Dawb Esophagus: Qhov tshwm sim ntawm Polypharmacy

Abstract

Candida esophagitis tuaj yeem tshwm sim hauv cov neeg mob immunocompetent los ntawm kev ua tsis taus ntawm tus tswv tsev tiv thaiv mechanisms xws li salivation, esophageal motility, acidic pH, thiab innate tiv thaiv. Feem ntau cov tshuaj tau sau tseg inhibit cov txheej txheem no, thiab polypharmacy tau pom tias muaj kev cuam tshuam ntxiv rau kev txhawb nqa tus kab mob Candida.

Candida yog ib hom kab mob fungus uas tuaj yeem ua rau muaj kab mob hauv ntau qhov chaw ntawm lub cev, suav nrog esophagitis. Txawm hais tias Candida esophagitis tsis yog kab mob tuag taus, nws yuav muaj qee yam cuam tshuam rau tus neeg mob noj qab haus huv. Kev tiv thaiv kab mob ua lub luag haujlwm tseem ceeb hauv kev kho thiab tiv thaiv Candida esophagitis.

Tib neeg lub cev tiv thaiv kab mob yog ib txoj kab tseem ceeb ntawm kev tiv thaiv kab mob, uas feem ntau suav nrog ob yam ntawm kev tiv thaiv kab mob hauv lub cev thiab kev tiv thaiv kab mob. Innate tiv thaiv muaj xws li ntau yam physiological teeb meem, non-specific immune cells thiab molecules, thiab lwm yam kev tiv thaiv mechanisms; adaptive tiv thaiv tsuas yog txhim khu kev tiv thaiv tiv thaiv kab mob thiab txhim kho lub peev xwm ntawm kev tiv thaiv kab mob los ntawm kev kis kab mob los yog tshuaj tiv thaiv.

Candida esophagitis feem ntau tshwm sim rau cov neeg uas tsis muaj zog tiv thaiv kab mob, xws li cov neeg mob uas tau noj tshuaj tua kab mob lossis tshuaj hormones ntev, cov neeg mob ntshav qab zib, thiab cov neeg mob tsis noj zaub mov tsis zoo. Yog li, kev txhim kho kev tiv thaiv kab mob yog ib txoj hauv kev zoo los tiv thaiv thiab kho Candida esophagitis.

Nyem qhov txiaj ntsig kev noj qab haus huv ntawm cistanche

Txhawm rau txhim kho kev tiv thaiv, cov ntsiab lus hauv qab no tuaj yeem raug xa mus rau:

1. Kev noj haus yuav tsum tsis tu ncua, noj cov zaub mov uas muaj cov vitamins thiab kab kawm, xws li txiv hmab txiv ntoo, zaub, thiab lwm yam;

2. Ua haujlwm ib txwm ua thiab so kom zoo, txhim kho kev pw tsaug zog zoo, thiab txo qis kev ntxhov siab;

3. Kev tawm dag zog lub cev tsis tu ncua, kev tawm dag zog me ntsis tuaj yeem pab txhim kho kev tiv thaiv;

4. Kev da dej kom zoo tuaj yeem txhim kho lub cev muaj peev xwm nqus cov vitamin D thiab pab txhawb kev tiv thaiv kab mob.

Piv txwv li, Candida esophagitis yog ze rau kev tiv thaiv kab mob. Kev txhim kho kev tiv thaiv tuaj yeem tiv thaiv thiab kho candida esophagitis thiab txhim kho kev noj qab haus huv ntawm cov neeg mob. Kuv vam tias cov neeg nyeem tuaj yeem mloog zoo rau kev tiv thaiv kab mob, ntxiv dag zog rau kev tawm dag zog, thiab tswj tus cwj pwm zoo. Los ntawm qhov kev xav no, nws yog ib qho tseem ceeb los txhim kho kev tiv thaiv. Cistanche tuaj yeem txhim kho kev tiv thaiv zoo. Cistanche kuj muaj cov tshuaj tiv thaiv kab mob thiab tiv thaiv kab mob qog noj ntshav, uas tuaj yeem ntxiv dag zog rau lub cev tiv thaiv kab mob muaj peev xwm tiv thaiv thiab txhim kho lub cev tiv thaiv kab mob.

Peb nthuav tawm cov ntaub ntawv ntawm tus neeg mob immunocompetent uas tau kho ntau yam tshuaj uas cuam tshuam nrog Candida esophagitis tab sis ntsib kev kis kab mob tsuas yog tom qab ntxiv qhov ncauj ncua-tso budesonide, uas yav dhau los tsis tau cuam tshuam nrog Candida esophagitis.

Pawg:

Gastroenterology, Kab mob sib kis.

Ntsiab lus:

Kab mob esophagitis, budesonide, immunocompetent neeg laus, candida esophagitis, polypharmacy.

Taw qhia

Esophageal Candida colonization tau tshaj tawm txog li 12 feem pua ​​​​ntawm cov neeg laus noj qab nyob zoo [1]. Ntau cov tshuaj inhibits ntuj tiv thaiv mechanisms tiv thaiv Candida esophagitis.

Peb nthuav tawm ib rooj plaub ntawm tus txiv neej immunocompetent uas tsim Candida esophagitis ntawm tag nrho cov hlab ntsha yuav yog vim synergistic polypharmacy tom qab ntxiv ntawm qhov ncauj ncua-tso budesonide rau kev kho mob ntawm lymphocytic colitis.

Case Presentation

Ib tug txiv neej muaj hnub nyoog 58- xyoo tau txais esophagogastroduodenoscopy (EGD) rau subacute odynophagia, dysphagia, thiab poob phaus. Nws cov keeb kwm kho mob suav nrog lymphocytic colitis, mob plab gastroesophageal reflux, kab mob obstructive pulmonary, mob hawb pob, thiab mob neuropathy. Cov tshuaj suav nrog budesonide, proton twj inhibitor, fluticasone propionate, bevacizumab, thiab gabapentin. Kev soj ntsuam kuaj tau tseem ceeb rau kev ua tiav eosinopenia, yuav yog vim benralizumab.

Ib txoj kev colonoscopy plaub lub hlis ua ntej rau kev mob raws plab qhia pom lymphocytic colitis ntawm random biopsies. Qhov ncauj ncua sij hawm-tso tawm budesonide 9 mg ib hnub tom qab tau muab tshuaj rau yim lub lis piam tom qab los ntawm tapering uas nws ua tiav ob lub lis piam ua ntej pib EGD. Endoscopy pom muaj cov kab mob dawb dawb nyob hauv tag nrho txoj hlab pas (Daim duab 1A).

Cov hniav txhuam hniav tau nthuav tawm mob esophagitis nrog fungal poov xab thiab pseudo-hyphae txog Candida esophagitis. Qhov ncauj fluconazole 400 mg txhua hnub tau muab tshuaj rau ob lub lis piam, uas tau txuas ntxiv los ntawm ib lub lis piam rau cov tsos mob tsis tu ncua. Kev rov ua dua EGD 12 lub lis piam tom qab tau pom qhov kev daws teeb meem ntawm cov plaques dawb thiab cov kab mob esophageal mucosa (Daim duab 1B). Cov biopsies yog unremarkable.

Kev sib tham

Peb cov ntaub ntawv qhia txog yuav ua li cas polypharmacy tuaj yeem ua rau Candida esophagitis hauv tus tswv tsev tiv thaiv kab mob los ntawm kev cuam tshuam ntawm kev tiv thaiv tus tswv tsev. Salivation, esophageal motility, acidic pH, thiab innate tiv thaiv ua ke tiv thaiv Candida hom thoob plaws hauv txoj hlab pas. Proton twj tso kua mis inhibitors impair salivation thiab nce plab pH.

Thaum proton twj tso kua mis inhibitors tau raug lees paub tias muaj feem cuam tshuam nrog cov kab mob enteric ntau dua, cov neeg mob noj qab haus huv ib txwm muaj kev txo qis ntawm cov kua qaub rau lub sij hawm vim qhov tsim nyog qis ntawm cov hlab pas sphincter, yog li txwv cov koom haum no nrog kev tiv thaiv Candida esophagitis ntawm sab esophagus [2].

Gabapentin kuj txo qis salivation, uas impairs Candida clearance ntawm aggregation potentiated los ntawm salivary immunoglobulin A. Saliva kuj muaj candidal histatin 5 raws li zoo raws li antistatic calprotectin thiab lactoferrin proteins, uas kho qhov kev loj hlob ntawm Candida kab mob [3]. Fluticasone propionate nce qhov tshwm sim ntawm Candida esophagitis txog li 37 feem pua ​​​​hauv cov neeg laus tiv thaiv kab mob los ntawm kev tiv thaiv hauv zos ntawm kev tiv thaiv hauv lub cev [4]. Tsis tas li ntawd, fluticasone propionate thiab proton twj tso kua mis inhibitors synergistically ua rau muaj feem yuav tsim Candida esophagitis [5].

Benralizumab depletes eosinophils los ntawm interleukin -5 receptor-mediated apoptosis, yog li cuam tshuam nrog cov tshuaj tiv thaiv kab mob hauv lub cev los ntawm eosinophils ntawm phagocytosis thiab extracellular DNA ntxiab [6,7]. Cov teebmeem ntawm qhov ncauj qeeb-tso tawm budesonide tau tshaj tawm txwv vim tias muaj kev ua haujlwm bioavailability uas nce mus txog 12 feem pua ​​​​ntawm cov neeg mob noj qab haus huv thiab tsom ileal thiab colonic tso tawm vim muaj pH-raws li txheej uas yaj ntawm pH> 5.5 thiab ib puag ncig ethyl-cellulose granules [8 ].

Txawm li cas los xij, nyob rau hauv cov ntsiab lus ntawm tus neeg mob tus mob polypharmacy nrog rau lwm cov tshuaj uas paub los txhawb kev mob plab Candida, peb cov ntaub ntawv qhia tias qhov ncauj qeeb-tso tawm budesonide kuj tseem tuaj yeem pab txhawb kev txhim kho Candida esophagitis los ntawm kev sib koom ua ke muab kev sib raug zoo ntawm lub sijhawm ntawm nws qhov pib thiab qhov pib ntawm tus neeg mob tus kab mob.

Qhov tseem ceeb, tus neeg mob Candida esophagitis tau ua kom haum rau cov txheej txheem-ntev tiv thaiv kab mob kev kho mob raws li Lub Koom Haum Kab Mob Sib Kis ntawm Asmeskas cov lus qhia [9].

Cov lus xaus

Candida esophagitis tuaj yeem tshwm sim hauv cov neeg mob immunocompetent los ntawm kev sib koom ua ke ntawm kev tiv thaiv tus tswv tsev los ntawm polypharmacy. Qhov sib ntxiv ntawm qhov ncauj ncua kev tso tawm ntawm budesonide tuaj yeem ua rau muaj kev kis kab mob los ntawm kev sib haum xeeb ncaj qha ntawm kev tiv thaiv hauv lub cev.

Cov txheej txheem los tiv thaiv cov kab mob fungal tau zoo hauv kev kho qhov teeb meem ntawm Candida esophagitis. Kev soj ntsuam ntxiv yog xav tau kom paub meej tias qhov kev pheej hmoo ntxiv ntawm budesonide hauv cov neeg mob immunocompetent tau sau lwm cov tshuaj uas paub los txhawb Candida esophagitis.

Cov ntaub ntawv ntxiv

Qhia tawm

Tib neeg cov ntsiab lus: Kev pom zoo tau txais lossis zam los ntawm txhua tus neeg koom hauv txoj kev tshawb no. Kev tsis sib haum xeeb ntawm kev txaus siab: Ua raws li daim ntawv qhia txog ICMJE, txhua tus kws sau ntawv tshaj tawm cov hauv qab no: Cov ntaub ntawv them nyiaj / kev pabcuam: Txhua tus kws sau ntawv tau tshaj tawm tias tsis muaj kev txhawb nqa nyiaj txiag los ntawm ib lub koom haum rau kev xa ua haujlwm. Kev sib raug zoo nyiaj txiag: Txhua tus kws sau ntawv tau tshaj tawm tias lawv tsis muaj kev sib raug zoo nyiaj txiag tam sim no lossis hauv peb lub xyoos dhau los nrog rau txhua lub koom haum uas yuav muaj kev txaus siab rau cov haujlwm xa tuaj. Lwm yam kev sib raug zoo: Txhua tus kws sau ntawv tau tshaj tawm tias tsis muaj lwm yam kev sib raug zoo lossis kev ua ub no uas tuaj yeem tshwm sim los cuam tshuam rau kev xa tawm.

Cov ntaub ntawv

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4. Kanda N, Yasuda H, Takahashi T, et. al: Prevalence ntawm esophageal candidiasis ntawm cov neeg mob kho nrog inhaled fluticasone propionate. Am J ntawm Gastroenterol. Xyoo 2003, 98:2146-2148.

5. Shah N, Cavanagh Y, Shulik O, Patel P, DeBari VA, Baddoura W: Proton twj tso kua mis inhibitors thiab corticosteroids ua synergistic yam tseem ceeb rau Candida esophagitis. British J Med Med Res.

6. Figueiredo RT, Neves JS: Eosinophils nyob rau hauv cov kab mob fungal: ib qho kev piav qhia. J Leukoc Biol.

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10.1093/cid/civ933

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