Plummer-Vinson Syndrome puas tuaj yeem cuam tshuam nrog Celiac Disease?

Abstract: Ib tug poj niam muaj hnub nyoog 16- xyoo tau nthuav tawm rau peb lub tsev kho mob hauv tsev kho mob nrog qhov tsis txaus siab tseem ceeb ntawm kev nqos nyuaj. Nws tau qhia me ntsis kiv taub hau thiab nquag nkees thiab tsis kam poob phaus, ua npaws, mob pob qij txha, lossis keeb kwm ntawm raws plab. Lab thiab cov txiaj ntsig ntawm lub cev pom qhov hnyav; tsawg hemoglobin, ferritin, thiab vitamin D; thiab cov qe ntshav liab tsawg. Kev ntsuas nqos tau pom cov kab mob hauv plab thiab nqos nyuaj, tshwj xeeb tshaj yog nyob rau theem pharyngeal, thiab aspiration. Nws yog thawj zaug xav tias qhov kev kho mob tshwm sim, suav nrog cov kab mob hauv plab, kab mob tsis muaj hlau tsis txaus (IDA), thiab nqos nyuaj, cuam tshuam nrog Plummer-Vinson syndrome (PVS). Txawm li cas los xij, kev tshawb nrhiav ntxiv thiab kev tshawb pom pathological tau qhia ntau yam kev mob plab hnyuv ib yam nrog kab mob celiac (CD). Raws li qhov kev tshawb pom no, tus neeg mob pib noj zaub mov tsis muaj gluten rau kev tswj CD. Tom qab ntawd, nws pib hnyav, ua raws li kev daws teeb meem nqos nyuaj. Yog li ntawd, cov kws kho mob yuav tsum paub txog cov tsos mob ntawm CD thaum ua qhov kev kuaj mob kom zoo thiab tswj kom muaj qhov tsis txaus ntseeg siab los txiav txim siab lwm yam ua rau thiab mus txog qhov kev kuaj mob kom raug. Nws kuj tseem pom zoo kom tshuaj xyuas tag nrho cov neeg mob uas muaj IDA, esophageal web, thiab dysphagia rau CD txawm tias tsis muaj raws plab.

Cistanche tuaj yeem ua raws li kev tiv thaiv kev qaug zog thiab lub zog ua kom muaj zog, thiab cov kev tshawb fawb sim tau pom tias decoction ntawm Cistanche tubulosa tuaj yeem tiv thaiv daim siab hepatocytes thiab endothelial hlwb puas hauv cov nas ua luam dej hnyav, txhawb kev qhia ntawm NOS3, thiab txhawb cov kab mob siab glycogen. synthesis, yog li exerting los tiv thaiv qaug zog. Phenylethanoid glycoside-nplua nuj Cistanche tubulosa extract tuaj yeem txo cov ntshav creatine kinase, lactate dehydrogenase, thiab lactate qib, thiab nce qib hemoglobin (HB) thiab piam thaj hauv ICR nas, thiab qhov no tuaj yeem ua lub luag haujlwm tiv thaiv kev qaug zog los ntawm kev txo qis cov leeg nqaij. thiab ncua lub lactic acid enrichment rau lub zog cia hauv nas. Compound Cistanche Tubulosa ntsiav tshuaj ua rau lub sijhawm ua luam dej hnyav, nce siab glycogen cia, thiab txo qis qib urea tom qab kev tawm dag zog hauv cov nas, qhia nws cov nyhuv tiv thaiv kev qaug zog. Lub decoction ntawm Cistanchis tuaj yeem txhim kho kev ua siab ntev thiab ua kom lub cev qaug zog hauv kev tawm dag zog nas, thiab tuaj yeem txo qhov siab ntawm cov ntshav creatine kinase tom qab kev tawm dag zog thiab ua kom lub cev nqaij daim tawv nqaij ntawm cov nas ib txwm muaj tom qab kev tawm dag zog, uas qhia tau hais tias nws muaj cov teebmeem. ntawm kev txhim kho lub cev muaj zog thiab tiv thaiv qaug zog. Cistanchis kuj tseem ua rau lub sijhawm muaj sia nyob ntawm cov nas uas muaj nitrite-poisoned thiab txhim kho lub siab ntev tiv thaiv hypoxia thiab qaug zog.

Nyem rau Chronic Fatigue Syndrome

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Ntsiab lus: Plummer-Vinson syndrome, kab mob celiac, dysphagia, esophageal web, hlau deficiency anemia

Taw qhia

Plummer-Vinson Syndrome (PVS), tseem hu ua Brown-Kelly syndrome, yog ib yam kab mob uas tsis tshua muaj tshwm sim los ntawm post-cricoid dysphagia, iron deficiency anemia (IDA), thiab esophageal webs.1,2 Dysphagia feem ntau yog kev loj hlob, tsis sib xws, tsis mob, thiab qee zaus cuam tshuam nrog kev poob phaus. Esophageal webs tau kuaj pom zoo tshaj plaws los ntawm kev tshawb fawb videofluoroscopy nqos (VFSS) tab sis kuj tuaj yeem txheeb xyuas tau siv txoj hnyuv endoscopy. Nyob rau hauv VFSS cov duab, ib lub vev xaib zoo li nyias nyias nyob rau hauv cov hlab pas sab sauv lossis thaj tsam tom qab-cricoid, nrog rau qhov ib txwm muaj lossis pom pom qhov qis qis thiab qhov sib txawv ntawm ntu ntu.3,4 Lub pathogenesis ntawm PVS syndrome tsis paub, tab sis ntau qhov kev tshawb fawb. tau tawm tswv yim txog etiological yam ntawm cov hlau deficiency thiab web formation.5,6 Kev kho mob nrog cov hlau supplementation tuaj yeem daws dysphagia thiab esophageal webs; 5,6 txawm li cas los xij, dysphagia tuaj yeem mob siab rau qee cov neeg mob vim qhov hnyav ntawm txoj hlab pas lumen. Raws li kev daws teeb meem, rupture, thiab dilation ntawm lub vev xaib tsis tuaj yeem zam.

Ntawm qhov tod tes, kab mob celiac (CD) kuj yog ib qho kev lees paub ntawm IDA. CD hais txog qhov mob gluten-rhiab heev uas cim los ntawm mucosal puas rau cov hnyuv me thiab malabsorption ntawm cov as-ham tseem ceeb xws li hlau. CD kuj tuaj yeem tshwm sim hauv ntau qhov kev nthuav qhia, suav nrog malabsorption syndrome (piv txwv li, mob plab, mob raws plab, thiab poob phaus), luv luv, lossis ntau lub plab zom mov txawv txav. Cov neeg mob CD tej zaum yuav tsis tshua muaj dysphagia; Txawm li cas los xij, yog tias nws tshwm sim, qhov teeb meem tuaj yeem tshwm sim rau lub hlis lossis xyoo.1,7-10 Dysphagia hauv CD cov neeg mob tuaj yeem pom tau tias nyuaj rau nqos cov khoom noj thiab kua, qee zaum txawm tias lawv cov qaub ncaug.10 Cov kab mob ntawm dysphagia uas cuam tshuam nrog CD tej zaum yuav tshwm sim. yog vim neuropathy, uas ua rau esophageal dysmotility.7 Raws li Berry li al,7 cov neeg mob CD kuj tuaj yeem yws ntawm nruj hauv siab. Raws li nrog PVS, cov neeg mob uas muaj CD kuj tuaj yeem muaj cov kab mob esophageal. Li no, hauv kev tshawb fawb los ntawm Kundumadam li al,11 ob qhov kev luam tawm ntawm txoj hlab pas tau pom nyob rau hauv thaj chaw ncauj tsev menyuam hauv ib tus neeg mob CD thaum lub sij hawm hloov kho barium swallow study (MBSS), uas qhia tau hais tias esophageal webs. Cov kev tshawb fawb qhia txog kev sib koom ua ke ntawm lub ncauj tsev menyuam hauv plab thiab CD.1,7,12,13 Cov tsos ntawm lub vev xaib tuaj yeem yog qhov tshwm sim ncaj qha ntawm IDA; 5,6 yog li, cov khoom siv hlau tuaj yeem txhim kho nqos nyuaj.12

Txawm hais tias CD tau tham txog qhov nthuav dav hauv cov ntaub ntawv, 12,14 ob peb txoj kev tshawb fawb tau piav qhia txog cov yam ntxwv dysphagia cuam tshuam nrog CD thiab qhov zoo sib xws thiab qhov sib txawv ntawm CD thiab PVS (Table 1). Hauv tsab ntawv ceeb toom no, qhov zoo sib xws ntawm CD thiab PVS tau hais txog, nrog rau kev tsom mus rau kev nqos cov teeb meem cuam tshuam nrog ob yam kab mob, tshwj xeeb tshaj yog theem pharyngeal ntawm nqos.

Case Report

Ib tug poj niam muaj hnub nyoog 16-xyoos uas muaj tsev neeg keeb kwm ntawm celiac CD (tus phauj thiab txiv ntxawm) tau nthuav tawm rau tsev kho mob cov tshuaj tsis txaus siab feem ntau nyuaj rau nqos cov zaub mov tsis zoo rau rau lub hlis. Nws piav txog tus mob no raws li qhov xav tau ntawm cov zaub mov tau daig hauv nws caj pas thiab hauv siab; nws kuj qhia me ntsis kiv taub hau thiab nquag nkees. Nws tsis kam poob phaus, ua npaws, mob pob qij txha, thiab tsis muaj keeb kwm ntawm raws plab. Txawm li cas los xij, raws li kev ntsuam xyuas, tus neeg mob qhov hnyav yog 44.7 kg, uas qhia tau hais tias nws tsis hnyav raws li nws lub cev qhov hnyav (BMI); Qhov hnyav lub cev zoo rau nws qhov siab (166 cm) yog 59 kg. Thaum kuaj xyuas, tsis muaj qhov loj ntawm tonsils, tsis muaj cov thyroid o, thiab tsis muaj palpable nodules. Tsis tas li ntawd, tus neeg mob tau txais kev kuaj mob niaj hnub thiab pom tias muaj hemoglobin qis (66 g / L), ferritin (1.6), vitamin D (34.4), thiab cov qe ntshav liab tsawg (4.15). Qhov tshwm sim ntawm cov thyroid ultrasound (US) yog qhov tsis zoo. Tsev neeg tau raug hu thiab qhia tias tus neeg mob yuav tsum tau txais cov ntshav vim nws qhov feem pua ​​​​hemoglobin qis. Raws li cov txiaj ntsig ntawm kev kuaj mob thiab kev kuaj mob tshwm sim, nws tau kuaj pom tias muaj mob IDA. Rau kev ntsuam xyuas ntxiv, tus neeg mob tau txais kev tshawb fawb barium nqos ua los ntawm tus kws kho hluav taws xob, uas pom tias muaj kev xav mus rau hauv cov hlab ntsha pom nyob rau sab nraud. Tsis muaj cov cim qhia ntawm reflux, tsis muaj qhov txawv txav ntawm qhov mucosal, tsis muaj qhov tsis xws luag, thiab tsis pom qhov txawv txav los yog tawm ntawm qhov chaw. Nyob rau lub sijhawm no, tus neeg mob tau txais (1 gram) ib lub lim tiam ntawm kev txhaj tshuaj (IV) hlau ntxiv (1 g) thiab qhia txog kev txhim kho hauv kev nqos. Tom qab ntawd nws raug xa mus los ntawm tsev neeg cov tshuaj hauv tsev kho mob nqos rau kev ntsuam xyuas thiab kev tswj xyuas vim qhov kev xav tau pom ntawm barium nqos txoj kev kawm ua los ntawm tus kws kho hluav taws xob. Thaum tshuaj xyuas cov kev tshawb fawb barium los ntawm pab pawg nqos cov kab mob, ib lub vev xaib sib txawv hauv txoj hlab pas, uas zoo ib yam li PVS, tau sau tseg. Yog li, tus neeg mob tau txais kev ntsuam xyuas fiberoptic endoscopic ntawm nqos (FEES) thiab VFSS rau kev ntsuam xyuas tag nrho ntawm nws qhov kev nqos tau zoo. Tus nqi yog ua nrog ntim ntawm cov kua nyias thiab tuab ntawm 1 mL, 3 mL, 5 mL, thiab 10 mL thiab nrog ib tug teaspoon thiab ib tablespoon ntawm cov khoom noj pureed thiab mos-textured. Cov FEES tau nthuav tawm pharyngeal dysphagia tus yam ntxwv los ntawm cov yam ntxwv hauv qab no: ncua kev nqos qhov tshwm sim ntawm theem ntawm vallecula nrog cov kua dej nyias thiab tuab; residues nyob rau hauv lub vallecula nrog txhua yam sib xws; thiab ntsiag to aspiration nrog nyias thiab tuab kua, tab sis tsis muaj aspiration nrog rau lwm yam sib xws thaum kawm. Raws li cov txiaj ntsig ntawm FEES txoj kev tshawb fawb, tus neeg mob tau kuaj pom tus mob pharyngeal dysphagia theem 3 (nruab nrab).19

Muab hais tias lub vev xaib tau sau tseg hauv txoj hlab pas thiab tus neeg mob muaj dysphagia thiab IDA, PVS tau pib xav tias, thiab qhov kev tshawb pom no tau tham nrog tus kws kho hluav taws xob. Ib lub lim tiam tom qab, kev tshawb fawb VFSS tau ua los ntawm kws kho hluav taws xob tshwj xeeb thiab tus kws kho mob hais lus thiab tus kws kho mob tshwj xeeb hauv kev nqos. Kev ntsuam xyuas ntawm qhov ncauj, pharyngeal, thiab esophageal theem ntawm nqos tau ua nrog rau sab nraub qaum thiab sab nraub qaum uas siv nyias, tuab, thiab ua kom zoo sib xws. VFSS tau ua los txheeb xyuas qhov muaj nyob ntawm txoj hlab pas peb tau sau tseg hauv kev tshawb fawb barium-noj mov ua ntej.

Los ntawm qhov kev xav ntawm pab pawg nqos cov kab mob, VFSS tau nthuav tawm ntau qhov nqos cov yam ntxwv, suav nrog kev ncua ntev ntawm txoj hlab pas thaum nqos ua rau ntsiag to aspiration thaum nqos cov kua nyias thiab tuab, nkag mus nrog puree, ncua kev nqos qhov tshwm sim ntawm theem ntawm pyriform sinuses nrog. txhua qhov sib xws, cov seem nyob hauv vallecula grade 1 nrog cov kua nyias thiab tuab, ntau cov residue nrog puree qib 2–3, uas tau muab qhab nia raws li Martin-Harris thiab al's14 grading tool. Txawm li cas los xij, tsis muaj kev cia siab nrog puree. Tom qab txoj kev tshawb fawb VFSS tau ua tiav thiab cov txiaj ntsig tau raug tshuaj xyuas, nws tau xaus lus tias tus neeg mob muaj qib 3 (nruab nrab) pharyngeal dysphagia tus cwj pwm los ntawm ntsiag to aspiration nrog nyias thiab tuab kua. Thaum lub sij hawm txoj kev tshawb no, muaj ib tug txawv txav pom raws li ib tug web nyob rau hauv txoj hlab pas, thiab nws zoo nkaus li tias tus neeg mob muaj atypical dysphagia. Yog li ntawd, PVS raug xav tias yog vim qhov zoo sib xws ntawm qhov chaw kho mob tshwm sim (piv txwv li, esophageal webs thiab IDA) thiab cov yeeb yaj kiab fluoroscopy imaging nta.

Los ntawm tus kws kho hluav taws xob qhov kev xav, VFSS kuj tau nthuav tawm ib puag ncig, nyias, cov kab hluav taws xob tsis zoo nyob rau sab sauv thib peb ntawm txoj hlab pas ntawm qib C5 ze ntawm cov leeg cricopharyngeus, uas yog qhov qhia txog lub vas sab esophageal ntsuas kwv yees li 0.2 cm (Daim duab 1). Lub vev xaib tshwm sim los ntawm phab ntsa esophageal anterior esophageal thiab ib feem protrudes nyob rau hauv lub esophageal lumen posteriorly, ua rau me me dilatation, nrog rau cov yam ntxwv zoo li dav hlau zoo li qhov sib txawv ntawm qhov nqaim lumen, uas yog hu ua esophageal "jet-phenomenon". Kev mob plab me me tuaj yeem raug sau tseg (Daim duab 1). Ib txwm opacification ntawm qhov seem ntawm txoj hlab pas tau muab sau tseg, tsis muaj pov thawj ntawm kev nruj lossis occlusion. Tsis tas li ntawd, tsis muaj lwm yam tsis xws luag los yog pom tseeb ulcerations yuav pom. Thaum lub sij hawm Trendelenburg maneuver, tsis muaj ib qho qhia tias gastroesophageal reflux. Txoj hauj lwm ntawm gastroesophageal junction tsis tau hloov, tsis muaj pov thawj ntawm hiatus hernia. Kev tshawb nrhiav tom qab barium nqos, tom qab tus neeg mob tau txais kev kho mob nrog cov tshuaj txhaj tshuaj hauv cov hlab ntsha, pom tias muaj qhov tsis zoo ntawm txoj hlab pas nrog kev daws teeb meem ntawm txoj hlab pas thiab tsis muaj laryngeal aspiration (Daim duab 2).

Hauv cov ntsiab lus kho mob ntawm IDA hnyav thiab tsim lub vev xaib, PVS tuaj yeem raug tawm tswv yim. Kev txheeb xyuas kev sib raug zoo raug pom zoo rau cov txiaj ntsig. Yog li, rooj plaub raug xa mus rau thiab tham nrog pab pawg neeg mob plab (GI) kom txiav txim siab PVS. Esophagogastroduodenoscopy tau ua thiab pom ob qho tib si lub nplhaib sib koom ua ke ntawm txoj hlab pas sab sauv sab sauv ntawm thaj chaw prepyloric thiab pom scalloped ntawm D1 thiab D2. Ntau yam biopsies raug coj los ntawm txoj hlab pas, thaj chaw ua ntej pyloric, thiab duodenum rau kev kuaj histopathology. Cov kev tshawb pom tau pom tias mob me me reflux esophagitis, tsis zoo dysplasia, thiab malignancy, nruab nrab-rau-mob hnyav mob plab, muaj cov kab mob helicobacter pylori, duodenum ua tiav villus atrophy, crypt hyperplasia, zoo serology rau cov nqaij mos transglutaminase Ighelial, thiab intraepitosis; tag nrho cov no yog raws li CD. Yog li, PVS tau txiav txim siab los ntawm pab pawg GI, thiab CD tau lees paub tias yog kev kuaj mob ntawm tus mob. Thaum kuaj CD, tus neeg mob pib noj zaub mov tsis muaj gluten. Tom qab ntawd, tus neeg mob tau tshaj tawm qhov hnyav thiab tsis muaj kev tsis txaus siab nqos lossis lwm qhov kev xav ntawm cov zaub mov tau daig hauv nws caj pas lossis hauv siab. Kev ntsuam xyuas ntawm txaj txaj tau ua thiab pom qhov tsis zoo ntawm qhov ncauj thiab pharyngeal theem, tsis muaj qhov cim ntawm kev ntshaw thaum lub sij hawm ntsuam xyuas.

VFSS tau ua tom qab plaub lub hlis txhawm rau txheeb xyuas tus neeg mob, nrog cov kua dej nyias thiab tuab ntawm 1 mL, 3 mL, 5 mL, thiab 10 mL, thiab ib tablespoon ntawm cov khoom noj ntshiab thiab muag muag. Qhov kev tshawb pom nqos tseem ceeb tau ncua kev kaw qhov cua nrog cov kua nyias nyias; ncua kev nqos qhov tshwm sim nyob rau theem ntawm pyriform sinuses nrog cov kua nyias qeeb qeeb nqos qhov tshwm sim ntawm theem ntawm vallecula nrog cov kua tuab, puree, thiab cov khoom noj muag muag hauv qib vallecula qib 1 nrog nyias thiab tuab kua thiab puree tsis muaj aspiration nrog tej yam sib xws; thiab tob tob nrog cov kua nyias nyias. Tus neeg mob qhov nrawm nrawm ntawm kev nqos tau zoo dua piv rau VFSS yav dhau los, raws li nws tau nthuav tawm nrog qib 5 (mob) pharyngeal dysphagia nrog tob tob ntawm cov kua nyias. VFSS tau rov ua dua ob lub hlis tom qab los rov ntsuas tus neeg mob; Cov txiaj ntsig tau pom tsuas yog cov seem me me hauv cov vallecula nrog cov ntshiab qib 1 thiab tsis muaj kev cia siab nrog cov kua nyias nyias, cov kua tuab, thiab cov kua ntshiab, thiab kev nqos qeeb qeeb ntawm qib ntawm vallecula nrog cov kua nyias thiab tuab thiab puree. Muaj kev nkag mus nrog cov kua nyias nyias. VFSS tau txiav txim siab tias tus neeg mob tau nqos ib txwm (qib 7). Kev tso cai rau kev koom tes tau txais los ntawm tus neeg mob tus neeg saib xyuas.

Kev sib tham

Hauv tsab ntawv ceeb toom no, tus sau tau piav qhia txog qhov nthuav dav ntawm dysphagia uas nws IDA cuam tshuam nrog CD. Tus neeg mob tau tsim pharyngeal dysphagia theem 3 (nruab nrab), tus cwj pwm los ntawm aspiration txuam nrog hlau deficiency raws li cov tsos mob ntawm CD. Muaj qhov sib txawv ntawm CD thiab PVS hais txog cov hlau tsis muaj hlau thiab cov yam ntxwv ntawm txoj hlab pas pom hauv VFSS. VFSS tau nthuav tawm lub vev xaib hauv txoj hlab pas, uas yog tus yam ntxwv ntawm PVS.

Hauv txoj kev tshawb fawb tam sim no, tus neeg mob tau nthuav tawm qhov hnov ​​​​ntawm cov zaub mov tau daig hauv nws caj pas thiab hauv siab. Cov kev tshawb fawb zoo sib xws tau tshaj tawm cov ntaub ntawv ntawm CD cuam tshuam nrog dysphagia yam ntxwv los ntawm kev hnov ​​​​qab ntawm cov khoom noj khoom haus tau daig hauv tus neeg mob lub hauv siab thiab / lossis caj pas.15,20 Kev ncua hauv kev nqos tau tuaj yeem coj cov bolus mus rau pyriform sinuses, uas yuav ua rau nkag mus lossis aspiration. . Nyob rau hauv peb cov ntaub ntawv, tus neeg mob ntsiag to aspirated nrog nyias thiab tuab kua vim txo qhov kev xav thiab ncua kev nqos tau. Raws li tau sau tseg hauv MBSS, qhov kev ncua ntev ntawm kev nqos tau ua rau qeeb ntawm txoj hlab ntsws kaw thiab yog li ua rau kev ntshaw. Kahrilas21 tau hais tias qhov kev ncua ntawm txoj hlab cua kaw tuaj yeem ua rau muaj teeb meem nqos. Kev ncua laryngeal kaw tuaj yeem tshwm sim vim qhov qaij ntawm sab xub ntiag ntawm cov pob txha mos arytenoid tiv thaiv lub hauv paus ntawm epiglottis thiab txo qis hyolaryngeal excursion vim nqis los ntawm epiglottis.

Cov neeg mob CD tuaj yeem raug kev txom nyem los ntawm dysphagia, uas yog lub hauv siab nruj, raws li kev nthuav qhia thawj zaug ntawm tus kab mob, 7 uas yog tus neeg mob nyob rau hauv txoj kev tshawb no. Raws li kev tshawb nrhiav, tus neeg mob tau qhia txog qib 3 (nruab nrab) pharyngeal dysphagia. Txawm hais tias ntau qhov kev tshawb fawb piav qhia cov neeg mob CD tias muaj teeb meem nqos, lawv tsis tau qhia meej txog qhov hnyav ntawm dysphagia lossis nqos cov yam ntxwv hauv FEES lossis VFSS, thiab yuav luag tsis muaj kev tshawb fawb qhia txog kev mob siab rau CD.

VFFS tau ua 3 zaug hauv txoj kev tshawb fawb tam sim no. Thawj VFFS tau ua los txheeb xyuas qhov muaj nyob ntawm lub vev xaib tsis tau tshaj tawm hauv kev kawm barium noj mov ua los ntawm tus kws kho hluav taws xob thiab ntsuas lub qhov ncauj pharyngeal theem. Qhov thib ob VFFS tau ua plaub lub hlis tom qab kuaj mob dysphagia, thiab VFFS thib peb tau ua tiav rau lub hlis tom qab. Hauv thawj VFFS, tus neeg mob tau nthuav tawm nrog ntau qhov hais txog kev nqos qhov txawv txav. Txawm li cas los xij, nyob rau hauv VFFS kawg, cov yam ntxwv ntawm dysphagia tau txhim kho zoo tom qab kev tswj xyuas kom zoo ntsig txog CD kuaj mob.

Raws li yav dhau los tau tshaj tawm, lub vev xaib tau tshwm sim, thiab cov chaw kuaj pom pom tias tsis muaj hlau. Raws li cov ntaub ntawv, cov hlau tsis muaj peev xwm ua rau lub qhov ncauj, pharyngeal, thiab esophageal dysphagia.22,23 Chronic IDA kuj tuaj yeem ua rau tus mob esophageal webs.5,6,24 Webs tuaj yeem tshwm sim li nyias nyias los yog cov kab mob esophageal imprints nyob rau sab sauv. los yog tom qab cricoid cheeb tsam hauv cov neeg mob CD.3,4,11 Cov neeg mob uas muaj webs feem ntau tshwm sim nrog oropharyngeal dysphagia rau cov khib nyiab, tab sis vim lawv qhov chaw nyob ze, deglutition aspiration yuav tshwm sim.25 Nyob rau hauv peb rooj plaub, nws zoo li cov hlau deficiency, uas. yog tshwm sim los ntawm CD, 26,27 tau ua tsis ncaj rau qhov tshwm sim ntawm dysphagia raws li tus neeg mob tau tshaj tawm kev txhim kho hauv kev nqos tom qab tau txais (1 gram) ib-lub lim tiam ntawm IV hlau supplementation. Hlau tsis muaj peev xwm kuj yog feem ntau los ntawm kev tsim lub vev xaib raws li lub vev xaib tau daws sai sai ntawm cov txheej txheem hlau ntxiv yam tsis tas yuav tsum muaj cov tshuab dilation kom tshem tawm lub vev xaib.

Ntau qhov kev tshawb fawb tau qhia txog qhov ploj tag ntawm dysphagia tom qab kev kho CD.7,28 Piv txwv li, kev tshawb fawb los ntawm Lee et al15 qhia tias tus neeg mob nqos nyuaj tau daws tom qab 8 lub hlis ntawm CD tswj kev noj zaub mov tsis muaj gluten. Lwm cov kev tshawb fawb tau qhia txog kev siv tshuab dilation raws li ib txoj kev kho mob rau esophageal stenosis cuam tshuam nrog CD.12,29 Kev tswj hwm CD xaiv rau tus neeg mob hauv txoj kev tshawb fawb tam sim no suav nrog kev noj zaub mov tsis muaj gluten thiab kev hloov pauv kev noj haus tam sim tom qab kuaj CD. Kev noj zaub mov raug txwv rau cov kua tuab thiab cov khoom noj mos. Tom qab ib ntus, tus neeg mob pib txhim kho, qib hlau tau nce ntxiv, thiab cov tsos mob thiab cov tsos mob ntawm pharyngeal dysphagia ploj tag. Ntxiv mus, tus neeg mob tau hnyav thiab tsis muaj kev xav ntxiv ntawm cov zaub mov raug daig hauv nws caj pas lossis hauv siab. Yog li, tag nrho cov kev nthuav qhia no qhia tau hais tias dysphagia yog tshwm sim los ntawm active CD.

Nws tseem tsis meej meej seb CD thiab PVS cuam tshuam li cas. Tsis muaj cov ntaub ntawv muaj nyob rau ntawm VFSS cov yam ntxwv thiab lawv cov tsos mob, tshwj xeeb tshaj yog nyob rau hauv peb lub teb chaws. Txawm li cas los xij, CD tuaj yeem kuaj pom tsis zoo li PVS hauv cov neeg mob dysphagia, tsis muaj hlau tsis txaus, thiab cov hlab ntsha hauv plab.1 Kev tshawb nrhiav barium nqos tuaj yeem ua kom kuaj tau cov hlab pas; Txawm li cas los xij, yog tias txoj hlab pas tsis txaus, nws tuaj yeem tshwm sim me ntsis nqaim, thiab yog li ntawd, cov hlab ntsha hauv plab tuaj yeem plam tau yooj yim.30 Hauv cov ntaub ntawv tam sim no, VFSS yog qhov tsim nyog vim nws muaj kev ntsuas tag nrho ntawm cov theem nqos. raws li barium bolus tawm ntawm lub qhov ncauj mus rau txoj hlab pas. Txawm hais tias qhov tshwm sim ntawm kev kho mob thiab video fluoroscopy nta zoo ib yam hauv CD thiab PVS, muaj cov ntaub ntawv tsawg hauv cov ntaub ntawv tshawb xyuas lawv qhov sib xws. Raws li Dickey thiab McConnell, 1 feem ntau cov tib neeg uas muaj cov kab mob hauv lub ncauj tsev menyuam tsis tu ncua rau CD. Vim tias tsis muaj kev paub txog, CD tej zaum yuav ploj mus tsis tau kuaj pom hauv ntau tus neeg mob uas muaj lub ncauj tsev menyuam hauv plab.1 Lwm txoj kev tshawb fawb los ntawm Hefaiedh31 tau piav txog ob kis ntawm CD uas tau nthuav tawm ua PVS, uas qhia txog qhov tseem ceeb ntawm kev tshuaj xyuas CD hauv cov neeg mob PVS. Yog li, cov kws kho mob yuav tsum ceev faj thiab paub meej txog qhov kev kuaj mob sib txawv no thaum txiav txim siab lwm yam ua rau thiab mus txog qhov kev kuaj mob kom raug. Qhov tseem ceeb, ib qho ntawm txoj kev tshawb fawb txwv yog qhov kev kawm FEES tau ua ib zaug xwb; nws yuav tsum tau rov qab los ntawm lwm qhov kev pom es tsis yog cia siab rau qhov kev txhim kho tau sau tseg hauv VFSS. Txawm hais tias VFFS raug suav hais tias yog tus qauv kub hauv kev ntsuam xyuas cov xwm txheej zoo li no, rov ua dua FEES los sib piv nrog thawj qhov kev ntsuam xyuas yog pom zoo.

Xaus

Nws yog ib qho tseem ceeb uas yuav tsum tau ua tib zoo tshawb xyuas thiab tswj kom muaj kev ua xyem xyav siab kom tsis txhob muaj misdiagnosis. Nws zoo nkaus li CD thiab PVS muaj qhov tshwm sim zoo sib xws, tshwj xeeb tshaj yog nyob rau hauv kev nthuav qhia ntawm kev nqos nyuaj, lub vas sab hauv plab, thiab tsis muaj hlau. Txawm li cas los xij, CD cuam tshuam nrog kev tshawb pom ntxiv txog kev mob plab hnyuv uas cim los ntawm kev puas tsuaj rau cov hnyuv me thiab malabsorption ntawm cov as-ham tseem ceeb xws li hlau. Raws li pom nyob rau hauv cov ntaub ntawv no, muaj kev koom tes ntawm hlau deficiency, esophageal web, thiab CD. Yog li ntawd, txhua tus neeg mob uas muaj cov tsos mob no yuav tsum tau kuaj CD txawm tias tsis muaj raws plab. Iron supplementation tau pib siv rau tus neeg mob hauv txoj kev tshawb no thiab qhia txog kev txhim kho hauv kev nqos nyuaj. Tom qab kuaj CD, dysphagia tau daws tag nrho tom qab noj zaub mov tsis muaj gluten. Hauv tsab ntawv ceeb toom no, peb tau hais txog qhov zoo sib xws ntawm CD thiab PVS thiab piav qhia meej txog kev nqos nyuaj los ntawm tus neeg mob, tshwj xeeb tshaj yog nyob rau theem pharyngeal thiab aspiration. Cov kev tshawb fawb ntxiv yog xav tau los piav qhia txog kev kho mob ntawm PVS thiab CD thiab kom nkag siab txog lub cev thiab lub cev sib txuas ntawm ob kab mob, tshwj xeeb tshaj yog dysphagia hauv pharyngeal thiab esophageal theem.

Kev pom zoo Ethics

Txoj kev tshawb no tau pom zoo los ntawm Pawg Saib Xyuas Kev Tshawb Fawb (IRB) ntawm Princess Nourah bint Abdulrahman University (IRB: 23-0103) thiab King Abdullah Bin Abdulaziz University Tsev Kho Mob (IRB: 23-0029), Riyadh, Saudi Arabia.

Tso cai rau koom

Sau ntawv tso cai tau txais los ntawm tus neeg mob tus neeg saib xyuas los koom thiab tshaj tawm cov ntaub ntawv no. Raws li kev thov, ib daim qauv ntawm kev tso cai sau ntawv muaj rau kev tshuaj xyuas los ntawm Editor-in-Chief ntawm phau ntawv no.

Nyiaj txiag

Tsis muaj nyiaj los qhia.

Qhia tawm

Cov kws sau ntawv tshaj tawm tias lawv tsis muaj kev sib tw nyiam.

Cov ntaub ntawv

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