{"id":8453,"date":"2013-06-05T16:09:45","date_gmt":"2013-06-05T16:09:45","guid":{"rendered":""},"modified":"2013-06-05T16:09:45","modified_gmt":"2013-06-05T16:09:45","slug":"antisekrecinis-gydymas-ir-rikoseto-fenomenas","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/antisekrecinis-gydymas-ir-rikoseto-fenomenas\/8453\/","title":{"rendered":"Antisekrecinis gydymas ir riko\u0161eto fenomenas"},"content":{"rendered":"<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!--[if !mso]>\n\n\n<style>\nv\\:* {behavior:url(#default#VML);}\no\\:* {behavior:url(#default#VML);}\nw\\:* {behavior:url(#default#VML);}\n.shape {behavior:url(#default#VML);}\n<\/style>\n\n\n<![endif]--><\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!--[if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:PunctuationKerning\/>\n  <w:ValidateAgainstSchemas\/>\n  <w:SaveIfXMLInvalid>false<\/w:SaveIfXMLInvalid>\n  <w:IgnoreMixedContent>false<\/w:IgnoreMixedContent>\n  <w:AlwaysShowPlaceholderText>false<\/w:AlwaysShowPlaceholderText>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n   <w:DontGrowAutofit\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><!--[if gte mso 9]><xml>\n <w:LatentStyles DefLockedState=\"false\" LatentStyleCount=\"156\">\n <\/w:LatentStyles>\n<\/xml><![endif]--><!--[if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";\n\tmso-ansi-language:#0400;\n\tmso-fareast-language:#0400;\n\tmso-bidi-language:#0400;}\n<\/style>\n\n\n<![endif]--> <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><em style=\"mso-bidi-font-style: normal;\"><span lang=\"LT\">Ligos, pasirei\u0161kian\u010dios padid\u0117jusia skrand\u017eio sul\u010di\u0173 sekrecija, yra vienos da\u017eniausi\u0173 ne tik gastroenterologo, bet ir \u0161eimos gydytojo praktikoje. Tai pepsin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/opalige\/4346\">opalig\u0117<\/a>, <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/gastroezofaginio-refliukso-liga\/4363\">gastroezofaginio refliukso liga<\/a> (GERL), funkcin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dispepsija\/4503\">dispepsija<\/a>, retesn\u0117 \u2013 kasos gastrinoma. Vaistai, skirti \u0161ioms ligoms gydyti, yra vieni populiariausi\u0173 ir pla\u010diausiai vartojam\u0173. <\/span><\/em><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Proton\u0173 siurblio inhibitoriai (PSI) da\u017eniausiai i\u0161ra\u0161om\u0173 vaist\u0173 s\u0105ra\u0161e JAV u\u017eima tre\u010di\u0105j\u0105 viet\u0105, per metus j\u0173 parduodama beveik u\u017e 14 mlrd. doleri\u0173. Histamino 2 receptori\u0173 blokatoriai (HRB) skrand\u017eio sul\u010di\u0173 sekrecij\u0105 slopina \u0161velniau negu PSI, tod\u0117l yra saugesni, j\u0173 poveikis lengviau nusp\u0117jamas ir valdomas. Pastar\u0173j\u0173 met\u0173 tyrimai rodo, kad vartojant PSI, ypa\u010d jei gydoma ilgesn\u012f laik\u0105, gali pasireik\u0161ti sunkus \u0161alutinis poveikis: padid\u0117ti vir\u0161kinamojo trakto ir kv\u0117pavimo tak\u0173 infekcij\u0173, skrand\u017eio gleivin\u0117s atrofija, \u0161launikaulio l\u016b\u017ei\u0173, klini\u0161kai reik\u0161mingos nepageidaujamos s\u0105veikos su kai kuriais vaistais (pirmiausia, su klopidogreliu) rizika. \u012evairi\u0173 autori\u0173 nuomone, PSI vartojimo indikacijos tur\u0117t\u0173 b\u016bti grie\u017e\u010diau reglamentuojamos \u2013 j\u0173 tikt\u0173 skirti sunkesn\u0117s hipersekrecijos atvejais, kai ilgalaikis gydymas HRB\u00a0 nepakankamai veiksmingas arba reikia greitai nuslopinti skrand\u017eio sul\u010di\u0173 gamyb\u0105, pavyzd\u017eiui, kraujuojant i\u0161 vir\u0161kinamojo trakto opos. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Vienas klini\u0161kai reik\u0161mingas gydymo PSI nepageidaujamas padarinys \u2013 riko\u0161etin\u0117 skrand\u017eio sul\u010di\u0173 hipersekrecija nutraukus gydym\u0105 \u0161iais vaistais. Riko\u0161etinis skrand\u017eio sul\u010di\u0173 gamybos suaktyv\u0117jimas galimas nutraukus ir HRB, ir PSI vartojim\u0105, ta\u010diau pastaruoju atveju jis b\u016bna ry\u0161kesnis, ilgiau trunka ir da\u017eniau lemia padid\u0117jusio r\u016bg\u0161tingumo simptom\u0173 (r\u0117mens, epigastriumo skausmo ir kt.) atsinaujinim\u0105.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span lang=\"LT\">Skrand\u017eio sul\u010di\u0173 sekrecijos fiziologija<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Skrand\u017eio sultis gamina skrand\u017eio gleivin\u0117s pasienin\u0117s l\u0105stel\u0117s. \u0160iame procese dalyvauja endokrininiai, parakrininiai, autokrininiai ir nerv\u0173 sistemos mediatoriai, stimuliuojantys arba slopinantys druskos r\u016bg\u0161ties sekrecij\u0105. Fiziologin\u0117mis s\u0105lygomis maisto su\u017eadinama skrand\u017eio sul\u010di\u0173 sekrecija vyksta trimis etapais:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">cefalin\u0117 faz\u0117: sekrecij\u0105 stimuliuoja cholinerginiai\/klajoklio nervo mediatoriai;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">skrand\u017eio (gastrin\u0117) faz\u0117: sekrecij\u0105 stimuliuoja gastrinas, stipriausias mediatorius;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">\u017earnyno (intestin\u0117) faz\u0117: jos \u012ftaka sekrecijai nedidel\u0117, mechanizmas neai\u0161kus. <\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Skrand\u017eio sul\u010di\u0173 gamybos ir jos reguliavimo procese dalyvauja 4 tip\u0173 l\u0105stel\u0117s:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">pasienin\u0117s;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">\u012f enterochromafinines pana\u0161ios (ang. ECL);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">G ir D l\u0105stel\u0117s.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Gastrinas yra svarbiausias skrand\u017eio sekrecijos, su\u017eadinamos maisto arba skrand\u017eio mechaninio tempimo, mediatorius. Gastrin\u0105 i\u0161skiria skrand\u017eio prievartyje esan\u010dios vadinamosios gastrino rai\u0161kos l\u0105stel\u0117s. I\u0161siskirti druskos r\u016bg\u0161t\u012f i\u0161 pasienini\u0173 l\u0105steli\u0173 gastrinas skatina netiesioginiu b\u016bdu. Prad\u017eioje i\u0161 ECL l\u0105steli\u0173 i\u0161siskiria histaminas, kuris jungiasi su specifiniais pasienini\u0173 l\u0105steli\u0173 H2 receptoriais ir stimuliuoja r\u016bg\u0161\u010di\u0173 gamyb\u0105.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Nervus vagus\u00a0\u00a0\u00a0\u00a0\u00a0 Acetilcholinas\u00a0\u00a0\u00a0\u00a0 Pasienin\u0117s l\u0105stel\u0117s\u00a0\u00a0\u00a0 ATF-az\u0117 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Somatostatinas\u00a0\u00a0\u00a0\u00a0\u00a0 Histaminas\u00a0\u00a0\u00a0\u00a0 D l\u0105stel\u0117s (kasos, \u017earn\u0173)\u00a0\u00a0\u00a0 Gastrinas\u00a0\u00a0\u00a0\u00a0 Somatostatinas\u00a0\u00a0\u00a0\u00a0\u00a0 G l\u0105stel\u0117s\u00a0\u00a0\u00a0\u00a0\u00a0 D l\u0105stel\u0117s\u00a0\u00a0\u00a0\u00a0 ECL l\u0105stel\u0117s\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Gastrino sukelta histamino sekrecija priklauso nuo bendrosios ECL l\u0105steli\u0173 mas\u0117s, kuri\u0105 reguliuoja gastrinas. Nustatyta, kad gastrinas yra \u017emogaus skrand\u017eio ECL l\u0105steli\u0173 trofinis reguliatorius. Esant gastrinomai (gastrin\u0105 i\u0161skirian\u010diam navikui) d\u0117l ilgalaik\u0117s hipergastrinemijos prasideda skrand\u017eio gleivin\u0117s hipertrofija. Tuo tarpu po antrektomijos pasirei\u0161kia pasienini\u0173 l\u0105steli\u0173 atrofija ir suma\u017e\u0117ja j\u0173 mas\u0117, nes nuslopinama gastrino stimuliacija. Bet kokios kilm\u0117s hipergastrinemija sukelia gleivin\u0117s hiperplazij\u0105 ir padidina ECL l\u0105steli\u0173 tankum\u0105, tod\u0117l padid\u0117ja bendrasis sekrecinis skrand\u017eio potencialas.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Skrand\u017eio gleivin\u0117s D l\u0105stel\u0117s gamina somatostatin\u0105 \u2013 stipr\u0173 skrand\u017eio sekrecijos inhibitori\u0173. Somatostatinas aktyviai slopina histamino, kiek ma\u017eiau \u2013 gastrino sekrecij\u0105, veikia pasienines l\u0105steles. Kita vertus, skrand\u017eio r\u016bg\u0161tys ir gastrinas daro \u012ftak\u0105 somatostatino sekrecijai. Taigi, svarbiausia somatostatino paskirtis \u2013 gr\u012f\u017etamojo ry\u0161io principu reguliuoti sekrecin\u012f skrand\u017eio atsak\u0105 \u012f gastrin\u0105.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Pana\u0161\u016bs procesai vyksta gydant antisekreciniais vaistais: nuslopinus sekrecij\u0105, did\u0117ja gastrino gamyba, o hipergastrinemija skatina gleivin\u0117s hiperplazij\u0105 ir pasienini\u0173 l\u0105steli\u0173 mas\u0117s bei sekrecinio skrand\u017eio potencialo did\u0117jim\u0105. Tuo galima paai\u0161kinti nepageidaujamus ilgalaikio gydymo antisekreciniais vaistais padarinius \u2013 pripratim\u0105 ir riko\u0161etin\u0117s hipersekrecij\u0105 nutraukus vaist\u0173 vartojim\u0105. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Klinicistams gerai \u017einoma, kad prie ilg\u0105 laik\u0105 vartojam\u0173 HRB priprantama d\u0117l:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">histamino sekrecijos ECL l\u0105stel\u0117se sustipr\u0117jimo d\u0117l hipergastrinemjos;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">HRB molekuli\u0173 konkurencijos su histaminu d\u0117l pasienini\u0173 l\u0105steli\u0173 receptori\u0173. <\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Pripratimas prie PSI neb\u016bdingas, nes \u0161i\u0173 vaist\u0173 antisekrecinio poveikio mechanizmas kitoks: PSI veikia ne konkurenciniu principu, o tiesiai H+ ir K+ ATF-az\u0119.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span lang=\"LT\">Proton\u0173 siurblio inhibitoriai ir histamino 2 receptori\u0173 blokatoriai<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Riko\u0161etin\u0117 hipersekrecija, atsirandanti nutraukus antisekrecin\u012f gydym\u0105, detaliai apra\u0161yta daugiau nei prie\u0161 du de\u0161imtme\u010dius, ta\u010diau jos klinikin\u0117 reik\u0161m\u0117 iki \u0161iol n\u0117ra ai\u0161kiai apibr\u0117\u017eta.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Pirm\u0105 kart\u0105 riko\u0161etin\u0117s hipersekrecijos fenomenas buvo apra\u0161ytas prie\u0161 30 met\u0173: nustatyta, kad, nutraukus 4 savai\u010di\u0173 trukm\u0117s gydym\u0105 ranitidinu, trump\u0105 laik\u0105 skrand\u017eio sul\u010di\u0173 sekrecija buvo didesn\u0117 nei iki ranitidino vartojimo. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Reimer su bendradarbiais nustat\u0117, kad sveikiems savanoriams, tam tikr\u0105 laik\u0105 vartojusiems PSI ir nutraukusiems j\u0173 vartojim\u0105, atsirado dispepsijos simptom\u0173. V\u0117liau \u0161\u012f rei\u0161kin\u012f pagrind\u0117 kiti tyrimai. Prewett su bendradarbiais atsitiktini\u0173 im\u010di\u0173 dvigubai aklame tyrime lygino naktin\u0119 skrand\u017eio sekrecij\u0105 sveikiems savanoriams prie\u0161 gydym\u0105 ranitidinu arba omeprazoliu, 25 dien\u0173 gydymo periodu ir po gydymo. Nustatyta, kad ranitidino vartojusiems asmenims tre\u010di\u0105 dien\u0105 po gydymo nutraukimo skrand\u017eio sekrecija, lyginant su buvusia iki gydymo, buvo padid\u0117jusi 17 proc., \u0161e\u0161t\u0105 dien\u0105 \u2013 14 proc., bet devint\u0105 dien\u0105 susilygino su buvusia iki gydymo.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Nors riko\u0161etin\u0117 hipersekrecija gali pasireik\u0161ti nutraukus gydym\u0105 bet kuriuo antisekreciniu preparatu, dauguma autori\u0173 mano, kad hipersekrecija po HRB vartojimo nutraukimo da\u017eniausiai neb\u016bna klini\u0161kai reik\u0161minga \u2013 ji trunka neilgai, o jos simptomai lengvi. Riko\u0161eto fenomenas ry\u0161kesnis <em style=\"mso-bidi-font-style: normal;\">Helicobacter pylori<\/em> neu\u017esikr\u0117tusiems asmenims.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Kas kita PSI. J\u0173 vartojimas sukelia ry\u0161kesn\u0119 hiposekrecij\u0105 bei hipergastrinemij\u0105 ir antrin\u0119 ECL l\u0105steli\u0173 hiperplazij\u0105, kurios trunka ilgiau negu antisekrecinis PSI poveikis. Waldum su bendradarbiais pirmieji \u012frod\u0117, kad pacientams, sergantiems <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/gastroezofaginio-refliukso-liga\/4363\">gastroezofaginio refliukso liga<\/a> (GERL), 14 dien\u0105 po nutraukto 3 m\u0117n. trukm\u0117s gydymo omeprazoliu bazin\u0117 ir pentagastrino su\u017eadinta skrand\u017eio sekrecija buvo reik\u0161mingai didesn\u0117 negu iki gydymo. Per 3 m\u0117nesius reik\u0161mingai padid\u0117jo ECL l\u0105steli\u0173 mas\u0117 \u2013 tai buvo hipergastrinemijos pasekm\u0117. Fossmark su bendradarbiais nustat\u0117, kad riko\u0161etin\u0117s hipersekrecijos trukm\u0117 priklauso nuo gydymo trukm\u0117s. Nutraukus ilgiau nei metus vartotus PSI riko\u0161etin\u0117 hipersekrecija laik\u0117si daugiau kaip 2 m\u0117nesius, tai yra kol suma\u017e\u0117jo ir normalizavosi ECL l\u0105steli\u0173 mas\u0117.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Reimer su bendradarbiais tyr\u0117, ar riko\u0161etin\u0117 hipersekrecija gali sukelti klinikini\u0173 simptom\u0173. 120 sveik\u0173 savanori\u0173 buvo suskirstyti \u012f dvi grupes: pirmosios grup\u0117s tiriamieji 12 savai\u010di\u0173 vartojo placeb\u0105, antrosios grup\u0117s \u2013 4 savaites placeb\u0105, o paskui 8 savaites esomeprazolio. Tyrimo pabaigoje 44 proc. pacient\u0173, vartojusi\u0173 esomeprazolio, nurod\u0117 patyr\u0119 ma\u017eiausiai vien\u0105 hipersekrecijos simptom\u0105 (r\u0117men\u012f, dispepsij\u0105, r\u016bg\u0161\u010di\u0173 atpylim\u0105) per paskutines 4 tyrimo savaites. Placeb\u0105 vartojusi\u0173 pacient\u0173 grup\u0117je padid\u0117jusio r\u016bg\u0161tingumo simptom\u0173 patyr\u0117 15 proc. tiriam\u0173j\u0173. Tai rodo, kad nutraukus gydym\u0105 PSI galimi klini\u0161kai reik\u0161mingi simptomai, pacient\u0173 apib\u016bdinami kaip ligos atsinaujinimas. Tiesa, kol kas turim\u0173 mokslini\u0173 tyrim\u0173 duomen\u0173 labiau apibendrintoms i\u0161vadoms padaryti nepakanka. Iki \u0161iol nenustatyta, kaip da\u017enai riko\u0161etin\u0117 hipersekrecija pasirei\u0161kia ligonio juntamais klinikiniais simptomais, koks ry\u0161ys tarp riko\u0161etin\u0117s hipersekrecijos intensyvumo ir simptom\u0173 ry\u0161kumo ir pan.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Tyrimai rodo, kad riko\u0161etin\u0117 hipersekrecija po gydymo antisekreciniais vaistais b\u016bna ry\u0161kesn\u0117 asmenims, neu\u017esikr\u0117tusiems <em style=\"mso-bidi-font-style: normal;\">H. pylori<\/em>. <em style=\"mso-bidi-font-style: normal;\">H. pylori<\/em> eradikacija riko\u0161eto simptomus da\u017enai suaktyvina. Tyrimas, kuriame <em style=\"mso-bidi-font-style: normal;\">H. pylori<\/em> neu\u017esikr\u0117t\u0119 savanoriai 4 savaites vartojo pantoprazolio arba placebo, rodo, kad per 1 savait\u0119 po gydymo nutraukimo dispepsijos simptom\u0173 atsirado 44 proc. pantoprazolio vartojusi\u0173 asmen\u0173 ir 9 proc. \u2013 vartojusi\u0173j\u0173 placeb\u0105. Dispepsijos simptomai buvo susij\u0119 su serumo gastrino koncentracija, ta\u010diau kiekybin\u0117 koreliacijos i\u0161rai\u0161ka nenustatyta. Tre\u010di\u0105 savait\u0119 po gydymo nutraukimo dispepsijos da\u017enumas abiejose tiriam\u0173j\u0173 grup\u0117se susivienodino \u2013 tai rod\u0117 riko\u0161eto fenomeno pabaig\u0105.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span lang=\"LT\">I\u0161vados<\/span><\/strong><\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Gydymo bet kuriais antisekreciniais vaistais nutraukimas da\u017eniausiai b\u016bna lydimas riko\u0161etin\u0117s skrand\u017eio hipersekrecijos.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Riko\u0161eto fenomenas po gydymo HRB paprastai b\u016bna klini\u0161kai nereik\u0161mingas \u2013 ma\u017eesnio intensyvumo ir trunka trumpiau negu po gydymo PSI.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Riko\u0161etin\u0117 hipersekrecija po gydymo PSI b\u016bna ry\u0161kesn\u0117, trunka ilgiau ir neretai lemia hipersekrecijos simptom\u0173 atsinaujinim\u0105.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Riko\u0161etin\u0117 hipersekrecija po gydymo PSI gali b\u016bti svarbi prie\u017eastis t\u0119sti antisekrecin\u012f gydym\u0105, o tai atsiliepia paciento gyvenimo kokybei, did\u0117ja gydymo i\u0161laidos.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><em style=\"mso-bidi-font-style: normal;\"><span lang=\"LT\">Pagal<strong style=\"mso-bidi-font-weight: normal;\"> Ivan Lerotic, Nevan Bar\u0161ic, Sanja Stojsavljecic. Acid inhibition and the acid rebound effect. Dig Dis 2011; 29: 482-486 <\/strong>pareng\u0117<\/span><\/em><span lang=\"LT\">gyd. J. Kastys<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Lietuvos Gydytojo \u017eurnalas<br \/><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p><!--[if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:PunctuationKerning\/>\n  <w:ValidateAgainstSchemas\/>\n  <w:SaveIfXMLInvalid>false<\/w:SaveIfXMLInvalid>\n  <w:IgnoreMixedContent>false<\/w:IgnoreMixedContent>\n  <w:AlwaysShowPlaceholderText>false<\/w:AlwaysShowPlaceholderText>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n   <w:DontGrowAutofit\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/p>\n<p><!--[if gte mso 9]><xml>\n <w:LatentStyles DefLockedState=\"false\" LatentStyleCount=\"156\">\n <\/w:LatentStyles>\n<\/xml><![endif]--><!--[if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";\n\tmso-ansi-language:#0400;\n\tmso-fareast-language:#0400;\n\tmso-bidi-language:#0400;}\n<\/style>\n\n\n<![endif]--><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\" lang=\"LT\">Vienas klini\u0161kai reik\u0161mingas gydymo PSI nepageidaujamas padarinys \u2013 riko\u0161etin\u0117 skrand\u017eio sul\u010di\u0173 hipersekrecija nutraukus gydym\u0105 \u0161iais vaistais. Riko\u0161etinis skrand\u017eio sul\u010di\u0173 gamybos suaktyv\u0117jimas galimas nutraukus ir HRB, ir PSI vartojim\u0105, ta\u010diau pastaruoju atveju jis b\u016bna ry\u0161kesnis, ilgiau trunka ir da\u017eniau lemia padid\u0117jusio r\u016bg\u0161tingumo simptom\u0173 (r\u0117mens, epigastriumo skausmo ir kt.) atsinaujinim\u0105.<\/span><\/p>\n","protected":false},"author":1,"featured_media":8454,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[1264,7,795,791,937,92,2149,138],"site":[],"post_item_type":[27345],"class_list":["post-8453","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gydymo-naujienos","tag-atrofija","tag-inhibitoriai","tag-mase","tag-mases","tag-mediatoriai","tag-opalige","tag-rikoseto-fenomenas","tag-vaistai"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8453","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=8453"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8453\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/8454"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=8453"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=8453"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=8453"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=8453"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=8453"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}