Isifo se-celiac esicabangelayo singaba ukuxilongwa okwesabekayo: ngencazelo, kusho ukuthi ukwelashwa okujwayelekile kwesifo se- celiac - ukudla okungekho gluten- kuhlulekile ukusebenza, futhi manje kufanele ufune ezinye izindlela.
Kodwa izindaba ezinhle, yilokhoyacac ephikisayo engavamile kakhulu. Ezimweni eziningi, inkinga yakho akuyona isifo se-celiac esiphendukayo-kunalokho, inani elincane kakhulu le-gluten ekudleni kwakho noma esinye isimo sezokwelapha cishe sibangela izimpawu zakho eziqhubekayo.
Kodwa-ke, uma udokotela wakho ebeka ezinye izimbangela futhi ekugcineni uthola ukuthi unesifo se-coliac refractory, kufanele wazi ukuthi odokotela bayakwazi ukuphatha kahle amacala amaningi; ukwelashwa kuzoxhomeke kunoma yiluphi uhlobo lwe-celiac engalahleki oluhlupheka ngalo, kanye nezinye izici emlandweni wakho wezokwelapha nesimo.
Uhlobo Lwezifo Ezibhekisayo Zama-Celiac Ukhetha Izinketho Zokwelashwa, Inkambo
Kunezinhlobo ezimbili zesifo se-coliac refractory: Thayipha I nohlobo II. Uma utholakala, udokotela wakho uzokutshela ukuthi hlobo luni onalo. Ngokuvamile, Uhlobo I luvame futhi luphathwa kangcono, kodwa ucwaningo lwamuva lubike imiphumela ethembisayo yokuphatha uhlobo lwesibili.
Ngaphansi kwezimo eziningi, uzokwelapha ngenxa yesifo esibi se-celiac esikhungweni se-celiac esinokuphatha nokuqapha isimo; ngoba celiac enamaqabunga ajwayelekile, gastroenterologists eziningi azizange zibhekane namacala ngaphambili.
Ukwelashwa Kungase Kuqale Ngokusekelwa Kwempilo
Isifo se-reflexory celiac singaholela ekulahlekelweni kwesisindo esikhulu nokuntuleka kwesondlo , ngisho noma udla ukudla okunomsoco, okulinganiselayo kwe-gluten. Lokhu kungenxa yokuthi umonakalo emathunjini wakho omncane, owaziwa ngokuthi i- villous atrophy , awukhiphile - naphezu kokudla kwakho ngokucophelela.
Ngakho udokotela wakho angase aqale ukwelashwa kwakho ngokuhlola izinga lomzimba wakho wamavithamini, amaminerali, nezinye izakhi, futhi ubeka ukwesekwa okunomsoco ukusiza ukuguqula ukungondleki kwakho. Ukuze iziguli ezingafika ku-60%, lokhu kusekelwa okunomsoco kuhlanganisa lokho okubizwa ngokuthi yi-Total Parenteral Nutrition, okuyinto isisombululo sezakhi esinikezwe ngqo emthanjeni, ngokweqile indlela yakho yokugoma.
Udokotela wakho angase futhi anqume ukuzama lokho okubizwa ngokuthi ukudla okuqinile okuyisisekelo - ukudla okunomsoco okuhlinzeka izakhi ngendlela ye-hypo-allergenic kakade sehlile emabhuloki wokwakha amino acid ayisisekelo. Esinye isifundo esincane sathola ukuthi iziguli eziyisishiyagalombili eziyisishiyagalombili ezinezifo eziphikisana nohlobo lweTeveli zabonisa ukuthuthukiswa kwamagciwane abo emathunjini ekudleni okunjalo; Abangu-6 kulabo nabo babhekene nokuthuthukiswa kwezibonakaliso zabo.
Ezimweni ezimbalwa ezibandakanya isifo sohlobo lwe-Type I, ukwesekwa kokudla okunomsoco kanye nokudla okunamandla kakhulu kwe-gluten kungase kube yilokho okudingayo ukuqala ukuphulukiswa. Kodwa abantu abaningi nabo bathola ukwelashwa kwezidakamizwa.
Ukwelashwa Kwezidakamizwa Uhlobo I Ngokuvamile Kuhlanganisa Steroids
Kuze kube manje, ukwelashwa kwezidakamizwa zesifo se-celiac esicabangelayo sigxile emithonjeni yokwelashwa eyenzelwe ukuvimbela isistimu yakho yomzimba emzamweni wokunikeza amathumbu akho ikhefu kusukela ekuhlaselweni okuzenzakalelayo okuzenzakalelayo.
(Khumbula ukuthi akuyona i- gluten ngokwayo eyabangela ukulimala kwamathumbu emzimbeni we-celiac - isenzo sakho sokuzivikela komzimba ku-gluten. Esifweni se-celiac esiphendukayo, isimiso sakho somzimba samasosha omzimba siyaqhubeka nokuhlasela amathumbu akho, ngisho noma kungekho gluten ekudleni kwakho.)
Kuzo zombili zohlobo lwe-Type I nohlobo lwe-II lwe-reflexory leliac, ukwelashwa kokuqala kwezidakamizwa ngokuvamile kuyindlela yokwelashwa kwe-steroid eyaziwa ngokuthi i-glucocorticoids. Ama-glucocorticoids asetshenziselwa ukwelashwa kwezinye izimo ezizimele njenge-arthritis ye-rheumatoid nesifo sofuba.
Esinye isidakamizwa esingasetshenziswa ekwelashweni kwakho yi-azathioprine, esisebenza ngokucindezela isimiso sakho somzimba omzimba.
Abantu abane-arthritis enesifo esibi kakhulu kanye nalabo abahlala ne-organ ebizwa ngokuthi i-azathioprin.
Ucwaningo lubonisa ukuthi iningi labantu abane-TB I-refractory leliac isifo esiyokhipha isifo se-celiac sizokwazi ukungena ekukhulumeni - ngamanye amazwi, bona izimpawu zabo zixazululwe futhi amathumbu abo aqala ukuphulukisa - ngokusebenzisa ukusetshenziswa kwe-steroids, mhlawumbe kuhlangene ne-azathioprine.
Uhlobo Lwezifo Eziyisikhombisa Ezibhekisayo Zama-Celiac Okubaluleke Kakhulu Okumele Ukwenze
Iziguli ezinezifo ze-Type refractory zivame ukubona ukuphumula kwezimbonakaliso zazo ezivela kuloluhlobo lwemithi yezidakamizwa, kodwa ngeshwa, amakhemikhali abo emathumbu akaphuluki kuwo, futhi kubonakala sengathi ayabalandeli ngendlela ebulalayo ye- non-Hodgkin i-lymphoma ehlobene nesifo se-celiac .
Ezinye izivivinyo zomtholampilo ziye zahlola umuthi okuthiwa i-Cladribine - isisetshenziswa esinamandla samakhemikhali we-chemotherapy esetshenziselwa i-leukemia - ezigulini eziphikisayo ze-Type II. Isivivinyo esisodwa, esenziwa eNetherlands, sathola ukuthi i-Cladribine yanciphisa lesi sifo ngokwanele ukuze ibeke iziguli ezingu-18 kwabangu-32. Kodwa naphezu kokuthi izidakamizwa zibeka ezinye iziguli ukuba zithethelelwe, kunesinye ukwesaba ukuthi kungavimbela ukungena kwe-T-cell lymphoma (EATL) ehlotshaniswayo: leyo fomu engavamile, ebulalayo ye-lymphoma. I-EATL ihlupha iziguli ze-Type II ngokungahambisani.
Noma kunjalo, abanye odokotela baye baqala ukusebenzisa i-Cladribine njengokhetho lokuqala lokuphatha isifo se-Celiac sifo se-Type II, futhi bathola ukuthi bayakwazi ukubeka cishe isigamu seziguli zabo zibe yi-remission nesidakamizwa. Kulolu cwaningo, ukusinda kwaminyaka emihlanu ezigulini zeTepi II ezithinte ukwelashwa kwe-Cladribine kwakungamaphesenti angu-83, uma kuqhathaniswa namaphesenti angu-22 kulabo abangazange babone imiphumela emihle ekwelapheni. Okubaluleke kakhulu, akuzange kubonakale sengathi ukwanda kwamazinga e-lymphoma. Kodwa-ke, leyo miphumela yokwelapha ayingakaphindaphindiwe.
Okokugcina, kulabo abanesifo se-Celiac se-Type II esiphendukayo abahluleka ukuphendula kuzo zonke ezinye izindlela zokwelapha, okufaka phakathi i-Cladribine, okungenani isikhungo esisodwa se-celiac - esifanayo esashicilela imiphumela yecala le-Cladribine - ihlolwe i-autologous stem cell transplant, inqubo lapho kutholakala khona amaseli avela emnothweni wakho avunwa, akhulile ebhodini bese efakwe kabusha kuwe emva kokulandela i-chemotherapy ephezulu. Lena inqubo enobungozi enezinga eliphezulu lezinkinga, kufaka phakathi ukufa.
Esikhathini esisodwa sokuhlolwa kwezokwelapha okubandakanya isifo seCyliac refractory celiac kanye ne-autologous stem cell transplant, izimpawu ezingu-11 kweziguli ezingu-13 zathuthuka kakhulu phakathi nonyaka wenqubo ye-stem cell. Umuntu oyedwa wabulawa yinkqubo yokufakelwa yona, kanti izingxenye ezimbili kwezintathu zeziguli zazisaphila eminyakeni emine kamuva. Esinye isiguli sakhiwe i-EATL.
Ukwelashwa Kwakho Okukwenziwe Ngokweqile Kungase Kuqhubeke Kwesikhathi Eside
Ukuvimbela ukuphindaphinda kwesifo sakho se-reflexory celiac, kungadingeka uthathe i-steroids ngokungapheli. Kodwa ukusetshenziswa kwesikhathi eside kwe-steroids kubangela izingozi zayo (kubandakanya ushukela ophezulu wegazi, amathumba amancane kanye nengozi yokutheleleka). Ngaphezu kwalokho, ukusebenzisa i-steroids isikhathi eside kwandisa ingozi yakho ye-lymphoma - futhi-ke, iziguli ezingenayo i-celiac zivele ziphakeme kakhulu kunengozi evamile yale fomu yomdlavuza.
Ngakho-ke abacwaningi bahlola ezinye izidakamizwa ezingase zikwazi ukuthola izidakamizwa ze-celiac, okufaka imithi ebizwa ngokuthi i-mesalazine, isidakamizwa esivimba ukuvuvukala okwamanje esisetshenziselwa ukwelapha isifo sofuba esivuvukalayo esihlolwe iziguli ze-Type I. Ucwaningo oluthe xaxa kule fomu engavamile yesifo se-celiac cishe luzokhishwa esikhathini esizayo esiseduze.
Okwamanje, kungakhathaliseki ukwelashwa kwesikhashana okuphakanyisiwe kuwe, kuzodingeka uhlale usondelene nodokotela wakho futhi ubheke noma yiziphi izimpawu (njengokuvuselelwa kwesisindo somzimba kanye nesifo sohudo) ukuthi isifo sakho se-reflexory celiac iphuma ekuxoxweni.
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