeni, okungabangela ukuthi indawo yokukhipha isikhwama inciphe. Lokhu kungaphazamisa nokujikeleza kwegazi endaweni, kuvimbele inqubo yokuphulukisa yemvelo.
- Ukuguguleka kolwelwesi: Ukuvuvukala kwesikhathi eside kungaguguleka ulwelwesi lwangaphakathi lwesikhwama, okungase kuholele ezilondeni ezingase ziphume igazi. Amagciwane abangela izifo angalimaza kakhulu udonga lwamathumbu.
- Ukungamuncwa kahle kanye nokungondleki kahle: Uma ulwelwesi lwesikhwama lonakele, ikhono lomzimba wakho lokumunca izakhamzimba ekudleni liyancishiswa, okungaholela ekungondlekini kahle.
- Ukwehluleka kwesikhwama: Ezimweni ezinzima neziqhubekayo lapho ukwelashwa kungasebenzi kahle, isikhwama singase singasasebenzi. Lokhu kungadinga ukuhlinzwa okwengeziwe ukuze kususwe isikhwama futhi kuqondiswe kabusha amathumbu nge-ileostomy.
Itholakala kanjani i-pouchitis?
Ukuxilongwa kuqala ngengxoxo eningiliziwe yezimpawu zakho kanye nomlando wezokwelapha. Udokotela wakho cishe uzohlola ingaphakathi lesikhwama sakho esebenzisa i -endoscope —ithubhu elincane neliguquguqukayo elinekhamera encane. Lokhu kubavumela ukuthi babone ukuvuvukala noma noma yikuphi ukukhubazeka. Phakathi nale nqubo, bangase benze ne-biopsy (ukuqoqa isampula encane yezicubu) ukuze bathole imbangela eyisisekelo yezimpawu zakho.
Udokotela wakho angase asebenzise nokuhlolwa kwezithombe ukuhlola isakhiwo sangaphandle sesikhwama kanye nezindawo ezizungezile, okusiza ekuvimbeleni ezinye izimo ezikhona kanye.
Ukuhlolwa okwengeziwe kokuxilonga kungafaka:
- I-pouchography yokuhlukanisa (i-pouchogram): I-X-ray ekhethekile lapho kusetshenziswa khona uketshezi lokuhlukanisa ukuze kuchazwe kahle isikhwama, njenge-barium enema, kodwa ikakhulukazi esikhwameni se-ileal.
- I-CT scan.
- Ukuskena kwe-MRI.
Iphathwa kanjani i-pouchitis?
Ukwelashwa kokuqala kwe-acute pouchitis yinkambo yama-antibiotic yamasonto amabili , exazulula ngempumelelo izimpawu zeziguli eziningi. Uma isimo sakho singathuthuki, udokotela wakho angase alungise imithi yakho, ahlanganise ama-antibiotic ahlukene, noma andise isikhathi sokwelashwa. Uma izimpawu ziqhubeka ngaphezu kwamasonto amane, ungase utholakale une-pouchitis engamelana namagciwane, okudinga uphenyo olwengeziwe lokuxilonga ukuze kutholakale indlela engcono kakhulu yokuqhubekela phambili.
Kuthiwani nge-pouchitis ephindaphindayo?
Uma ululama ku-pouchitis ebukhali kodwa izimpawu zibuya, udokotela wakho cishe uzophinda ukwelashwa kokuqala okusebenzayo. Uma nje ukwelashwa kusebenza futhi ukuqubuka kwesikhumba kungavamile, le ndlela ihlala iyindinganiso. Kodwa-ke, uma uhlangabezana neziqephu ezingaphezu kwezintathu ngonyaka, ihlukaniswa ngokuthi 'i-pouchitis encike kuma-antibiotic,' futhi udokotela wakho uzoshintshela ekwelashweni kokunakekelwa kwesikhathi eside ukuze avimbele ukuqubuka kwesikhumba okuqhubekayo.
Izindlela zokwelapha zokulungisa zingafaka:
- Ama-antibiotic: Ukusetshenziswa isikhathi eside kwama-antibiotic anesilinganiso esincane kungasiza ekugcineni isikhwama siphilile futhi kuvimbele ukuphindaphinda kwaso.
- Ama-Probiotic: Lezi yizithasiselo eziqukethe amabhaktheriya awusizo asiza ekubuyiseleni ibhalansi enempilo esikhwameni sakho futhi alwe namabhaktheriya abangela izifo.
Yiziphi izindlela zokwelapha i-pouchitis (CARP) engapheli, engamelani namagciwane?
Uma i-pouchitis yakho ingakaze isabele kuma-antibiotic, noma uma ike yasabela ngaphambilini kodwa ingasaphenduli, odokotela bayibiza ngokuthi i -Chronic Antibiotic-Resistant Pouchitis (CARP) . Ezimweni ezinjalo, udokotela wakho uzoqala aphenye izici eziyisisekelo okungenzeka ukuthi awuzange uzibone, njengokutheleleka kwesibili, isimo sokuzivikela komzimba, noma inkinga yesakhiwo ngesikhwama. Uma kungekho sizathu esicacile esitholiwe, bazophatha i-pouchitis engamahlalakhona ngendlela esiphatha ngayo i-Inflammatory Bowel Disease (IBD).
Amanye amasu okwelapha angaba khona afaka:
- Ama-enema e-Mesalamine:I-Mesalamine, noma i-5-aminosalicylic acid (5-ASA), iyindlela yokwelapha yokuqala ye-ulcerative colitis. Iza ngesimo se-enema, ongayifaka ngqo esikhwameni sakho.
- I-Bismuth enemas: I-Bismuth subsalicylate, isithako esisebenzayo ku-Pepto-Bismol®, sitholakala njenge-foam enema (i-bismuth carbomer), engasiza ekunciphiseni izimpawu zakho.
- Ama-Corticosteroids: Le yimithi yokulwa nokuvuvukala esetshenziselwa ukwelapha ukuvuvukala okungapheli.
- Ama-immunosuppressants: Le mithi inciphisa impendulo yesimiso sakho somzimba, odokotela abayinikezayo lapho isimiso sakho somzimba somzimba sibangela ukuvuvukala okungapheli.
- Ama-antibodies e-Monoclonal (Biologics): Lawa ngamaprotheni enziwe ngabantu asebenza njengama-antibodies emvelo omzimba wakho, akhulisa impendulo yesimiso sakho somzimba ekulweni nokuvuvukala.
- Ama-molecule amancane: Lena imithi emisha, yokwenziwa esebenza ngendlela efanayo nama-antibodies e-monoclonal.
- Ukufakelwa Kwe-Fecal Microbiota (FMT): Nakuba kuvunyelwe yi-US FDA ukwelapha izifo ze-C. diff ezingamelani namagciwane, ngezinye izikhathi kusetshenziswa ngaphandle kwelebula le-pouchitis engamelana namagciwane ukusiza ukubuyisela i-microbiome yamathumbu enempilo.
Kuthatha isikhathi esingakanani ukuthi i-pouchitis iphole?
Izimpawu ze-acute pouchitis zivame ukuqala ukuphela zingakapheli izinsuku ezimbalwa kusukela uqala ukusebenzisa ama-antibiotic. Kodwa-ke, noma ngabe uzizwa ungcono, kubalulekile ukuqeda inkambo ephelele yama-antibiotic yamasonto amabili.
Kufanele ulandelele udokotela wakho ngemva kokuqeda ukwelashwa. Kungase kudingeke benze ukuhlolwa kwe-endoscopic kwesikhwama sakho ukuqinisekisa ukuthi ukuvuvukala sekuphelile ngokuphelele.
Ingabe i-pouchitis ingavinjelwa?
Ubufakazi obuthile busikisela ukuthi ama-probiotic angasiza ekuvimbeleni ukuqala kwe-pouchitis ngemuva kokuhlinzwa noma ukuvimbela ukuphinda kwenzeke ngemva kokwelashwa okuphumelelayo. Nakuba engasebenzi kuwo wonke umuntu, angase abe yinzuzo kuwe. Odokotela ngezinye izikhathi banikeza ingxube ethile yama-probiotic (isb., ifomula ye-DeSimone). Ngenxa yokuthi uhlobo oluthile lubalulekile, kubalulekile ukuxoxa ngalokhu nodokotela wakho.
Yini ongayilindela uma unesifo se-pouchitis?
Uma uba ne-pouchitis ngemuva kokuhlinzwa kwesikhwama sakho se-ileal—noma ngabe kwenzeka kaningi—kunethuba elikhulu lokuthi izosabela ngempumelelo kuma-antibiotic. Abanye abantu bangadinga inkambo ende yama-antibiotic kunabanye. Uma ubhekana nokuphindaphinda njalo, ungadinga ukwelashwa kwesikhathi eside kokunakekelwa ngama-antibiotic noma ama-probiotic. Kubantu abambalwa abane-pouchitis, lokhu kwelashwa kungase kungasebenzi.
Uma uqhubeka nokuhlupheka nge-pouchitis eqhubekayo engaphenduli kuma-antibiotic, udokotela wakho uzohlola izimbangela ezifihliwe zokuvuvukala, njenge-ischemia, ukusetshenziswa kwe-NSAID, noma isifo esizimele esiyisisekelo. Uma kungatholakali imbangela yesibili, izohlukaniswa njenge-CARP. Odokotela bazophakamisa izinketho ezahlukene zokwelapha ze-CARP, besebenzisana nawe eduze ukuthola ukuthi yini esebenza kahle kakhulu esimweni sakho esithile.
Kwezinye izimo, uma umthwalo wokuphatha isikhwama udlula izinzuzo, ungakhetha ukususa isikhwama ukuze uphile ungenazo izimpawu. Lokho futhi kuyindlela efanelekile.
Ingabe ukudla kuyayithinta i-pouchitis?
Yebo, kungadlala indima.
Ubufakazi obuthile busikisela ukuthi uma ukudla kwakho kunamafutha amancane okulwa nezifo ezilwa nezifo, ingozi yakho yokuba ne-pouchitis inganda. Ama-antioxidants, atholakala ngokwemvelo ezithelweni nasemifino eminingi, asiza ekunciphiseni amakhemikhali emzimbeni wakho abizwa ngokuthi 'ama-free radicals.' Lapho ama-free radicals eqoqana, angalimaza amangqamuzana futhi afake isandla ekuvuvukeni. Ama-antioxidants avela ekudleni asebenza kakhulu kunalawo avela ezithasiselo.
Ngakolunye uhlangothi, uma okwamanje unezimpawu ze-pouchitis, ukunciphisa i-fiber yokudla kungasiza. Odokotela bavame ukuncoma ukudla okungenayo i-FODMAP eningiLokhu kunciphisa ukudla okuthile—kufaka phakathi imicu ethile—okuthandwa yibhaktheriya yakho yamathumbu. Ukunciphisa lokhu kudla okwesikhashana kungasiza ekunciphiseni izimpawu zakho zesisu. Kodwa-ke, isikhathi eside, kufanele uhlose ukuvuselela kancane kancane ukudla okuhlukahlukene.
Ukudla okungasiza ekusekeleni impilo yesikhwama sakho:
Qinisekisa ukuthi uthola ama-antioxidants anele ngokudla izinhlobo ezahlukene zezithelo nemifino. Imithombo emihle ifaka:
- Ama-apula
- Amajikijolo (isb., ama-strawberry, ama-blueberry)
- Amagilebhisi
- Ama-Prunes
- Ubhontshisi
- Ama-artichokes
- Amazambane e-Russet
- Imifino eluhlaza okwesibhakabhaka (isib. isipinashi)
Ukufaka ukudla okuphelele, ikakhulukazi okukhethwa kukho okusekelwe ezitshalweni, ekudleni kwakho kuyisimiso esiyisisekelo sendlela yokuphila yokulwa nokuvuvukala. Ama-antioxidants ayisizathu esisodwa nje.
Ukudla okufanele ukugweme ngesikhathi sokuqubuka kwe-pouchitis (ukunciphisa izimpawu):
Ukuze kuxazululwe izimpawu zakho, odokotela bangase batuse ukudla okune-FODMAP ephansi, okungenani uze uthole ukuthi yimaphi ama-FODMAP abangela izinkinga zakho ezithile. Ama-FODMAP avamile afaka:
- I-Fructose (ushukela wezithelo)
- I-Lactose (ushukela wobisi)
- U-anyanisi
- Ugaliki
- Ubhontshisi
- Ukolweni
Ukudla okune-FODMAP ephansi kuyindlela yokuqeda isikhashana. Ususa okwesikhashana amaqembu athile okudla ukuze uthole izimbangela zakho bese, ngaphansi kwesiqondiso sezokwelapha, uwabuyisela kabusha ngendlela ehlelekile.
Ukuthatha Kokugcina
Uma unesikhwama se-ileal, kungenzeka ukuthi ungase ube ne-pouchitis ngesinye isikhathi. Nakuba ingathinti wonke umuntu, labo abayitholayo bangase babhekane nezigameko eziphindaphindayo. Kuyaqondakala ngokuphelele ukuzizwa ukhungathekile lapho izinkinga zokugaya ukudla ziqhubeka ngisho nangemva kokuba ikholoni lakho selisusiwe. Kodwa-ke, izindaba ezinhle ukuthi kubantu abaningi, i-pouchitis iyisithiyo esivame ukwenzeka esilula kakhulu ukusilawula kunezimo zamathumbu ezingamahlalakhona okungenzeka ukuthi wawuzibekezelele esikhathini esidlule.
I-pouchitis engamelana nama-antibiotic (i-CARP) engapheli iyinkinga enzima kakhulu. Kwezinye izimo, ingase ihlotshaniswe nesifo sakho samathumbu esingamahlalakhona esiyisisekelo, okwenza indlela yokwelapha ibe nzima kakhulu. Noma kunjalo, ngokunakekelwa okuqhubekayo kanye nesu elilungiselelwe wena, ithimba lakho lezokwelapha lingathola inhlanganisela ephumelelayo yokwelashwa okukusebenzelayo.
Sicela ukhumbule ukuthi awuwedwa kulolu hambo. Sikukhuthaza ukuthi ukhulume ngokukhululekile nodokotela wakho futhi ubuze noma yimiphi imibuzo ongase ube nayo. Ngesiqondiso nokwelashwa okufanele, iNirogi Lanka ilapha ukuzokusekela ekugcineni impilo yakho isezingeni eliphezulu.
