Ukusebenzisa iziqu ze-Marsh ukuze zihlolwe izifo ze-Celiac

by I-Nancy Lapid; Ibukezwe ngu-Emmy Ludwig, MD

Izibalo ze-Marsh zilimala umonakalo wamathumbu kusuka esibhedlela se-celiac

Uma uhlolwe isifo se-celiac , udokotela wakho cishe uzokwenza i-endoscopy ne-biopsy ukuze abone ukuthi intombazane yakho encane ibhidliwe yi- gluten , iphrotheni etholakala ngotshini, ibhali, ne-rye. Udokotela wakho uzosebenzisa i-instrument yezokwelapha, ebizwa ngokuthi i-endoscope, enekhamera encane ukuze ubheke ngqo ohlelweni lwakho lokugaya, futhi uzothatha amasampula amancane kakhulu amathisipula emalini emathumbu akho amancane.

Ukulandela i-endoscopy yakho, i-pathologist izobheka amasampula akho amathishu ukubona ukuthi kukhona yini umonakalo ohlobene no-gluten. Leyo pathologist izolinganisa isimo salezi sampuli ngokusekelwe ohlelweni lokukala olubizwa ngokuthi i-Marsh Score. Isilinganiso sakho se-Marsh sizonquma ukuthi uthola ukuthi unesifo se-celiac, nokuthi isimo sakho sithuthukisiwe kangakanani.

Isifo se-Celiac akuyona kuphela isimo esingabangela ezinye zalezi zinguquko, yingakho i-biopsy ingenye yezivivinyo zokuxilonga ezinconywe isifo se-celiac-nakuba i-biopsy ithathwa ngokuthi "izinga legolide" lokuxilongwa kwe-celiac. Imiphumela yokuhlolwa kwegazi le- celiac kanye nokuphendula komuntu okuphelele ekudleni okungenalutho kwe-gluten nakho kungasiza ekutholeni ukuxilongwa okulungile.

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Isigaba 0

Isithombe seSayensi Co / Getty Images

Lesi sithombe esithathwe ngesikhathi sokuphela kwe-endoscopy, esibonisa intathu emincane evamile ehlanganiswe ne-villi enempilo. Njengoba amantombazane emathumbu avela evamile, akunakwenzeka ukuthi umuntu unesifo se-celiac.

Kulesi simo, isampula ye-biopsy izobekwa njenge-Marsh Stage 0, eyaziwa nangokuthi "isigaba sangaphambi kokufakelwa phansi." ibizwa ngokuthi "pre-infiltrative" ngoba i-lymphocytes ayingakaqali ukuhamba, noma "ukungena ngaphakathi," ukugqoka emathunjini.

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Izigaba 1 no-2

Ukwakhiwa kwamathumbu emathunjini - I-Marsh Isilinganiso 1. © Ludvigsson et al, 2009

Isigaba sokuqala esingu-Marsh sisho ukuthi amaseli ebusweni bamathumbu emathumbu, eyaziwa ngokuthi amangqamuzana e-epithelial, anama-lymphocyte amaningi, amangqamuzana egazi elimhlophe, phakathi kwawo kunejwayelekile.

Emathunjini amancane avamile, akumele kube khona amangama-lymphocytes angaphezu kuka-30 ngamaseli angu-100 e-epithelial, kodwa uma kwenzeka kuthathwa isigaba soku-1, kukhona okungaphezulu kwalokho. Uma unesiteji 1, umbiko wakho we-pathology cishe uzofunda "ukwandisa i-lymphocyte yangaphakathi ye-intraepithelial."

Isifo se-Celiac akusona kuphela isimo esingabangela ukwanda kwe-lymphocytes yokulwa nezifo. Ungase ube ne-lymphocytes engaphezulu uma unezifo zesifo sofuba, isifo se-Sjogren, kanye nokunye ukungabekezelelani kokudla. Izifo ezinama-bacteria okuthiwa i- Helicobacter pylori (ehlanganiswe nezilonda), futhi ukusetshenziswa kobuhlungu obuningi bokubulala obufana ne-aspirin ne-ibuprofen, nakho kungabangela lokhu.

Abantu abanesifo se-celiac abalandela ukudla okungenamalusi , amalungu omndeni oseduze wabantu abanesifo se-celiac, kanye nabantu abanesifo se- dermatitis herpetiformis , ukuqhuma okukhulu kakhulu okubhekwa njengukubonakala kwesikhumba sesifo se-celiac, kungase kube nesiteji esingu-1 Marsh Umphumela.

Ngesigaba sesi-2, ubona i-lymphocytes engaphezulu kunokujwayelekile nokukhunjulwa okukhulu kunokujwayelekile phakathi kwamathumbu emathumbu. Lezi ziphazamiso zibizwa ngokuthi "crypts," kanye namakhophi amakhulu ajwayelekile-ajwayelekile-okubizwa ngokuthi "ama-hyperplastic," ngakho uma umbiko wakho we-pathology ulandela i-biopsy yakho uthi une "crypts experplastic" noma "crypt hyperplasia," kusho ukuthungwa okubonwe ku-biopsy yakho zikhulu kunazo zonke ezaziyobe zihlala emathunjini ajwayelekile emathunjini.

Isigaba sesi-2 sincane kakhulu-sibonakala kubantu abanesifo se-dermatitis herpetiformis.

_{Le photomicrograph ivela ku-Figure 1b kaLudvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{i-doi: 10.1186 / 1471-230X-9-19.} _{Ama-photomicrographs atholakala ku-Prof. Åke Öst, owayengusihlalo weSweden National Steering Group for Pathology Small Intestinal).}

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Isigaba 3

Lokhu kubonisa ukwelashwa kwamathumbu emathunjini aseMarr Score 3. © Ludvigsson et al, 2009

Odokotela abaningi ngeke baxilonge isifo se-celiac kuze kube yilapho izibilini zakho zamathumbu zifika esiteji 3. Kulesi sigaba, izinguquko zesigaba 2 zikhona - i-lymphocytes engaphezulu kunokudonswa okujwayelekile nokukhudlwana kunokujwayelekile - kanye nokwehliswa kwamaphilisi emathunjini emathunjini , yini eyaziwa ngokuthi i-atrophy ene-villous.

Isigaba sesi-3 sinezigaba ezintathu:

I-atrophy ye-villous (i-Stage 3a) ehlukile: Amakhumbu akho emathumbu asekhona, kodwa amancane
I-subtotal i-atrophy enamandla (Isiteji 3b): I-vil yakho yemathumbu i-shrunken kakhulu
Ingqikithi ye-atrophy eyinqaba (Isiteji 3c): Ukwakheka kwamathumbu emathumbu kubomvu okungekho flat emathunjini emathunjini asele

Iningi labantu abatholakala ukuthi banesifo se-celiac banesilinganiso se-3 Marsh.

_{Le photomicrograph ivela ku-Figure 1c kaLudvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{i-doi: 10.1186 / 1471-230X-9-19.} _{Ama-photomicrographs atholakala ku-Prof. Åke Öst, owayengusihlalo weSweden National Steering Group ye-Pathology Emincane Yamathumbu Omzimba.}

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Isigaba 4

Isigaba 4 yisigaba esithuthukisiwe kunazo zonke futhi ngenhlanhla ayibonakali konke okuvame ukukwenza. Esikhathini sesigaba 4, i- villi yakho ihlaziye ngokuphelele (i-atrophied) ukuphambana phakathi kwabo (i-crypts) nayo i-shrunken futhi.

Isigaba sesi-4 sivame kakhulu phakathi kwabantu asebekhulile abanesifo se-celiac. Uma uphawu lwakho lwe-Marsh luyisigaba sesine, ungase ube nengozi ephezulu yezifo ze-celiac, okufaka i-lymphoma.

Ukuvuma:

_{Le photomicrograph ivela ku-Figure 1d ye-Ludvigsson et al.} _{BMC Gastroenterology 2009 9:19.} _{i-doi: 10.1186 / 1471-230X-9-19.} _{Ama-photomicrographs atholakala ku-Prof. Åke Öst, owayengusihlalo weSweden National Steering Group ye-Pathology Emincane Yamathumbu Omzimba.}

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Izwi kusuka

I-Gastroenterologists isebenzisa izikolo ze-Marsh ukulinganisa umonakalo emithini yakho emathunjini emathumbu kusuka esibhedlela se-celiac. Isaphulelo sakho se-Marsh sinquma ukuthi unesifo se-celiac, nokuthi kungakanani okonakalise i-vil yakho yamathumbu.

Le mihlahlandlela yamazinga we-Marsh angakusiza ukuthi uhumushe umbiko kusuka ku-biopsy yakho yamathumbu. Kodwa-ke, uma unenkinga yokuyiqonda, ungesabi ukukhuluma nodokotela wakho ngalokho okushoyo. Futhi khumbula: uma usuqala ukudla okungenayo i-gluten, umonakalo omubi wamathumbu kufanele uqale ukuphulukisa.

> Imithombo:

> Ludvigsson JF et al. Ukuhlola ukuqinisekiswa kwe-atrophy ene-villous nokuvuvukala kwamathumbu emathumbu kuma-Swedish biopsy registers. BMC Gastroenterology . 2009; 9: 19.

> Snyder CL, Young DO, Green PHR, Taylor AK. GeneReviews: Izifo zeCeliac. 2009.

> ID ID et al. Isiqondiso sokuxilongwa nokuphathwa kwesifo se-celiac ezinganeni: izincomo zeNorth American Society ye-Pediatric Gastroenterology, Hepatology kanye Nutrition. I-Journal ye-Gastroenterology ye-Pediatric ne-Nutrition. 2005; 40: 1-19.

> Imigomo yokuhlinzeka ngezifo ze-Stanford Medicine: I-Celiac Disease.

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