Izifo ze-Ulcer Disease

Ingqwalaselo yee-Peptic Ulcer Disease

Isifo sesilonda se-Peptic sisifo esiqhelekileyo sokugaya okungekho nje kuphela esingenza ubomi bukhulu kakhulu, kodwa kunokufumana nemiphumo emibi. Uphuhliso olutshanje-ngokukodwa ulwazi olutsha malunga nezizathu kunye nokunyanga-luye lwaguqula ukunakekelwa kwesifo sezilonda zesilonda. Ukuba wena okanye othandekayo unesifo sesilonda sesilonda, kufuneka uqiniseke ukuba uqaphela ulwazi olutshanje kule ngxaki eqhelekileyo.

Liyiphi i Ulcer?

Isilonda sesipilisi kukukhukhula kwesibonda sesisu okanye i-duodenum (inxalenye yokuqala yesisu esincinci). Ezi zilonda zibizwa ngokuba yi "peptic" zilonda ngenxa yokuba zihambelana nomsebenzi we-asidi kunye ne-pepsin (i-enzyme ebalulekileyo ye-digestive) kwiiseli ezihamba ngesisu kunye ne-duodenum.

Isilonda sesipilisi esisendaweni esiswini sisithi isilonda esiswini. Ukuba ku-duodenum kuthiwa isilonda se-duodenal.

• Ukutya okulungileyo nokubi kwezilonda ze-Ulcers

• Ngaba Uzibeka Kwi-Ulcer?

Iimpawu ziyahlukahluka phakathi kwezi ntlobo ezimbini zezilonda zamathambo kwaye ugqirha wakho unokubaphatha kakubi. Oogqirha babona abantu abanezilonda zepilisi rhoqo. Ngaliphi na ixesha elithile, ukuya kwipesenti enye yabantu emhlabeni wonke baya kuba nesilonda se-peptic.

Iimpawu zesilonda se-peptic ziba nzima kakhulu. Okubi kakhulu, ezi zilonda zingakhokelela ekubalulekileyo, mhlawumbi iziphumo ezisongela ubomi. Ngethamsanqa, kubantu abaninzi banokuphulukiswa kunye noxinzelelo olunzima lunokuphetshwa ngonyango olufanelekileyo lwezonyango kunye namanyathelo okukhusela izilonda eziphindaphindiweyo.

Iimpawu

Uphawu oluyinhloko lwesilonda se-peptic sisifo sesisu .

Uninzi lwabantu luya kuchaza intlungu okanye umlilo ovuthayo ovame ukufumaneka emhadini yesisu okanye ngaphantsi kwembambo ngaphantsi kwinqanaba elungileyo okanye lasekhohlo.

Umzekelo weentlungu zesisu unokuxhomekeka kwindawo yokulonda. Ngezilonda zesisu, iintlungu zidla ngokugqithiseleyo ngesidlo kwaye, ngamanye amaxesha, umntu onesilonda esiswini (mhlawumbi angaziqondi kakuhle) unqande ukutya kwaye aze alahlekelwe ubunzima.

Ngokwahlukileyo, izilonda zomzimba zivame ukuvelisa intlungu phakathi kwesidlo xa isisu singenalutho-intlungu ihlala ikhululekile ngokutya into ethile. Abantu abanesilonda se-duodenal bavumi ukulahlekelwa isisindo kwaye banokwenene.

Ukuba isilonda se-peptic siyaba sikhulu ngokwaneleyo, sinokungena kwisitya segazi kunye nokuvelisa igazi. Oogqirha bathi le "i- GI ephezulu " iphuma kwi-site yokuphuma kwamanzi kwinqanaba lezintlu zesisu. Iimpawu ze-GI yegazi ephezulu zinokuba zinzima kakhulu kwaye akunakwenzeka ukungahoywa, njengokuhlanza igazi elibomvu elibomvu.

Ngakolunye uhlangothi, ukuba ukuphuma kwegazi kuphuculwa , iimpawu zingaba zifihlakele kwaye zingabandakanyeka ukuhamba buthathaka (ukususela kwi- anemia ), ukuzondloba , ukubethelwa kwintliziyo (ukusuka kwizinga lentliziyo elikhawulezayo), ukuxinwa kwesisu (kubangelwa igazi elihamba, kwaye ecasulayo, amathumbu), kunye ne- melena okanye i-tarry stool (ebangelwa inkqubo yokugaya igalelo egazini kwi-intestinal tract).

Isilonda sesigxina esisendaweni yesisu kunye ne duodenum (indawo ebizwa ngokuba ngumzila we-pyloric) kunokubangela ukuvuvukala ngokwaneleyo kwisithambiso esiswini ukuze kuveliswe umqobo. Ukuba kunjalo, iimpawu zingabandakanya ukuqhaqhaqhaqha, ukunyanzelisa, ukuhlanza, kunye nokulahleka kwesisindo. Abantu abanezilonda zezilonda zamapulisi banethuba eliphezulu lokuphuhlisa isifo se-reflux (GERD) kunye neempawu ezinxulumene nayo, ingakumbi i- heartburn .

Nangona isilonda se-peptic senza ukuba kubekho iimpawu ezininzi ezahlukileyo, inani elimangalisa labantu abanezilonda zezilonda (mhlawumbi ukuya kuma-50 ekhulwini) alinakubona nayiphi na impawu. Ngelishwa, ezinye izilonda ezingapheliyo ngokuvelisa iimpawu zingabangela iingxaki ezinkulu.

Funda ngokubanzi malunga neempawu zezilonda zesilonda.

Iingxaki

Ukuba kuphela into eyenziwa yizilonda zezilonda zamapulpers eyenziwa kukuba kubangele ubuhlungu besisu, abanokuthi bangabonwa ngxaki enjalo. Kodwa, njengoko sele sibonile, banokwenza okungaphezulu koko!

Iingxaki eziphambili zesifo sezilonda zesilonda ziquka:

• Ukuhlamba. Le ngxaki eqhelekileyo yesifo sesilonda sesilonda. Ukuphuma kwegazi kunganciphisa kwaye kunokuba kuphazamise okanye kukwazi ukukhulula ngokukhawuleza. Ngokuphawulekayo, isilonda esisinyukayo esingazange saziwayo singagqitywa ngokugqithiseleyo-xa sithe siphumelele kwisitya segazi.
• Isithintelo sokukhupha isisu. Le meko-ukukhutshwa kwintlanganiso yesisu kunye ne-duodenum-kunokubangelwa sisilonda esisigxina se-peptic isilonda okanye sisifo esingasigxina ngenxa yesilonda se-peptic. Ukuba ukuvinjelwa kunzima, okanye ukuba isithintelo esilinganiselweyo singasombululwanga emva kwexesha elifanelekileyo leyeza unyango, unyango oluchanekileyo lunokuba luyimfuneko.
• Ukugqithiswa. Ukuba isilonda se-peptic sigxotha ngokupheleleyo udonga lwesisu okanye i-duodenum, kunokubangela ukugqithisa. I-perforation inokuvumela i-acid isisu ukuba ivule kwisisu esiswini, kubangele ubuhlungu besisu esiswini kwaye ngamanye amaxesha ukutshitshiswa . Ukuguqulwa kwesilonda sesigulane sinesimo esisongela ubomi. Unyango udinga unyango otyando.

• Iimpawu zezilonda ze-Ulcers

• Ziziphi Iintlobo Zophando Lwezilwanyana Zase-Peptic Ulcers?

• Fistula. Isilonda se-peptic singaphinde siphumelele kwisiguli esiswini esiseduze kwaye senze i-fistula (oko kukuthi, uxhumano) phakathi kwesisu okanye i-duodenum kunye nesakhiwo esiseduze. I-fistula inokwenza kunye nekoloni, umthi we-biliary, i-pancreas, okanye isitya esikhulu segazi. Ngokuxhomekeke kwiliphi iqumrhu elibandakanyekayo, iimpawu ziyahlukahluka ekuhlanjuleni izinto eziphathekayo kwiimpawu ezinzima, ezikhulu okanye ezibulalayo. Kuyafana nokugqithiswa, unyango olugqithwayo lufunekayo kunyango.

Funda ngokubanzi kwiingxaki zezilonda zesilonda.

Izizathu

Kwimeko eninzi yeziganeko, izilonda zamapulpus zibangelwa enye yezinto ezimbini:

1. Usulelo lwebhaktiriya ebizwa ngokuba nguHelicobacter pylori (H. pylori)
2. Ukusetyenziswa okungapheliyo kwezidakamizwa ezingekho-steroidal ezichasayo (i-NSAIDS)

Ukuqonda ukuba i-H. pylori izifo zijongene nokuba uninzi lwesifo sesilonda sesinye isinye sezona nkqubela phambili zonyango kwiminyaka embalwa edlulayo. Ukusuleleka kwintsholongwane kaHl pylori kuqheleke kakhulu. Iingqinisiso kukuba ubuncinane ama-50 ekhulwini kubo bonke abantu baneHl pylori kumaphecana abo asezantsi. Kwaye kukholelwa ukuba oku kuye kwimeko kwimbali yabantu.

Uphando lubonisa ukuba iHl pylori inokubangela ukuba abantu babe nezilonda eziphambili ngeendlela ezahlukeneyo, kuquka:

• Ukwandisa ukukhutshwa kwesisu esiswini
• Kubangela ukuvuvukala
• Ukunciphisa iindlela zokukhusela zesisu
• Ubangela amangqamuzana omzimba (okuyi-secrete acid kunye ne-pepsin) ukukhula kwimbombo ye-duodenum

Usulelo lwe-H. pylori luqheleke kakhulu kubantu abanesifo sesilonda sezilonda. Phantse iipesenti ezingama-75 zezilonda ze-peptic e-US zinxulumene nale ntsholongwane-kwaye inani liphakamileyo kweli hlabathi elingalulwanga. Ukumisa uHlyl pylori yinto ebalulekileyo yonyango ye-peptic isifo sesilonda.

Ukusetyenziswa okungapheliyo kwe-NSAID, kuquka i-aspirin, kwandisa umngcipheko wezilonda zepilisi nge-20. Abasebenzisi be-NSAID nabo baneHl pylori (iqela, kwakhona, libandakanya ngaphezu kwesigamu sabo bonke abantu) banokunyuka kwama-60 kwi-peptic isifo sesilonda.

Ii-NSAID zicingelwa ukuba zandise umngcipheko wezilonda zezilonda ze-peptic ulmers ngokuvimbela i- COX-1 receptor kwisigxina esiphezulu sesisu. Ukuvinjelwa kwe-COX-1 kunciphisa ukuveliswa kwee-prostaglandines ezahlukahlukeneyo ezisebenzela ukukhusela umbane wesisu kunye ne-duodenum. (I-NSAID ezingavimbeli i-receptor ye-COX-1 iye yaphuhliswa, kodwa ezi zifumene idumela elibi ngenxa yokunyuka okubonakalayo kwiingxaki zentliziyo.)

Funda kabanzi malunga ne-NSAID kunye nentliziyo .

Abantu abangenabo H. pylori banakho ukuvelisa izilonda ze-peptic, ngakumbi xa zisebenzisa ii-NSAID. Abantu abangasebenzisi ii-NSAID bangahlakulela izilonda ze-peptic, ingakumbi ukuba bane-H. pylori. Kodwa abantu abanezi zinto zineengozi eziphezulu kakhulu zesifo sezilonda zesilonda.

Ngoxa i-H. pylori kunye ne-NSAID i-akhawunti yeyona nto isifo sesilonda sesilonda, kukho nezinye iimeko ezinokuba nazo. Ezi ziquka:

• Ezinye iziyobisi (ngakumbi i-steroids, i- clopidogrel , i- spironolactone , i-SSRI, i-cocaine, i-methamphetamine, kunye ne- acetaminophen )
• I-Chemotherapy kunye neyeza
• Iimvumi ezihlukahlukeneyo kuquka i- Zollinger-Ellison syndrome kunye ne- carcinoid syndrome
• Ezinye izifo, kuquka i-herpes simplex kunye ne-cytomegalovirus
• Izifo ezivuthayo ezifana nesarcoidosis kunye nesifo sikaCrohn
• Utywala basebenzisa
• Ukutshaya
• Isifo somgubo we-peripheral esichaphazela imirhobho esinika isisu okanye i-duodenum
• Ubunzima bokutya

Nangona usenokuba ulivile ngayo yonke impilo yakho, akukho bukho ubungqina bokuthi ukutya nayiphi na uhlobo lokutya okuthe ngqo, njengokutya okucoca, kubangela isifo sesilonda sezilonda. Unokufumanisa ukuba, ngokwaloo nto, ukutya ukutya okunokuthi kunokuzisa ukuguquka, ukunyanzelisa okanye ezinye iimpawu zesisu-kwaye ukuba kunjalo, kufuneka uziphephe. Kodwa uyaziphepha ukuze uzive ungcono, kungekhona ukukhusela isifo sesilonda se-peptic.

Ngokufanayo, iingcali ngoku zichithekisa ukuba izilonda zibangelwa yi-acute okanye ingcinezelo yengqondo engapheliyo, njengokujongana nomphathi othukutheleyo, ngaphandle kokuba uxinzelelo lukhokelela ukuba ubheme, uphuze okanye uphawule i-Advil.

Funda ngokubanzi malunga nezimbangela zezilonda zesilonda.

Ukuxilongwa

Uvavanyo lokuxilonga lwe-peptic isifo sesilonda unenjongo ezimbini ezihlukeneyo:

1. Ukuseka ubukho okanye ukungabikho kwesilonda sezilonda
2. Ukuhlola imbangela yesilonda, ukuba kukho

Ukuba iimpawu zakho zincinci, ugqirha wakho unokukubeka kwinqanaba lonyango ukuvimba isisu esiswini. Ukuba iimpawu zakho ziyahamba kwaye awuyi kubuya emva kwalolu mqathango olula, onokubakho konke okukhoyo kuwo. Nangona kunjalo, ukuba iimpawu zakho zibuhlungu ngokwemali, okanye ukuba iimpawu zakho zibuyela emva kwekhosi efutshane emfutshane, ngokuqhelekileyo yinto efanelekileyo yokwenza i-diagnosis. Namhlanje, oku kwenziwa ngokuchanekileyo kwaye ngokuchanekileyo kunye nenkqubo yokugcina i- endoscopy .

Nge-endoscopy, ityhubhu eguquguqukayo equkethe i-fiberoptic system idluliselwa kwisisu kunye nesisu-kwaye isalathisi sesisu ne-duodenum iboniswe ngokuthe ngqo. I-Endoscopy iyakhawuleza kwaye ichanekile. Ukongezelela, ukuba isilonda sinobukhulu, ubunzima bayo bubanzi buya kuvavanywa kwaye buya kuhlolwa malunga nayiphi na impawu yokuziphatha kakubi-kwimeko apho i-biopsy ingathathwa. I-biopsy inceda kakhulu ekufumaneni ukuba uHl pylori ukhona.

Izifundo ze-GI ze-X eziphezulu , usebenzisa i-barium egxininisiweyo ukudala ukungafani, zingasetyenziselwa ukuxilonga izilonda zamapulp. Nangona kunjalo, lo vavanyo luchanile kakhulu kunokuba lube ne-endoscopy, kuthatha ixesha elide, kwaye aluboneleli ithuba lokuhlaziya i-malignancy okanye uHl pylori. Kwakhona kubandakanya ukunyuka kwamafutha. Ngenxa yezi zizathu, i-ray-ray ayisasetyenziswa ngokuqhelekileyo ukuxilonga isifo sesilonda.

Ukuba i-ulcer peptic ifunyaniswe, kubalulekile ukuvavanya ukuba isifo sikaHl pylori sikhoyo kwaye ingaba ii-NSAID zingaba yinto. Le ngcaciso ibaluleke kakhulu ekunqumeni ngokuphathelele unyango olufanelekileyo.

Indlela eyona ndlela yokufumana uHlpylori inesiphelo esithe senziwa ngexesha lokugcina i-endoscopy. Ngaphandle koko, uvavanyo lokuphefumla urea lungasetyenziswa. H. pylori uyimfihlo i-enzyme urease ephumela ekugqibeleni i-urea-engabonwa ngomoya. Ukuvavanywa kwegazi kunye nokuvavanywa kwe-stool kungasetyenziselwa ukufumanisa uHl pylori.

Ngenxa yokuba ii-NSAID (kunye ngamanye amayeza nezinye iindidi) zidlalwa indima ebalulekileyo ekuphuhlisweni kwezilonda zesilonda, kubalulekile ukunika ugqirha wakho i-akhawunti epheleleyo ngayo yonke imichiza oyisebenzisayo, umyalelo okanye i-counter-counter-counter.

Ukuba unesilonda se-peptic kwaye ungenayo i-H. pylori ukusuleleka okanye ukusetyenziswa kwe-NSAID, ugqirha wakho angadinga ukwenza uphando olongezelelweyo lwezonyango, efuna ezinye iimbangela ezingundoqo. Kwisixa esikhulu sabantu abanesifo sezilonda zesilonda, kunjalo, oku akuyimfuneko.

Funda kabanzi malunga nokufumanisa izilonda zamapulp.

Unyango

Kwiimeko ezininzi, izilonda zamapulp zingaphathwa ngempumelelo ngonyango. Ngokubanzi, unyango lwezokwelapha luquka izinto ezintathu:

1. Ukuphelisa H. pylori
2. Ukunika iproton pump inhibitor (PPI) yonyango
3. Ukushiya izinto ezibangela izilonda

Ukuba ukuvavanya kukuhle ku-H. pylori, isitshixo ekupileni ngempumelelo isifo sesilonda sesilonda kukukhupha intsholongwane ngekhosi yamayeza. Ngokuqhelekileyo, ii-antibiotics ezimbini ezahlukeneyo zisetyenziselwa iintsuku ezisixhenxe ukuya kwezi-14-ngokuqhelekileyo i-clarithromycin, i-metronidazole, kunye ne-amoxicillin.

Kubalulekile ukuphinda ukuvavanywa kweH. H. pylori emva kwekhosi ye-antibiotics ukuba ibhale ukuba isifo siphelile. Ukuba akunjalo, enye inkqubo yokonyango, ukusebenzisa iziyobisi ezahlukeneyo okanye iifayili ezahlukeneyo, kuya kufuneka. Ukungaphumeleli ukuphilisa isilonda, kunye nezilonda eziphindaphindiweyo, kunokwenzeka kakhulu kubantu abanokutheleleka ngokwaneleyo ku-H. pylori.

Ukuphulukiswa kwezilonda kunakho ukukhuthazwa ngokukhubaza ukukhutshwa kwesisu esiswini. Xa kukho isilonda septic, le nto iyenziwa ngokusetyenziswa kwePPI, njenge- esomeprazole (Nexium) , i-pantoprazole (Prevacid), i- omeprazole (Prilosec) , okanye i-rabeprazole (AcipHex). Ukunciphisa i-asidi esiswini asinceda kuphela isilonda ukuphilisa kodwa kwenza i-antibiotics isebenze ngakumbi kwiHl pylori. I-PPI unyango luqhubela phambili kwiiveki ezisibhozo ukuya kwezi-12 kubantu abanezifo zesilonda esiswini.

Ukongezelela ukuphepha zonke i-NSAID, nabani na isilonda se-peptic kufuneka bayeke ukutshaya nokunciphisa utywala ngaphandle kokusela olunye ngosuku (ukuba oko).

Emva kokuba kuthathwe i-antibiotics, i-H. pylori yapheliswa, iiveki ezisibhozo ukuya kwe-12 zonyango lwe-PPI, kunye nokuphelisa ama-offensive agents ezifana ne-NSAID, amathuba okuphilisa ngokupheleleyo isilonda se-peptic ziphezulu-ngokubanzi ngaphezu kwama-90-95 ekhulwini. Ngaphezu koko, umngcipheko wesilonda esiphindayo siphantsi.

Nangona kunjalo, ukuba uH. H. pylori akapheli-okanye ukuba uqhubeka (okanye uqale) usebenzisa i-NSAIDS, ukutshaya okanye ukuchitha amaninzi otywala-kukho ithuba elihle kakhulu ukuba isilonda singaphumeleli ukuphilisa okanye siya kubuya.

Uninzi lweengcali zincoma ukuphinda i-endoscopy emva kokunyangwa kwesilonda sesisu sokuqinisekisa ukuba ukuphilisa kuphelile. Izilonda zamathumbu ezinamaxesha athile ziba kwindawo yesifo somhlaza wesisu- nokuba oko kubalulekile ukubonelela indawo emva kwonyango ukuqinisekisa ukuba isayithi eliphilileyo liqhelekile. Ngokuqhelekileyo akukho mfuneko yokuphinda i-endoscopy emva kokonyangwa kwesilonda esisisigxina.

Isilonda sesipilisi esingaphilanga emva kweveki ezili-12 ze-PPI unyango libizwa ngokuba yi-"refractory" ulcer. Ukuba unesilonda esichasayo ngaphezulu kwesinye iiveki ezili-12 ze-PPI unyango:

• Unokuthi ube nelinye i-endoscopy enee-biopsies ezininzi, ukhangele ukusuleleka kweH H. pylori, kwaye uqinisekise ukuba akukho mqondiso wesifo.
• Unokufuneka ufumane uncedo olungakumbi lwezokwelapha olukhangela izizathu ezingavamile zezizathu zesifo sezilonda zesilonda.
• Umele ulindele ugqirha wakho ukuba enze uphando olunzulu lweempawu zakho malunga nokusetyenziswa kwe-NSAID, ukutshaya, ukusela, kunye naliphi na ukusebenzisa ezinye iziyobisi.

Konke oku kuyimfuneko. Ukufumana indlela yokunyanga isilonda esibangelisayo kubaluleke kakhulu, ekubeni abantu abanezilonda ezingabonakaliyo banokuthi bahlakulele enye yeengxaki ezinobungozi zesifo sezilonda zesilonda.

Ndidlulileyo, unyango lwe-peptic isifo sasisigxina. Nangona kunjalo, ekubeni iHl pylori yafunyanwa ukuba ibaluleke kakhulu kwaye ibangele ibangele-kwaye ekubeni izidakamizwa ezinamandla zePPI zaphuhliswa-utyando luye lungafaneli luyimfuneko.

Ukuphanda ngoku kuyafuneka ngokukodwa kwizilonda ezibonakalisa ngokupheleleyo ukukhankanya unyango, zikhankanywa ukuba zinobuhlungu, okanye njengonyango lweengxaki zesifo sesilonda, njengegazi lokukhupha, ukuphazamiseka, ukuphazamiseka, okanye ukubunjwa kwe-fistula.

Funda kabanzi malunga nokuphatha izilonda zamathambo.

ILizwi

Nangona isilonda sesigulane sinengxaki ebalulekileyo yezokwelapha ezinokuba nemiphumo emibi, ukunyamekela kwonyango lweminyaka embalwa edluleyo kuye kwatshintshela unyango lwalo mqathango kunye nokugxekwa kwabantu abanayo.

Ukuba ufumene unyango lwesifo sesilonda, xa nje usebenza nogqirha wakho ukuseka isizathu esithile, ulandele ngokuthembeka inyanga yeenyanga ezimbini ukuya kwinyanga yokwelapha unyango oluya kukwaziswa, kwaye ugweme imichiza-nemikhwa- Kufuneka ukhuphe, kukho ithuba elihle lokuba isilonda sakho siphilise ngokupheleleyo kwaye asiyi kubuya.

> Imithombo:

> Lau JY, Sung J, Hill C, et al. Ukuhlaziywa koMsebenzi we-Epidemiology ye-Ultimate Disease Epidemic: Ingozi, ukuphindaphinda, Izinto ezijongene nobungozi kunye nokufa. Ukugonywa ngo-2011; 84: 102.

> Leodolter A, Kulig M, Brasch H, et al. Uhlalutyo lwe-Meta Ukuqhathaniswa nokuxothwa, ukuPhilisa nokubuyela kwiRhafu kwizigulane kunye ne-Helicobacter pylori-ehambelana ne-Gastric okanye i-Duodenal ulcer. Ukuthengiswa kwe-Pharmacol Ther 2001; 15: 1949.

> Li LF, Chan RL, Lu L, et al. Ukubhema nokuThatya kwezifo: iCausal Relationship and Underlying Mechanisms (Ukuhlaziywa). I-Int J Mol Med 2014; 34: 372.

> Malfertheiner P, Megraud F, O'Morain CA, et al. Ulawulo lwe-Helicobacter Pylori Infection - i-Maastricht IV / ingxelo ye-Florence Consensus. Gut 2012; 61: 646.