Ураження шлунково-кишкового тракту при системній склеродермії: діагностично-лікувальні аспекти
DOI:
https://doi.org/10.30978/MG-2019-2-99Ключові слова:
системна склеродермія, шлунково-кишковий тракт, патогенез, стравохід, кишечник, діагностика, лікуванняАнотація
Системна склеродермія є рідкісним автоімунним розладом, який асоціюється з високою захворюваністю та смертністю. Характеризується фіброзом численних органів, зокрема шкіри, опорно-рухового апарату, легень, нирок, серця та шлунково-кишкового тракту (ШКТ). Найчастіше страждає ШКТ (у 90 % випадків). Патогенетичні механізми, котрі беруть участь у цьому захворюванні, охоплюють ендотеліальне ушкодження, васкулопатію і вивільнення цитокінів, які ініціюють імунну відповідь, відкладення колагену і, зрештою, фіброз. До клінічних виявів захворювання належать втрата нормальної перистальтики, гіпотонія, ригідність стінок і м’язова атрофія, які призводять до парезу і дилатації органів ШКТ, надмірного росту бактерій у кишечнику, хронічної кишкової псевдообструкції, діареї, запору. Стравохід є найчастіше ураженою частиною ШКТ, що виявляється гастроезофагеальною рефлюксною хворобою, езофагітом, ризиком розвитку інтерстиціальних захворювань легень і стравоходу Барретта та потребує ретельного спостереження для раннього виявлення злоякісної трансформації. Варіанти ведення хворих на системну склеродермію з ураженням ШКТ далекі від ідеалу з огляду на короткострокову ефективність і наявність багатьох побічних ефектів. Застосовують інгібітори протонної помпи, прокінетики, антибіотики та ендоскопічні втручання. Необхідно провести додаткові дослідження для виявлення терапевтичних методів, які можуть стримати фіброзний процес на ранніх стадіях захворювання, запобігаючи ускладненням і постійному пошкодженню життєво важливих органів. Протиревматичні препарати, котрі модифікують захворювання, не мають ефекту при ураженні ШКТ.
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