Te kikorangi metilīni i te tirohanga ā-roto o te pūnaha kūnatu me te tirohanga mā te waikano

He ōrite te rāpoi ngota kotahi o ēnei wai kikorangi e rua, engari tata kore he mea kē e ōrite ana. I te rūma tirohanga ā-roto, ka rehu te rata i te kikorangi metilīni kua waimehatia ki te kiriuhi o te kōpiro nui, kia māmā ake ai te kite i ngā wāhi kiko rerekē papatahi. I te kāinga, ka kotē tētahi tangata i ngā pata kikorangi mai i tētahi pounamu hokohoko ki te wai hei tikanga oranga. Ko te whakapoauau i ēnei mea e rua he hapa ā-ariā, ehara i te hapa rahinga anake: ko tētahi he tukanga whakakite hei tātaritanga, e mahia ana ki ngā whakarite haumanu; ko tērā atu he hua mā te kaihoko. Ka whakamārama tēnei tuhinga i te taha tirohanga ā-roto, kei reira te waikano hei taputapu mō te kite, ehara hei maimoatanga mō ngā mea ka kitea. Mō te tirohanga whānui ki ngā whakamahinga rongoā kua whakapūmautia me ngā whakamahinga whakamātau, tirohia te tirohanga whānui ki te kikorangi metilīni i te rongoā.

Te whakapoke i te mata: he waikano mō ngā pūtau ora, ehara i te pene miramira

Ko te whakakite mā te waikano i te wā o te tirohanga ā-roto ka kīia he tirohanga ā-roto mā te waikano. Ka mahia e te kikorangi metilīni te mea e kīia ana e ngā mātanga mātai mate he whakapoke pūtau ora, he whakapoke mā te ngongo rānei: ka ngongo ngā pūtau epiteri ora i te waikano ki roto i tō rātou wai pūtau. Nā reira, ka āhua ōrite te whakapokinga o te kiriuhi hūpē hauora, engari ka iti ake te waikano e ngongo ana ki ngā wāhi kua rerekē te tipu o ngā pūtau, kua kakā, kua mate pukupuku rānei, ka whakapokea rānei aua wāhi kia kōpurepure. Mā taua rerekētanga ka kitea te hanganga o te kiriuhi hūpē tērā pea kāore e kitea mā te rama mā anake, otirā ngā wāhi kiko rerekē papatahi.

He rerekē taua tikanga i tā te indigo carmine, arā, tērā atu waikano tuku iho mō te tirohanga ā-roto mā te waikano. He iti rawa te ngongonga o te indigo carmine; ka noho ki ngā rua me ngā awaawa o te mata, ka whakakaha ake i te kitea o tōna āhua. He whakapoke whakataurite tēnei, ehara i te whakapoke pūtau ora. He maha ngā arotake ka whakakotahi i ēnei waikano e rua ki raro i te tirohanga ā-roto mā te waikano. Nō reira, kāore te painga kua pūrongotia mō te tirohanga ā-roto mā te waikano whānui e tohu aunoa ana i tētahi painga mō te kikorangi metilīni ake.

He nui ngā taipitopito o te kawa whakahaere. I te tirohanga ā-roto mā te kikorangi metilīni o te kōpiro nui katoa, ka rehu te kaitiro ā-roto i te waikano tata ki te 0.1% mā tētahi ngongo iti, he wāhanga, he wāhanga. Ka tatari mō te tata ki te kotahi meneti kia ngongohia, kātahi ka momi atu i te toenga i mua i te tirotiro. Ka kitea ngā kukūtanga tae atu ki te tata ki te 0.5% i ngā kawa arotahi, whakarahi rānei, engari ko te 0.1% te tikanga noa mō te kōpiro nui katoa. Me tino pai te horoinga o te whēkau mō tēnei mahi katoa, me whai wā whakahaere anō hoki. Nā ēnei raruraru i whakaawe te waihanga o tētahi whakarite e whakapoke ana i te kōpiro nui i mua i te tīmatanga o te tukanga.

Te pire e whakapoke ana mai i roto

Ko Lumeblue, e kīia ana hoki ko te kikorangi metilīni MMX, he whakarite pire ka horomia, ka āta tuku i tōna matū mō te wā roa. Kua whakamanahia i te EU hei matū tātaritanga hei whakapai ake i te kitea o ngā wāhi kiko rerekē i te kōpiro nui me te tōu i te tirohanga ā-roto mō te rapu mate, mō te aroturuki rānei. Ko tōna whakamanatanga hokohoko mai i Ākuhata 2020 e whakamāramatia ana i te tirohanga whānui a EMA ki te rongoā. Ko te rahinga he pire e waru, he 25 mg ia pire, he 200 mg katoa. Ka horomia katoatia i te wā o te whakarite whēkau mā te PEG, i muri rānei, i te ahiahi i mua i te tirohanga ā-roto o te kōpiro nui, mā te raupapa 3-3-2 me ngā wā tatari i waenganui.

Ko te hanganga MMX te tino āhuatanga o te hoahoa. Ka mau tonu tōna paninga i te waikawa o te puku, ka pakaru i te tata ki te pH 7 e pātata ana ki te pito whakamutunga o te whēkau iti. Kātahi ka āta tuku i te waikano, kia pā atu ai ki te kiriuhi hūpē o te kōpiro nui mō te wā roa, kia āhua ōrite hoki te pānga ki ngā wāhi katoa. Hei te tīmatanga o te tirohanga ā-roto o te kōpiro nui, kua whakapokea kētia te kōpiro nui. Nā reira, he rongoā tātaritanga a Lumeblue e whakahaerehia ana i raro i ngā ture, he rahinga pūmau tōna, he whakamahinga kua āta tautuhia. He ariā rerekē tēnei i te wairewa e rehuhia ana e te kaitiro ā-roto, i tētahi hua oranga hokohoko rānei. He pātai rerekē ka whakautua e ēnei whakarite e toru, ā, kāore e taea te whakamahi i tētahi hei whakakapi i tētahi atu; ka kōrerotia motuhaketia ngā wairewa hokohoko i te aratohu ki ngā tāpiringa me ngā tapanga.

Ngā kitenga o ngā rangahau rapunga i te kōpiro nui

Ko ngā taunakitanga kaha rawa mō te kikorangi metilīni ake i te kōpiro nui me te tōu ko te whakamātau MB-MMX wāhanga III i pūrongotia e Repici me ōna hoa (PubMed 30742834): i tohaina matapōkeretia ngā tūroro 1,205 mō te rapu mate me te aroturuki ki te 200 mg MB-MMX, ki te matū horihori rānei. Ko te rapunga atenoma, kasinoma rānei i whakaūngia mā te mātai kiko he 56.29%, whakaritea ki te 47.81%. He rerekētanga pūmau tata ki te 8.5 ira ōrau tēnei, ā, ko ngā whakapikinga mārama rawa i ngā wāhi kiko rerekē kāore i rite ki te polyp, me ngā wāhi tino ririki. Kāore he painga hirahira mō ngā wāhi nui ake, mō ngā wāhi rite ki te polyp rānei.

Ko ngā taunakitanga o mua mō te rehu waikano i ahu mai i te nuinga i te aroturuki i te mate whēkau kakā, kaua i te rapu mate mō te hunga mōrea toharite. I tohaina matapōkeretia e Kiesslich me ōna hoa ngā tūroro 165 kua roa e pāngia ana e te kakātanga whai mariao o te kōpiro nui, ki te tirohanga ā-roto tikanga noa, ki te tirohanga ā-roto mā te kikorangi metilīni 0.1% rānei. I kitea e rātou ngā tipuranga hou i roto i te epiteri e 32, whakaritea ki te 10 (PubMed 12671882). I te kakātanga o te kōpiro nui e pā ana ki te IBD, i pai ake anō ngā tango tauira kiko arotahi mā te rehu waikano i te tango tauira matapōkere i te whakamātau a Marion me ōna hoa (PubMed 18844620). He kitenga ēnei mō te aroturuki kakātanga o te kōpiro nui, ā, me noho ki taua horopaki, i te taha o te kōrerorero motuhake mō te kikorangi metilīni me te mate whēkau kakā.

E tautoko ana ngā tātari whakakotahi whānui ake i te tirohanga ā-roto mā te waikano mō te rapunga, ahakoa ko te indigo carmine te mea i whakamātauria i te nuinga. I kitea e te arotake Cochrane o 2016 he pikinga o te tūponotanga kia kitea kia kotahi rawa te wāhi kiko whai tipuranga hou (PubMed 27056645). I pūrongotia hoki e te tātari whakakotahi a Antonelli o 2022, mō ngā whakamātau tohatoha matapōkere tekau, he pikinga pānga tata ki te 20% o te rapunga atenoma (PubMed 35588768). He whaihua mō te ariā, engari ehara i te taunakitanga mō te kikorangi metilīni ake.

Ehara te rapunga i te maimoatanga

Ko ngā kitenga katoa i runga ake nei e pā ana ki te kimi wāhi kiko rerekē, ehara ki te maimoatanga mate pukupuku. Kua whakamanahia a Lumeblue hei matū tātaritanga, ā, i whanganga tōna whakamātau rēhitatanga i ngā auau rapunga, kaua i te urupare o te puku mate, i te hokinga mai o te mate, i te oranga tonutanga rānei. He here anō kei ngā kupu a EMA ake: tērā pea mā te pai ake o te rapunga ka iti iho te mōrea mate pukupuku, mēnā ka tangohia ngā wāhi kiko rerekē kua kitea. Kāore e tika kia kīia anō te rerekētanga rapunga 8.5-ira hei hekenga 8.5% o te mate pukupuku, o te matenga rānei. Me pupuri ngā kaipānui e arotake ana i ngā kerēme maimoatanga i tēnei wehenga kia mārama tonu, pērā i te whakamārama o te aratohu taunakitanga taiwhanga me ngā taunakitanga tūroro mō te kikorangi metilīni me te mate pukupuku.

He ngoikore ake ngā taunakitanga mō te wāhanga runga o te pūnaha kūnatu

I te pū kai o Barrett, ka whakapoke te kikorangi metilīni i te kiko kua huri hei kiko momo whēkau kia kikorangi. Nā tēnei i puta te whakaaro kia arotahitia ngā tango tauira kiko ki ngā wāhi kua whakapokea, kaua e tango tauira i ngā hauwhā e whā me te kore e kite i tētahi wāhi whāinga. He āhua pai ngā kitenga tōmua mai i ngā pokapū takitahi, engari kāore ngā rangahau nui ake, pai ake hoki te whakahaere, i whakaū i tētahi painga mō te kimi tipu pūtau rerekē. I kitea e tētahi tātari whakakotahi o 2009 mō ngā rangahau e iwa kāore he pikinga hirahira ā-tauanga o te rapunga kiko kua huri hei kiko momo whēkau, o te tipu pūtau rerekē, o te tipu pūtau tino rerekē me te mate pukupuku tōmua rānei, ina whakaritea ki te tango tauira kiko ā-pūnaha (PubMed 19215918).

Kua neke kē ngā aratohu. E taunaki ana ngā aratohu aroturuki o nāianei a ACG, ESGE me ASGE mō te pū kai o Barrett i te tirohanga ā-roto mā te waikano, arā, mā te waikawa ahetiki, mā te tirohanga ā-roto mariko ā-hiko rānei. Me haere tonu ēnei i te taha o te kawa tango tauira kiko Seattle kua āta whakaritea, kaua ko te rehu kikorangi metilīni hei whakakapi i ngā tango tauira kiko matapōkere. Nō reira, ko te kī e taunaki ana ngā aratohu i te tirohanga ā-roto mā te waikano, kāore e tohu ana kei te taunaki rātou i te tirohanga ā-roto mā te kikorangi metilīni.

Te urunga kikorangi i raro i te wāhi kiko rerekē

Ko te paparanga kikorangi e kitea ana i te tangohanga kiriuhi hūpē mā te tirohanga ā-roto, i te wehewehenga kiko i raro i te kiriuhi hūpē rānei, he ariā tuatoru anō. I reira, ka ahu te hiki i te wairewa tote, i tētahi atu wai rānei, ka werohia ki raro i te wāhi kiko rerekē hei wehe i taua wāhi i te pakitara uaua. Ka tāpirihia he pata ruarua o te waikano kikorangi kia kite ai te kaiwhakahaere i te urunga, i te paparanga wehewehe, me te tapa hōhonu. Ka tohu te tae i te wāhi i haere ai te wai werohanga. Kāore e tohu ana i te huringa momo kiko, i te tipu pūtau rerekē rānei. Ko tōna kaupapa he haumaru ā-hanganga i te wā o te tapahi tango, he kaupapa e kōrerotia ana me ētahi atu whakamahinga pokanga i te aratohu ki te pokanga me ngā tukanga tātaritanga.

He tuhipoka haumaru tūturu: te rama me te waikano

He matū whakaarokoroko ki te rama te kikorangi metilīni, ā, nā ngā rangahau e rua i whakaaro anō ai ngā kaitiro ā-roto. I whakaatu a Olliver me ōna hoa nā te kikorangi metilīni 0.5% me te tirohanga ā-roto mā te rama mā i whakapiki te tūkino DNA i te kiriuhi hūpē o Barrett, i whanganga mā ngā whakamātautau comet. Kāore te waikano me te kore rama i pēnā (PubMed 12907012). I whakaputaina anō e Davies me ōna hoa taua tauira i te kōpiro nui: nā te kikorangi metilīni 0.1% me te rama mā i tūkino te DNA o ngā pūtau kōpiro nui i roto i te taiwhanga, i roto hoki i te rauropi ora, engari kāore te indigo carmine i pēnā (PubMed 17172595).

He whāiti te whakamāramatanga tika: kua whakaaturia te tūkino DNA ohorere, kāore anō kia whakaaturia te mate pukupuku. Kāore tētahi rangahau i whakaatu nā te tirohanga ā-roto mā te kikorangi metilīni i hua ai te mate pukupuku ki ngā tūroro. Engari, i te taha o te ngoikore o te painga mō Barrett, nā tētahi tohu tūkino ira ka taea te karo i kore ai taua waikano e manakohia mō reira. Koinei tētahi take e tautoko ai ngā aratohu i ētahi atu tikanga. Kua whakahiatotia te horopaki whānui mō te whakahaere me ngā pānga kino ki te tohutoro haumaru me ngā pānga taha.

I muri i te tukanga: e tūmanakohia ana te kikorangi

He waikano kaha te kikorangi metilīni, ā, ko te mimi me te tūtae kikorangi, kākāriki rānei mō te wā poto i muri mai he pānga e tūmanakohia ana nā te waikano, ehara i te raruraru o te tukanga. Ka āhua kākāriki pea te mimi nā te hanumi o te waikano kikorangi ki ngā matū tae kōwhai o te mimi. Ka waiho te waikano i runga i te kiri i tētahi poke kikorangi rangitahi. Heoi anō, kei te mau tonu tētahi whakatūpato ahakoa aua whakamārama whakatau: ki te hou te kikorangi o te kiri puta noa i te tinana, ā, ka haere tahi me te uaua ki te hā, me te rerekē rānei o te āhua mataara, he āhuatanga rerekē tēnei i te whakapokinga mata e kitea ana. Me aromatawai wawe, kaua e tatari noa kia ngaro te tae. Ā, ko tētahi whakatūpato ā-ariā whakamutunga: kaua rawa e whakatau ko tēhea waikano i whakamahia mā te tae anake. Kāore te āhua kikorangi e tautuhi ana i te kikorangi metilīni, nā te mea ka whakakikorangitia hoki te kiko e ētahi atu matū.

Ngā mea matua hei maumahara

Whakaarohia kia toru ngā kāwai motuhake: te whakapoke mata e whakamahi ana i te ngongonga a ngā pūtau epiteri; ngā whakarite tātaritanga mā te waha e whakapoke ana i te kōpiro nui i mua, i raro i tētahi whakamanatanga hokohoko; me te wai whai tae i raro i te kiriuhi hūpē e tohu ana i te paparanga tapahi tango. Pātaihia nō tēhea kāwai tētahi kerēme, mēnā i whanganga ōna taunakitanga i te rapunga, i te maimoatanga rānei, ā, ko tēhea whakarite me tēhea kukūtanga i tino whakamātauria. Kua whakarārangihia ngā rangahau e tautoko ana i ēnei wehenga ki te whare pukapuka rangahau kikorangi metilīni.