7/28/2019 Vinculacin del tracto digestivo con las enfermedades de SSC.pdf

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53((rheartjliera)jho

Tbiju`ljbi ma` trljth mbfastbvh

jhi `ls aidaroamlmas ma ZZJJlml vaz axbstai os astumbhs qua ra`ljbhili `hs jhid`bjths masl`um qua prasaitli `hs ldajtlmhs ma aidaroamlmas ma

saisbeb`bzljbi jaitrl`, jhi l`tarljbhias ma `l oujhsl bitastbil`)

@hs prhjashs daroaitltbvhs a bidajjbhshs shi uil ma ls

o`tbp`as jlusls qua avbmaijbli ih sh`h `hs trlsthrihs dsbjhs,

sbih bij`ush `hs psqubjhs) @l mbvu`fljbi ma astls jlusls puama

sar ma suoh bitars plrl lerbr ui iuavh jhijapth shera astls

aidaroamlmas plrl oujghs prhdasbhil`as y ldajtlmhs

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@hs `bphph`bsljrbmhs '@SZ", shi plrta ma `hs jhophiaitasma `l plram axtaril ma `l aivh`turl ja`u`lr eljtarblil,jhistbtuyai a` litfaih H y `l aimhthxbil ma `ls eljtarbls

Frlo/iafltbvls) Asta jhophiaita, julimh sa aijuaitrl aia` thrraita slifuiah, ljtbvl `hs sbstaols ma jhitljth yastbou`l `hs mbdaraitas tbphs ma j`u`ls biouih`fbjls,oamblita oh`ju`ls ma rajhihjbobaith, jhoh puamai saraitra htrls `ls JM

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prhjashs ma matarbhrh ma `l sl`um sa bibjbl phr `l rupturl ma mbjgh aqub`berbh, oujgls vajas phruil l`boaitljbi bilmajulml h jhitlobilml)

@l objrhd`hrl bitastbil` as ui rflih os, pardajtloaita bitafrlmh ai `l dbsbh`hfl ma` bimbvbmuh)@hs mhs a`aoaiths duijbhil`as 'trljth mbfastbvh y objrhd`hrl" shi bitarmapaimbaitas y su

aqub`berbh jhimbjbhil `l ghoahstlsbs ma` bimbvbmuh maitrh ma su aithrih loebaitl`)

@l ajh`hfl Bitastbil`Zleaohs qua a` bitastbih guolih jhitbaia ui gebtlt ilturl` jhi uil phe`ljbi iuoarhsl,mbvarsl y mbiobjl ma objrhhrflibsohs, prbijbpl`oaita eljtarbls, qua sa gli lmlptlmh l `l vbmlai `ls supardbjbas oujhsls h ai `l `uz ma` bitastbih)

A` trobih %objrhd`hrl% h %objrhebhtl% glja radaraijbl l `l jhouibmlm ma objrhhrflibsohsvbvhs rauibmhs ai ui oambh ajh`fbjh matarobilmh) Gle`lohs ma ajhsbstaol objrheblih ma`bitastbih, aitaimbaimh qua ai ` sa bij`uyai aspajbas iltbvls ma objrhhrflibsohs qua jh`hibzliparoliaitaoaita a` trljth flstrhbitastbil` y uil sarba vlrble`a ma objrhhrflibsohs vbvhs quatrlisbtli taophrl`oaita phr a` tueh mbfastbvh)

@ls eljtarbls iltbvls sa lmqubarai l` iljar y murlita a` prboar lh ma vbml, obaitrls qua `lseljtarbls ai trisbth sa bifbarai jhitbiuloaita l trlvs l`boaiths, eaebmls, axphsbjbi l`oambh, atj)

@l phe`ljbi objrheblil ma` bitastbih guolih bij`uya uihs

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h Ebdbmheljtarbuoh Aueljtarbuoh J`hstrbmbuoh @ljtheljb``ush Dusheljtarbuoh mbvarshs jhjhs frlophsbtbvhs lilarebjhs)

Ih hestlita, os ma` 13! ma `ls j`u`ls eljtarblils hesarvlmls oamblita axloaiobjrhsjpbjh ma ouastrls dajl`as ih puama jrajar ai oambhs ma ju`tbvh, phr asta gajgh `lbidhroljbi qua gli prhphrjbhilmh oamblita `hs astumbhs ma objrhebh`hfl j`sbjl as ouy`bobtlml) Ljtul`oaita oamblita tjibjls ma ebh`hfl oh`aju`lr, plrl jlrljtarbzlr `ls eljtarbls

ih ju`tbvle`as, sa asti bmaitbdbjlimh japls ih jhihjbmls pravbloaita) Frljbls l astls tjibjlssa gli phmbmh matajtlr mbdaraijbls ma jh`hibzljbhias ma aspajbas pramhobilitas aitra a` tarjbhprhxbol` y mbstl` ma` jh`hi, y aitra `ls jhouibmlmas oujhsl y dajl`)

Frljbls l `l frli ebhmbvarsbmlm ma aspajbas maitrh ma` ajhsbstaol bitastbil` dljb`btl `l vbml y a`maslrrh``h ma` jhinuith, qua bij`uya ih s`h l `ls jhouibmlmas eljtarblils sbih tloebi l`lidbtrbi guolih)

@hs astumbhs ral`bzlmhs l olodarhs jrblmhs elnh jhimbjbhias astrbjtls ma lsapsbl, ouastrli quaasths ih lmqubarai su d`hrl ilturl` y tbaiai ui maslrrh``h lihrol`>

Madbjbaijbls ai a` lplrlth mbfastbvh 'plram bitastbil` ltrdbjl y ohtb`bmlm l`tarlml" Qi oatleh`bsoh ma elnh frlmh 'jhrlzi, pu`ohias a gflmh ma elnh pash, jhi flsth

jlrmljh elnh, elnl taoparlturl jhrphrl` y jbdrls a`avlmls ma jh`astarh` ai slifra",

Qi sbstaol biouia biolmurh 'ibva`as elnhs ma biouihf`heu`bils, sbstaol `bidtbjhltrdbjh, atj)")

Oujgls oambjljbhias tloebi jhitrbeuyai l `l ldajtljbi ma `l plram bitastbil` y ih thmhs `hsprhmujths jhoarjbl`as shi tli rajuparlmhras ma su d`hrl jhoh prataima su pue`bjbmlm)

]hmh prhjash rajuparlmhr ma `l oujhsl bitastbil` raqubara ma ui prhthjh`h ma ljtuljbimbsalml y jhitrh`lml phr prhdasbhil`as ai a` taol) Ih thmh vl`a ib as adajtbvh)

Ua`ljbi ma `hs prhjashs bidajjbhshs jhi a` sbstaol iarvbhsh jaitrl`Ai a` lh 5332, a` mhjthr Jgl 'jhihjbmh Aspajbl`bstl ai Aidaroamlmas Bidajjbhsls qua saaijuaitrl anarjbaimh ai ]hrrlija, 'Jl`bdhribl)QZL", lpuitlel qua gly os ma 63 tbphs mbdaraitasma aitarhvbrus qua puamai ldajtlr a` Zbstaol Iarvbhsh Jaitrl` 'ZIJ", a` jhrlzi y `hs osju`hs,sithols qua pardajtloaita sa ouastrli ai `l AO(ZDJ) Astl ldbroljbi `l ral`bz oamblita a`li`bsbs ma ouastrls ma tanbmh astholjl`, 'ebhpsbls", ma

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flstrhbitastbil`as y htrls ih matarobilmls jhi sbitholth`hfls plrajbmls l `l frbpa, pumbaimhjluslr uil mbsduijbi ma `bidhjbths ] y JM7, phr `h qua prambsphiai l raljtbvljbhias ma Garpas/vbrus aimfaihs)

A` Mr) KAIIR MA OABU@ABU, jhluthr ma` `berh ZDJ Qil lprhxboljbi Ebh`fbjl y jh`lehrlmhr

jhoh axparth ai a` mhjuoaith ma jhisaish jlilmbaisa ma` ZDJ ma` 533:, ai mbvarshs trlelnhs yphiaijbls druth ma sus bivastbfljbhias y trlelnhs jhi aidarohs ai Ihruafl, olitbaia `l tahrlma` plpa` qua nuafl `ls oh`ju`ls prhjamaitas ma mbdaraitas lfaitas bidajjbhshs bitastbil`as,maihobilmls @bphph`bsljrbmhs '@SZ" y qua asti masjrbths jhoh jluslitas ma prhjashs maraspuastls bid`lolthrbls, jhoh hjurra ai astl aidaroamlm, l AO(ZDJ)

@ls @SZ, nuafli ui plpa` mastljle`a ai julith l `l paroaleb`bmlm ma `ls plramas ma` trljthmbfastbvh, safi `hs astumbhs ma K) ma Oabr`abr, ai `ls qua aijhitr uil jlitbmlm axtraolml matras tbphs ma eljtarbls ai pljbaitas ma AO(ZDJ) Zafi ui astumbh ral`bzlmh phr a` Mr) Gairy Eutt,ma `l Qibvarsbmlm ma Oa`ehuria, 'Lustrl`bl" `hs tras tbphs h dlob`bls ma eljtarbls l qua sa radbara

ma Oabr`abr shi>

Aitarhjhjhs, Astrapthjhjhs Sravhta``l)

Oamblita `ls jhij`usbhias ma astumbhs ral`bzlmhs phr loehs luthras, K) ma Oabr`abr y G) Eutt,qua aijhitrlrhi l`tls jlitbmlmas ma aimhthxbils '@SZ" ai slifra ai aidarohs ma AO(ZDJl`tloaita ldajtlmhs phr `l aidaroamlm qua `as he`bflel l astlr phstrlmhs ai jlol, faiarlrhi`l gbptasbs ma qua asths l`ths imbjas ma @SZ, phmrli prhvaibr ma `l paroaleb`bmlm ma `ls

plramas ma` bitastbih, l` astlr ldajtlmls phr prhjashs bid`lolthrbhs jhistlitas) Asta gajghjluslrl qua oujghs prhmujths trlsplslrli `l elrrarl ma `l plram bitastbil` y sa axtaimbarli phra` hrflibsoh, jhi ldajtljbi ma` sbstaol biouih`fbjh)

Ma astls sustlijbls qua sa axtbaimai, uil ma a``ls as a` su`durh ma gbmrfaih G5Z, prhmujbmh phr`ls eljtarbls jhoh a`aoaith trlisobshr ma sal`as, a` jul` puama sar suoloaita txbjh,bijbmbaimh ai a` sbstaol biouih`fbjh, y mllimh a` sbstaol iarvbhsh jaitrl`, aitra htrhsrflihs)

Ma Oabr`abr masjrbeb tloebi qua mbjgh fls raljjbhil jhi `hs oatl`as, `hs jul`as sa bitrhmujai

ai iuastrh hrflibsoh phr mbdaraitas vls, sbaimh `l os prbijbpl` `hs l`boaiths y `hsjhitlobilitas loebaitl`as)

Ua`ljbi ma `l oujhsl bitastbil` jhi `l oaohrbl y `l psbquaAxbstai astumbhs qua ra`ljbhiai trlsthrihs ma `l oaohrbl y ma` lpraimbzlna, jhi `l oljrhebtbjlbitastbil`) Astl ra`ljbi, masjhijartlita plrl oujghs prhdasbhil`as, pumbarl bop`bjlraidaroamlmas jhoh a` lutbsoh, ldajtljbhias biouih`fbjls y sus jhisajuaijblsou`tbhrfibjls, heasbmlmas, maprasbi, trlsthrihs ma `l parshil`bmlm aitra htrls) Ai astasaitbmh, Nlia L) Dhstar y jh`), ma` maplrtloaith ma Ssbjh`hfl y iaurhjbaijbls ma OjOlstarQibvarsbty ma Jlilml ai su astumbh Futerlbi lxbs> ghw tga objrhebhoa bid`uaijas lixbaty limmaprassbhi ra`ljbhil `l objrhebhtbjl bitastbil` jhi ui ana bitastbih/jaraerh)

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Astl ra`ljbi tbaia uil frli bid`uaijbl ai `l ghoahstlsbs 'aqub`berbh ma ui oambh bitarih" y sumasaqub`berbh puama jhitrbeubr l` rbasfh ma aidaroamlmas)

@ls l`tarljbhias ai> Zbstaol flstrhbitastbil` 'FB" Zbstaol iarvbhsh jaitrl` 'ZIJ" Zbstaol iarvbhsh lutihoh 'ZIL" Zbstaol iarvbhsh aitrbjh 'AIZ"

A` sbstaol biouih`fbjh ma `l objrhebhtlpuama jhimujbr l l`tarljbhias ai>'l" a` l`oljailobaith ma frlsl y a` el`lija

aiarftbjh

'e" `l duijbi ma elrrarl FB;'j" bid`loljbi faiarl` ma elnh frlmh 'FB ysbstobjhs"'m" luoaith ma `l raljtbvbmlm l` astrs'a" luoaith ma `l lisbamlm y `ls jhimujtlsma tbph maprasbvh)

A``h jhi``avlrl l ui prhjash jhitrbeutbvh maaidaroamlmas

Ls obsoh ai mbjgh astumbh ral`bzlmh jhi rlthias, sa jhidbrol `lra`ljbi aitra matarobilmhs prhjashs bid`lolthrbhs jhi `llisbamlm) @hs rlthias `beras ma froaias ohstrleli elnsbohibva` ma lisbamlm, `l jul` sa bel a`avlimh prhfrasbvloaita l`obsoh rbtoh qua sa bijraoaitlel a` astlmbh bid`lolthrbh)

Htrhs a`aoaiths pltfaihs l llmbr, `ls objhthxbilsUajbaitas pue`bjljbhias, jhoh `l ma Nhsapg G Erawar y jh`) Jhoh `l ral`bzlml ai 53

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pue`bjljbhias ai asta saitbmh, ai `ls qua sa matajtli objhthxbils ai o`tbp`as iutrbaitas, tlithlibol` jhoh vafatl` phr trlisobsbi ai `l jlmail l`boaitlrbl, phr `h qua as ui taol aoarfaital` qua gly qua prastlr oujgl ltaijbi raqubrbaimh ui jhitrh` slibtlrbh y uil prhtajjbi nurmbjl)

@ls objhthxbils paiatrli ai `hs libol`as l trlvs ma` sbstaol mbfastbvh phr `hs pbaishs, tlith

phr jhitlobiljbi mbrajtl jhoh bimbrajtl, y shi `ls jluslitas ma `ls aidaroamlmas jhihjbmlsjhoh objhthxbjhsbs)

@l jhitlobiljbi ma `hs l`boaiths y pbaishs tbaia `uflr julimh ui biframbaita ma` pbaish glastlmh pravbloaita bidajtlmh jhi ghifhs prhmujthras ma thxbils, `hs jul`as puamai paroliajarai a` pbaish, h ebai ohrbr, parsbstbaimh `l objhthxbil ai a` prhmujth dbil`) Asths ghifhs y thxbilssa puamai maslrrh``lr tlith murlita `l prhmujjbi lfrlrbl jhoh ai a` prhjaslmh, trlisphrta hl`oljailobaith ma hs pbaishs)

Maeaohs ma taiar ai juaitl uil sarba ma jhisbmarljbhias raspajth l `ls objhthxbils>

@l prasaijbl ma` ghifh ih lsafurl `l prasaijbl ma mbjgl thxbil Qil thxbil puama parsbstbr ai a` pbaish jhitlobilmh luiqua a` ghifh ih ast prasaita Qi matarobilmh ghifh puama prhmujbr os ma uil objhthxbil Qil objhthxbil puama sar prhmujbml phr mbdaraitas j`lsas ma ghifhs

Srhjashs bidajjbhshs fstrbjhs jhihjbmhs y phjh avl`ulmhs ai `ls ZZJ

Htrh taol ma bitars, as `l prasaijbl ma lfaita eljtarblih A`bjheljtar Sy`hrb ai uil frli olyhrlma aidarohs ma Dberhobl`fbl, safi a` rajbaita astumbh ma Zgaraai Ohgloam H`lol y jh`), ma `lQibvarsbmlm afbpjbl ma Olishurl, ls `h jhidbrol) Asta gajgh ih as tli ihvamhsh, plrl ih sar

jhisbmarlmh) Masma glja lhs as ui taol qua sa gl trltlmh ai mbvarsls pue`bjljbhias ma rbfhrjbaitdbjh, jhi vlrblitas tli sbfibdbjltbvls jhoh `l prasaijbl olyhrbtlrbl ai ldajtlmhs ma DO y `liu`bmlm ma prasaijbl ai AO(ZDJ) Sasa l a``h ih sa `a prastl `l sudbjbaita ltaijbi, julimh asuil matarobiljbi lil`tbjl djb`, sbop`a y ajhiobjl l ral`bzlr) Ls jhoh su trltlobaithl`tloaita rash`utbvh y ajhiobjh) Asta taol lplrajar trltlmh jhi os prhduimbmlmprxboloaita ui phstam aspajdbjh, ai asta e`hfgttp>((rheartjlera)jho

A` trljth mbfastbvh jhoh jlusl bophrtlita ai `ls ZZJ

Ma ui ohmh u htrh, jlml vaz sa rltbdbjli `l ra`ljbi ma `ls aidaroamlmas ma ZZJ jhi a` oambh y `l

iutrbjbi) Sasa l` phjh bitars ai eusjlr `ls jlusls qua prhvhjli l`tarljbhias biouih`fbjls,sl`vlimh `hs aihroas asduarzhs qua ral`bzli l`fuihs bivastbflmhras, qua bitaitli olitaiar`hsolrfbilmhs)

Aitaimar qua aidarolohs phr jlusls oambhloebaitl`as y iutrbjbhil`as as lmvartbr qua thmhs`hs glebtlitas ma` p`liatl, ma ui ohmh u htrh) Shr bitarasas ma `l bimustrbl l`boaitlrbl y susmarbvlmhs, jlml ml astlohs sbaimh ldajtlmhs thmhs `hs glebtlitas ma` p`liatl) Ldajtljbi quasa trlmuja ai l`fuihs jlshs ma os saisbeb`bmlm, ai aidaroamlmas aoarfaitas, ma `ls qua saaijuaitrli aitra htrls `ls ZZJ y ai htrhs jlshs ai mbvarsls plth`hfls ma` sbstaol iarvbhshjaitrl` a biouih`fbjh)

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Sasa l qua jlml vaz axbsta ui olyhr jarjh jbaitdbjh qua ra`ljbhil jlusl/adajth shera `lsaidaroamlmas ma ZZJ y su ra`ljbhili jhi a` trljth mbfastbvh, `l iutrbjbi y a` oambh loebaita, saparsbsta ai trltlobaiths sbithotbjh y luoaith ma oambjloaiths qua ldajtli y ratrhl`boaitliols `ls ldajtljbhias ma `l oujhsl bitastbil`, ljaitli a` prhe`aol y ih rasua`vai a` jhid`bjth masl`um)

@uafh nustbdbjli a` lelimhih ma `hs trltlobaiths y `l esquaml ma sh`ujbhias ai htrhs oebthslsbstaijbl`as ma `l sl`um, ldbrolimh qua `hs ldajtlmhs ma ZZJ shi sbou`lmhras, lesaitbstls`lehrl`as y(h psbjhplth`fbjhs)

Bijhopraisbe`a