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AFECTIUNI INTESTINALE FUNCTIONALE
COLON IRITABIL = intestin iritabil
- sindrom fara substrat organic
- 2 forme clinice: colon spastic = nevroza colica,
colonopatie functionala
dureri abdominale, constipatie cu
scaune fragmentate/diaree
diareea fara dureri = colita muco-membranoasa,
enterita membranoasa
scaune moi, apoase
intermitente/continui
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Cauze
- afectiune psiho-somatica, corelata cu situatiile de stres
- hiperiritabilitate a mecanismului neuromuscular
- scadere a pragului de durere
- riscul creste dupa infectii acute gastro-intestinale
- mod de viata neregulat (alimentatie, regim de viata/munca, fumat)
Simptome
- tulburari de tranzit intestinal: constipatie/diaree
- dureri abdominale
- disconfort abdominal
- tulburari digestive: greata, varsaturi,
pirozis, inapetenta, balonare, flatulenta
- intoleranta la diferite alimente
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senzatie de evacuare incompleta a intestinului
reflux gastro-esofagian
simptome corelate cu stari de labilitate neuro-psihica sau neuro-
vegetativa: insomnie, oboseala, tahicardie/bradicardie
anxietate, depresie, migrena
dureri de spate, simptome genito-urinare
Tratament
- laxative
- antispastice (anticolinergice)
- agonisti/antagonisti serotoninergici- antidepresive triciclice (doze mici)
- domperidona
- psihoterapie
- probiotice
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Fitoterapie
Menth ae aethero leum
- capsule enterosolubile cu 0,2 ml ulei
volatil/capsula;
2 picaturi ulei vol./cana ceai de musetel
cald, dimineata si seara;
frectii la nivel abdominal, dimineata si seara
cu:
Rp. Menthae aetheroleum 10 g
Helianthii oleum 90 g
asigura (pe cale viscero-cutanato-reflexa) o
decontracturare a musculaturii netede a
colonului,
actioneaza spasmolitic (prin blocarea
canalelor de calciu),analgezic.
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Contraindicatii:
ocluzia cailor biliare, colecistita, insuficienta hepatica grava.
Actiuni adverse:
la supradozare (0,6 ml odata) provoaca stare de rau,
greturi, dureri abdominale slabe, senzatie de usturime in zona anala
in timpul defecarii (mentol incomplet absorbit).
Interactiuni medicamentoase:
nu se asociaza antacidelor deoarece reduce pH-ul.
Durata tratamentului: 2-3 saptamani
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Produse vegetale cu mucilagii
- se indica laxative vegetale in perioada de
constipatie
NU !tarte de gru: contine pentozane care
baloneaza
- se prescriu: seminte de in (Lini semen)
seminte de Plantago psyllium
au capacitate mare ce gonflare,
maresc volumul bolului
activeaza peristaltismul si favorizeaza
evacuarea (prin presiunea exercitata de bol
asupra peretilor intestinali)
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Anticolinergice
Tinctura Belladonnae
5 pic./ infuzie de musetel
postprandial creste activitatea
musculaturii intestinale.
- in perioada de diaree:Psylli semen
fixeaza apa,
normalizeaza tranzitul
Se poate asocia cu o dieta (2 zile) constituita din (de 2 ori /zi):
100g branza de vaci + 5 linguri suc de presare din afine/3 lingurite de
afine uscate, pulverizate
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Probiotice
- microorganisme vii care atunci cand
sunt administrate in concentratii
adecvate confera beneficii de sanatateorganismului gazda.
- bacterii lactice, bifidobacterii
- obisnuit consumate ca si parte
componenta a alimentelor fermentatecu adaos de culturii vii speciale
(iaurturi, suplimente alimentare)Efecte specifice:
- ameliorarea boli cronice
inflamatorii intestinale- prevenirea si tratamentul diareeii
patogen induse
- infectii urogenitale
- boli atopice
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- Actiuni probiotice
- cresc imunitatea organismului
- prevenirea infectiilor tractului
digestiv
- impiedica dezvoltarea bacteriilor
patogene in tubul digestiv
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Iberogast
- formula lichida prokinetica indicata
in colonul iritabil si in dispepsie
- amelioreaza simptomatologia prin
imbunatatirea motilitatii, cresterea
tonicitatii- efect dual
spasmolitic (duoden, jejun)
cresterea contractiei
segmentelor ileus aton
- carminativ
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Angel ica
archangel ica
Matr icaria
chamomil la
Carum
carvi
Chel idonium
majus Melissaoff ic inal is
Mentha
piper i ta
Iberis amara
Si lybum
mar ianum
Glycyrrhizaglabra
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AFECTIUNI INTESTINALE INFLAMATORII
pancreatita acuta
pancreatita cronica
diverticuloza
boala Crohn
colita ulceroasa
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Produse vegetaleprescrise in tratamentul afectiunilor
intestinale inflamatorii
spasmolitice (Tinctura Opii, TincturaBelladonnae, preparate din musetel sau
Uzarae radix),
carminative (ulei de menta, chimion,
fenicul, anason),
adsorbtive si modificatoare ale
consistentei bolului intestinal (Lini semen,
Psyllii semen)
normalizatoare ale florei intestinale(preparate microbiene sau cu rutozida), dar
mai ales
antiinflamatoare(preparate ce contin acizi
boswellici, preparate ce contin mucilagii).
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Apartenenta chimica a structurilor importante pentru
afectiunile intestinale inflamatorii
- triterpene pentaciclice
- flavonoide
O
RO
COOH
acizi boswellici
OHO
OOH
OH
OH
OH
cvercetolrutozida
OHO
OOH
OH
OH
O Ru
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Pancreatita acuta cauzata de:
- suferinta biliara, - oreion, afectiuni endocrine,
- abuz de alcool, - alimentatie hiperlipidica,
- indusa iatrogen (azatioprina, clorotiazida, furosemid,
sulfonamide, tetracicline, estrogeni, acid valproic,
l-asparaginaza, clortalidona, corticosteroizi, acid etacrinic,
fenformina),
- hipercalcemia iatrogena
NU beneficiaza de
tratament fitoterapic !
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Pancreatita cronica caracterizata prin:
- dureri acute (pna la insuportabil) in segmentul
superior sau mijlociu al abdomenului cu iradiere in spate
- proces de atrofie progresiva a pancreasului cu
stingerea in cazuri grave, a functiei exocrinediabet
- cauze: abuz de alcool,
alimentatie hiperlipidica si metabolizarea deficitaraa grasimilor
Tratament
- dieta
- substitutie enzimatica
pancreatica
- antalgice
- chirurgical
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Fitoterapie
- substitutie enzimatica (papaina, bromelaina, ficina) si
- antiinflamatoare (Boswellia serrata)
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Papaina
- latexul (papaiotina) din fructele imature de Carica papaya
papaiotinacontine: papaina, chimopapainele A si B, amilaze,
pectinesteraze, lizozimpapaina: GM 21.000 D
pH optim = 6,5
usor oxidabila,
instabila in prezenta sucului gastric
preparate enterosolubile se prescriu in:
- gastrite hipoacide,
- substitutie enzimatica
- ascaridoza, oxiuraza
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Bromelaina
- glicoproteina din sucul de presare a frunzelor situlpinilor de ananas
- pH optim = 4,5 -5
- prescris ca antiinflamator, alaturi de rutozida,in tratamentul colitei ulceroase, bolii Crohn,
edemelor traumatice,- postoperator, deoarece potenteaza actiuneaanticoagulantelor (prelungeste timpul desangerare, inhiba agregarea plachetara)
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extracte de Olibanum resina
(Boswellia serrataRoxb./Burseraceae)
- extracte lipofile cu 37,5%-65% aciziboswellici
- inhibitori selectivi ai 5-LOX blocarea
sintezei de leucotriene
- nu influenteaza COX, 12-LOX, 15-LOX
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- H15 Ayurmedica
- reducerea inflamatiei intestinale
cronice, colici, diareea, hemoragia
- 350 mg extract/zi sau
350 mg x 2/zi (colita ulceroasa, boala
Crohn)
- durata administrare = 6 saptamani
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Ficina
- complex de 6 izoenzime, separat din latexul smochinului
- pH optim = 3,5-4,5
intra in compozitia:
preparatelor enzimatice de substitutie,
antiinflamatoarelor,
antihelminticelor
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Diverticuloza
- afectiune datorata imbatrnirii fiziologicea intestinului subtire si gros,
- apare o invaginare atrofica a mucoasei
(diverticul) cu infiltratie de inflamatie
cronica
- se caracterizeaza prin alternanta de
diaree / constipatie, pe fondul unor dureri
abdominale confuze
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Cauze
- presiune intraluminala crescuta (aerocolie,
constipatie, spasme colice, tuse cronica)- slabirea peretelui intestinal in zona de
deschidere a vaselor sanguine
- deshidratarea
- constipatia si colonul iritabil sunt stadiipremergatoare diverticulozei
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Fitoterapie
- antidiareice (Psyllii semen)
- laxative (Psyllii semen, Lini semen)
- tarate de grau
Tratament
- evitarea constipatiei, aerocoliei
- laxative usoare (constipatie)
- regim hidric, antibiotice, antiseptice
intestinale, repaus la pat (forme acute)
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- localizata in segmentul inferior al intestinului
subtire si in colon,
- caracterizata prin: diarei cronice /sanguinolente
dureri abdominale,
stari de rau,
scadere in greutate,
formare de fistule,fisuri anale, abcese
si/sau febra
- cauze:- predispozitie genetica,
- procese autoimune,
- infectii virale / bacteriene
- factori de mediu care modifica raspunsul
imun al organismului
- localizare: portiunea inferioara a intestinului
subtire, poate cuprinde toate segmentele tubului
digestiv.
Boala Crohn
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Tratament
- antibiotice
- antiinflamatoare (corticosteroizi,aminosalicilati)
- imunosupresoare
- naloxona (doze mici)
- hidratare adecvata
- dieta echilibrata
- renuntarea la fumat
- interventii chirurgicale
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Colita ulceroasa
- localizare initial la nivelul rectului
cauze: factori genetici,
procese autoimune,reactii de hipersensibilitate,
factori psihici.
simptomatologie: - dureri abdominale,
- diaree (sanguinolenta)
- greturi,
- scadere in greutate.
Complicatii:
- afectiuni articulare,
oculare, dermice
-megacolon toxic
= dilatare brusca a intreguluiintestin gros sau a unor
portiuni ale acestuia
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Tratament
-antiinflamatoare (aminosalicilati, corticosteroizi)
- imunosupresoare
- infliximab (anticorp monoclonal ce neutralizeaza activitatea
biologica a factorului de necroza tumorala )
- chirurgical
- clisme cu acizi cu catena scurta (butirat)
- bacterioterapie
- terapia antihelmintica
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-reducerea inflamatiei
- adsorbtia toxinelor si modificarea
consistentei materiilor fecale
- normalizarea florei intestinale
nefiziologice - substituirea enzimelor
digestive
Fitomedicatie
o stimulatori ai cresterii numarului deeubacterii butirat generatoare (glucide
greu digerabile + flavonoide tip rutozida)
oantiinflamatoare (extract de Boswellia,
bromelaina)
o carminative, spasmolitice (Asa
foetida, masaj abdominal cu sol. uleioasa
10% deAetheroleum Carvi)
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- acizii grasi cu catena scurta produsi prin
interventia eubacteriilor butirat generatoare =
esentiali pentru mentinerea integritatii
intestinale
- administrarea combinatiei de rutozida +
polizaharide greu digerabile:
reduce eliberarea de histaminaprevine dezvoltarea unor alterari tisulare
intestinale datorate stresului oxidativ
creste nivelul glutationului la nivelul colonului
stimuleaza cresterea fiziologica a celulelormucoasei colonului si previne degradarea
acesteia
normalizare barierei imunitare afectate
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absorbtie buna a rutozidei la asociere cu
bromelaina
biodisponibilitatea cea mai buna = rutozida
din ceapa (consum zilnic de 100 g
ceapa)
-
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Prezentare Rp
- Caracterizare farmacognostica a produselor vegetale
componente
- comentariu: indicatii terapeutice, precautii/contraindicatii,
reactii adverse
- durata de administrare (in functie de componente Rp)
- posologie posibila
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