tailieunhanh - Gastroenterology an illustrated colour text - part 6

.suy dinh dưỡng mãn tính kích thích kháng nguyên vi khuẩn có kết quả trong sự thay đổi ác tính sau này. mãn tính và không hợp vệ sinh quanh tạo ra một sự phát triển của các tế bào miễn dịch sản xuất phần chuỗi nặng của IgA có liên quan đến sự đàn áp của sản xuất IgA bình thường | MISCELLANEOUS COLITIDES AND OTHER CAUSES OF DIARRHOEA 59 a-CHAIN DISEASE IMMUNOPROLIFERATIVE SMALL INTESTINAL DISEASE - IPSID This condition is specifically located in the Eastern Mediterranean area particularly Iran. The basic aetiology seems to be similar to that of MALT tumours of the stomach in that the condition may be initiated by chronic bacterial antigenic stimulation which results in subsequent malignant change. Chronic malnourishment and unhygienic environs produce a proliferation of immune cells which produce the heavy chain portion of IgA. There is associated suppression of normal IgA production which may then result in small bowel bacterial overgrowth which exacerbates the problem. There is a premalignant stage during which prolonged treatment with antibiotics such as tetracycline may result in cure. This is followed however by a frankly malignant stage which requires chemotherapy. Clinical features are of abdominal pain weight loss diarrhoea and finger clubbing in a young adult from the appropriate geographical area. SMALL BOWEL BACTERIAL OVERGROWTH The proximal small bowel has relatively low concentrations of organisms. This situation is maintained by rapid transit of small bowel content mucous secretion and a lack of stasis. When these mechanisms are inadequate Table 1 a rise in small intestinal flora occurs that can result in diarrhoea malabsorption and vitamin deficiency. The protective aspects of intestinal motility and gastric acid production are less effective in the elderly and consequently small bowel bacterial overgrowth is more common in the aged and probably under-recognised. The diarrhoea seems to occur as a result of deconjugation of bile salts by bacteria and fat malabsorption. There may be a rise in serum folic acid as this may be produced by gut bacteria. Diagnosis may be made by documenting an early rise in exhaled hydrogen owing to small bowel bacterial metabolism following an ingested carbohydrate load. This test lacks sensitivity

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