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Environmental enteropathy

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Environmental enteropathy
obere ụdị nkeintestinal disease, neglected tropical disease, Ọrịa gburugburu ebe obibi Dezie
ihe kpatara yaopen defecation, erighị ihe na-edozi ahụ́ Dezie
health specialtygastroenterology Dezie
mgbaàmà na akaraspecific developmental disorder Dezie
usoro nnyefe ọrịafecal–oral route Dezie

Environmental enteropathy ( EE ma ọ bụ tropical enteropathy ma ọ bụ gburugburu ebe obibi n'adighi nke ọma ) bụ nsogbu nke mbufụt nke eriri afọ na-adịghị ala ala. [1] [2] [3] EE bụ ihe a na-ahụkarị n'etiti ụmụaka bi na ntọala akụrụngwa dị ala. [1] [2] [3] Mgbaàmà dị oke njọ na-adịkarị ntakịrị ma ọ bụ adịghị. [2] EE nwere ike iduga erighị ihe na-edozi ahụ, anaemia (anaemia na -adịghị ike nke ígwè na anaemia nke ọrịa na-adịghị ala ala ), [1] na-eto eto, ụbụrụ ụbụrụ na-adịghị mma, [4] [5] [6] na nzaghachi na-adịghị mma maka ịgba ọgwụ mgbochi ọnụ. [7] [8]

Ihe kpatara EE bụ multifactorial. N'ozuzu, ikpughe nri na mmiri emetọọ na-eduga na ọnọdụ mbufụt nke eriri afọ. [1] [2] [3] Nzaghachi na-egbuke egbuke na-eme ka mgbanwe dị iche iche na-eme mgbanwe na tract gastrointestinal: obere villi, nnukwu crypts (a na-akpọ hyperplasia crypt ), mmụba na- abawanye, na mmalite cell na-ewuli elu n'ime eriri afọ. [2] [3] [9] Mgbanwe ndị a na-ebute adịghị mma nke nri, vitamin na mineral.

Nchọpụta achọpụtara ahazi, nke bara uru na ụlọ ọgwụ adịghị. Nnwale nyocha kacha zie ezi bụ biopsy eriri afọ. Agbanyeghị, ule a na-akpa ike na ọ dịghị mkpa maka ọtụtụ ndị ọrịa. [1]

Mgbochi bụ nhọrọ kachasị ike na nke a pụrụ ịdabere na ya maka igbochi EE na mmetụta ya. Ya mere, a na-ekwurịtakarị mgbochi na ọgwụgwọ EE ọnụ. [9] [10] [11]

Ihe akara ama na mgbaàmà

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Ekwenyere na Environmental enteropathy gburugburu ebe obibi na-ebute erighị ihe na-edozi ahụ na-adịghị ala ala yana mbelata uto na-esote (ntụta ogo dị ala maka afọ) yana ụkọ ntolite ụmụaka ndị ọzọ. 

Mgbaàmà nke Obere oge

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EE adịkarịghị akara ngosi ma a na-ewere ya dị ka ọnọdụ subclinical . [1] [3] [2] Otú ọ dị, ndị okenye nwere ike inwe mgbaàmà dị nro ma ọ bụ malabsorption dị ka mgbanwe stool agbanwe agbanwe, ụbara stool ugboro na mbelata ibu. 

Mgbaama nke Ogologo oge

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  • Erighị ihe na-edozi ahụ́ [1] [2]
    • EE na-ebute erighị ihe na-edozi ahụ site na malabsorption na ụkọ nri.
  • Uto na mmepe anụ ahụ [9]
    • Afọ abụọ mbụ (na ọnwa itoolu gara aga nke ndụ nwa ebu n'afọ) dị oke mkpa maka uto ahịrị. Ịkwụ ụgwọ bụ ihe dị mfe iji tụọ ihe mgbaàmà nke erughi ntolite ụmụaka ndị a.
  • Neurocognitive (mmepe ụbụrụ) [5] [6]
  • Mmetụta na ịgba ọgwụ mgbochi ọnụ [8] [12]
    • Ọtụtụ ọgwụ mgbochi ọnụ, ma ndị dị ndụ ma ndị na-abụghị ndị dị ndụ, egosila na ha adịchaghị ihe nchebe ma ọ bụ na-echebe ya mgbe a na-enye ụmụ ọhụrụ, ụmụaka ma ọ bụ ndị okenye bi na ọnọdụ akụ na ụba dị ala na mba ndị ka na -emepe emepe karịa ka a na-eji ya na mba ndị mepere emepe . A na-eche na EE zuru ebe niile ka ọ bụrụ ihe na-enye aka maka nlebanya a.
Nwata na-anata ọgwụ mgbochi polio ọnụ. Enwere ụfọdụ ihe akaebe na njirimara dysfunction enteric nke EE nwere ike imebi ịdị irè nke ịgba ọgwụ mgbochi ọnụ.

Ihe kpatara ya

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Mmepe nke EE bụ ọtụtụ ihe, mana ọ na-emetụtakarị ya na ikpughe nri na mmiri adịghị ala ala. Nke a bụ eziokwu karịsịa n'ebe ndị ebe a na-asachapụ ebe niile na enweghị ebe ịdị ọcha na-adịkarị. [1] [2] [3]

Mechanism

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Ogologo oge ikpughe na pathogens gburugburu ebe obibi na-eduga n'ozuzu ọnọdụ nke mbufụt nke eriri afọ. Ọfụfụ na-adịghị ala ala na-ebutekari ma mgbanwe arụ ọrụ yana nhazi nke na-agbanwe ike nke eriri afọ na ikike nke eriri afọ iji nweta nri. [1] [2] [3]

Ihe akaebe nke atrophy villous na onyonyo endoscopic nke obere eriri afọ. [13]

Kpọmkwem, mgbanwe nhazi n'ime eriri afọ gụnyere obere villi, nnukwu crypts (nke a na-akpọ hyperplasia crypt ), ịba ụba nke permeability, na sel mkpali na-ebuli n'ime eriri afọ. Mgbanwe ndị a na-ebute adịghị mma nke nri, vitamin na mineral - ma ọ bụ " malabsorption nke dị ntakịrị". [1] [2] [3]

Usoro dị mfe na-akọwapụta ihe kpatara na mmetụta nke EE.

Nchọpụta nchọpụta

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Nnwale nyocha nke ọkọlọtọ ọla edo dị ugbu a maka EE bụ biopsy intestinal na nyocha histological. Mgbanwe nke akụkọ ihe mere eme gụnyere: [3]

  • Nkwuwa okwu ọjọọ
  • Crypt hypertrophy
  • Njikọ ọjọọ
  • Mucosal mbufụt

Otú ọ dị, a na-ewere usoro a dị ka ihe na-emerụ emerụ, mgbagwoju anya ma dị oke ọnụ iji tinye ya dị ka ọkọlọtọ nlekọta. [1] N'ihi ya, a na-eme mgbalị nyocha dị iche iche iji chọpụta ihe ndị na -emepụta ihe na-ejikọta na EE, nke nwere ike ịbụ ihe na-adịghị emerụ ahụ, ma na-anọchite anya ngwaọrụ iji nyochaa ma chọpụta EE site na ihe nlele nyocha nke nsi. [1]

N'ịgbalị ịchọpụta ule nyocha dị mfe, ziri ezi maka EE, Ntoala nke Bill na Melinda Gates (BMGF) eguzobela EE biomarkers consortium dị ka akụkụ nke atụmatụ Global Grand Challenges atumatu (kpọmkwem, Discover Biomarkers of Gut Function challenge). [1]

Ka ọ dị ugbu a, a họrọla ma mụọ ihe dị iche iche biomarkers dabere na nghọta ugbu a nke EE pathophysiology: [1]

  • Permeability nke eriri afọ /ọrụ mgbochi
    • Permeability nke shuga abụọ ( lactose -to- mannitol ruru)
  • Ọrịa eriri afọ
    • Alfa-1 mgbochi-trypsin
    • Neopterin
    • Myeloperoxidase
  • Exocrine (hormonal) akara
  • Ihe nrịbama ntụgharị nje bacteria
    • Endotoxin core antibody
  • Ihe nrịbama nke sistemu sistem
    • Alfa-1 glycoprotein
    • Protein C-reactive (CRP) 

A na-ekwupụta na njedebe nke nghọta nke EE bụ akụkụ ụfọdụ n'ihi ụkọ nke ndị na-emepụta ihe ndị a pụrụ ịdabere na ya, na-eme ka o siere ndị na-eme nchọpụta ike ịchọta ọrịa na-efe efe nke ọnọdụ ahụ ma chọpụta ịdị irè nke ntinye aka. [9]

Nhazi dị iche iche

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N'afọ ndị 1960, ndị na-eme nchọpụta kọrọ banyere ọrịa nke mgbanwe mgbanwe nke histopathological na arụ ọrụ na obere eriri afọ na ndị mmadụ bi n'ọnọdụ adịghị ọcha. [2] A na-ahụta ọrịa a na mpaghara okpomọkụ n'ofe Latin America, sub-Saharan Africa na Asia. Nkesa ala nke ọrịa ahụ na-eduga na okwu mbụ nke "enteropathy okpomọkụ" (mgbe ụfọdụ na-enwekwa "jejunopathy okpomọkụ"). [2]

N'ịgbaso akụkọ mbụ, nyocha ọzọ gosiri na mgbaàmà ndị a abụghị kpọmkwem maka ihu igwe okpomọkụ. Dị ka ihe atụ, ndị nọ ná mba ebe okpomọkụ ka baa ọgaranya, dị ka Qatar na Singapore, egosighị mgbaàmà ndị a. [3] N'otu aka ahụ, nchọpụta ndị ọzọ egosila na ọnọdụ a bụ ihe a na-ahụkarị n'ofe mba ndị na-emepe emepe, jikọtara ya na ọnọdụ ịda ogbenye ma na-adabereghị na ihu igwe ma ọ bụ ọdịdị ala. [3] [9] N'ihi ya, e webatara okwu ahụ bụ "environmental enteropathy" iji kọwaa na ọ bụghị nanị na a na-ahụ ọnọdụ a na ebe okpomọkụ ma kwenyere na ọ bụ ihe ndị metụtara gburugburu ebe obibi kpatara ya. [2]

Ụzọ Mgbochi

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A na-akwado usoro ịdị ọcha, dị ka ịsacha aka tupu ịkwadebe nri, na ụzọ mgbochi nke EE.

Ụzọ Mgbochi na-elekwasị anya n'ịkwalite ịnweta mmiri, idebe ihe ọcha na ịdị ọcha (WASH) . [14] [15]

Ihe ọzọ dị mkpa nwere ike ịbụ ala emetọọ n'ebe egwuregwu ụmụaka, nke na-ebutekarị site na ọnụnọ anụ ụlọ dịka ọkụkọ n'ime ezinụlọ. Ịmepụta oghere egwuregwu dị ọcha nwere ike bụrụ ihe mgbochi dị irè maka EE na ụmụaka. [16]

Ọgwụgwọ

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Ọgwụgwọ na-elekwasị anya n'ịgbasa isi ihe dị n'etiti mbufụt nke eriri afọ, mmụba nke nje bacteria na mgbakwunye nri. [1]

Epidemiology

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Environmental enteropathy (EE) na-emetụtakarị ụmụaka bi na mba ndị nwere obere ego na nke etiti (LMIC). [17] Achọpụtara ụmụaka ndị bi na mba ndị a ka ha nwere nje nje metụtara EE na sistemu ha n'ime oge niile ha bụ nwata. [17] Ọrịa afọ ime afọ jikọtara ya na EE abụghị ọmụmụ mana a na-enweta ya n'oge ọ bụ nwata ma na-adịgide ruo n'oge. [18] [19] Ọdịiche dị otú ahụ na-etolite mgbe ọkara nke mbụ nke ndụ na-adịghị adị na ụmụ ọhụrụ. [18]

Kemgbe ụwa, environmental enteropathy gburugburu ebe obibi agbasawo na LMICs. [19] Nkesa ala dum nke enteropathy gburugburu ebe obibi egosila mmụba nke ọnọdụ na mpaghara ndị dị otú ahụ nke adịghị ọcha na ịdị ọcha. [17] E bu ụzọ kọwaa EE na nyocha sitere n'afọ 1960-70 nke emere na Asia, Africa, subcontinent India, na Central America, n'oge a chọpụtara na akara EE dị elu n'etiti ndị okenye na ụmụaka nwere ahụike. [20] A na-akpọkarị ọmụmụ ihe sitere n'afọ 1971 na-esote ndị ọrụ afọ ofufo US Peace Corps dị ka ihe ọmụmụ mbụ gosipụtara ikike iji nweta na ịgbake na EE dịka gburugburu ebe obibi. [19] Ndị sonyere na-enweta ihe mgbaàmà nke ọrịa enteric na-adịghị ala ala n'oge na obere oge ka ha lọtachara na ntinye ha na mba ndị na-akpata obere ego na etiti. [17] Ekpebiri akara mgbaàmà nke ndị si mba ọzọ nwetara n'ime otu afọ ma ọ bụ afọ abụọ ka ha laghachiri n'ụlọ US. [19] Nsonaazụ ndị a na-eduga na aro nke gburugburu ebe obibi bụ ihe kpatara EE, na ọmụmụ ihe mechara na Zambia nwere ike nweta nkwubi okwu yiri nke ahụ. [19] Ka ọ na-erule mmalite mgbe afọ 1990s, a chọpụtara na enteropathy gburugburu ebe obibi bụ nsogbu zuru ebe niile na-emetụta ụmụ ọhụrụ na ụmụaka. [19] Taa, ọrịa enteric na ọrịa afọ ọsịsa dị ka gburugburu ebe obibi enteropathy na-akpata ọnwụ narị puku asaa na iri isii kwa afọ n'ụwa nile, na-eme ka EE bụrụ nke abụọ na-akpata ọnwụ na ụmụaka na-erubeghị afọ ise. [20]

Ihe kpatara ya na nsonaazụ EE siri ike guzobe n'ihi, akụkụ ụfọdụ, n'ihi enweghị nkọwa ọrịa doro anya. [17] Otú ọ dị, ihe ndị dị ize ndụ dị ma ha nwere ike ịbụ ma gburugburu ebe obibi na nri. [17] Ọnọdụ ndị dịbu adị dị ka ụkọ micronutrient, ọrịa afọ ọsịsa, na ọrịa na-adịghị ala ala dị iche iche na-eje ozi dị ka ihe ize ndụ maka EE. [17] Ọnọdụ gburugburu ebe obibi dị ka adịghị ọcha na-adịghị ọcha na ebe mmiri na-adịghị mma na-enyekwa aka na mgbasa nke EE. [17] A na-eche na ikpughe ihe ndị na-ahụ maka microbial gburugburu ebe obibi dị ka ndị a bụ ihe kachasị mkpa na mmepe nke EE. [18]

Atụmatụ nyocha

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Enwere ọtụtụ nnukwu ubi, atụmatụ nyocha nke mba dị iche iche na-elekwasị anya na atụmatụ iji gbochie na ịgwọ EE. [9]

Edensibia

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  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 (January 2016) "Environmental enteropathy". Current Opinion in Gastroenterology 32 (1): 12–7. DOI:10.1097/MOG.0000000000000226. PMID 26574871. 
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 (June 2012) "Environmental enteropathy: critical implications of a poorly understood condition". Trends in Molecular Medicine 18 (6): 328–36. DOI:10.1016/j.molmed.2012.04.007. PMID 22633998. 
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 (July 2017) "Tropical Enteropathies". Current Gastroenterology Reports 19 (7): 29. DOI:10.1007/s11894-017-0570-0. PMID 28540669. 
  4. ↑ (January 2014) "Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links". Annals of the New York Academy of Sciences 1308 (1): 118–28. DOI:10.1111/nyas.12330. PMID 24571214. 
  5. ↑ 5.0 5.1 (April 2017) "Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape". Pediatrics 139 (Suppl 1): S12–S22. DOI:10.1542/peds.2016-2828d. PMID 28562245. 
  6. ↑ 6.0 6.1 (April 2017) "Neurodevelopment: The Impact of Nutrition and Inflammation During Early to Middle Childhood in Low-Resource Settings". Pediatrics 139 (Suppl 1): S59–S71. DOI:10.1542/peds.2016-2828h. PMID 28562249. 
  7. ↑ (June 2016) "Early-life enteric infections: relation between chronic systemic inflammation and poor cognition in children". Nutrition Reviews 74 (6): 374–86. DOI:10.1093/nutrit/nuw008. PMID 27142301. 
  8. ↑ 8.0 8.1 (June 2015) "Vaccines against enteric infections for the developing world". Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 370 (1671): 20150142. DOI:10.1098/rstb.2015.0142. PMID 25964464. 
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 (May 2012) "Enteropathies in the developing world: neglected effects on global health". The American Journal of Tropical Medicine and Hygiene 86 (5): 756–63. DOI:10.4269/ajtmh.2012.11-0743. PMID 22556071. 
  10. ↑ (September 2009) "Child undernutrition, tropical enteropathy, toilets, and handwashing". Lancet 374 (9694): 1032–1035. DOI:10.1016/s0140-6736(09)60950-8. PMID 19766883. 
  11. ↑ (May 2016) "Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries". Maternal & Child Nutrition 12 Suppl 1: 106–20. DOI:10.1111/mcn.12220. PMID 26542185. 
  12. ↑ (June 2015) "Exploring the role of environmental enteropathy in malnutrition, infant development and oral vaccine response". Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 370 (1671): 20140143. DOI:10.1098/rstb.2014.0143. PMID 25964455. 
  13. ↑ (July 2017) "Tropical Enteropathies". Current Gastroenterology Reports 19 (7): 29. DOI:10.1007/s11894-017-0570-0. PMID 28540669. 
  14. ↑ (May 2016) "Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries". Maternal & Child Nutrition 12 Suppl 1: 106–20. DOI:10.1111/mcn.12220. PMID 26542185. 
  15. ↑ (January 2014) "Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links". Annals of the New York Academy of Sciences 1308 (1): 118–28. DOI:10.1111/nyas.12330. PMID 24571214. 
  16. ↑ (January 2018) "Enteric Infections in Young Children are Associated with Environmental Enteropathy and Impaired Growth". Tropical Medicine & International Health 23 (1): 26–33. DOI:10.1111/tmi.13002. PMID 29121442. 
  17. ↑ 17.0 17.1 17.2 17.3 17.4 17.5 17.6 17.7 (November 2019) "Environmental enteric dysfunction: a review of potential mechanisms, consequences and management strategies". BMC Medicine 17 (1): 181. DOI:10.1186/s12916-019-1417-3. PMID 31760941. 
  18. ↑ 18.0 18.1 18.2 (2019-03-01) "Environmental enteric dysfunction and growth". Jornal de Pediatria 95 Suppl 1: 85–94. DOI:10.1016/j.jped.2018.11.004. PMID 30629923. 
  19. ↑ 19.0 19.1 19.2 19.3 19.4 19.5 (March 2015) "Environmental enteric dysfunction: an overview". Food and Nutrition Bulletin 36 (1 Suppl): S76-87. DOI:10.1177/15648265150361S113. PMID 25902619. 
  20. ↑ 20.0 20.1 (July 2016) "Environmental Enteric Dysfunction in Children". Journal of Pediatric Gastroenterology and Nutrition 63 (1): 6–14. DOI:10.1097/MPG.0000000000001147. PMID 26974416. 
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