{"id":4867,"date":"2022-04-20T07:45:03","date_gmt":"2022-04-20T05:45:03","guid":{"rendered":"https:\/\/reseau-amylose.org\/jesuissoignant\/?page_id=4867"},"modified":"2022-04-20T08:26:36","modified_gmt":"2022-04-20T06:26:36","slug":"therapeutique-digestive","status":"publish","type":"page","link":"http:\/\/reseau-amylose.org\/jesuissoignant\/therapeutique-digestive\/","title":{"rendered":"Th\u00e9rapeutique digestive"},"content":{"rendered":"\t\t
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Prendre en charge l'atteinte digestive dans l'amylose cardiaque<\/h2><\/h6>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Atteintes infiltratives amylo\u00efdes<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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SE MANIFESTENT PAR\u00a0:<\/strong><\/span><\/h6>
\u00a0 \u00a0– Souvent totalement asymptomatique<\/h6>
\u00a0 \u00a0– Nodule ench\u00e2ss\u00e9 dans la paroi et\/ou ulc\u00e9rations pouvant se compliquer de :<\/h6>
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 – Saignements (rectorragie, m\u00e9l\u00e9na, an\u00e9mie)<\/h6>
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 – Perforations (douleurs, pneumop\u00e9ritoine\u2026)<\/h6>
CONDUITE \u00c0 TENIR\u00a0:\u00a0<\/strong><\/span><\/h6>
\u00a0 \u00a0– Ne pas h\u00e9siter \u00e0 r\u00e9aliser une endoscopie digestive haute (FOGD) ou une endoscopie basse (rectosigmo\u00efdoscopie ou coloscopie) pour \u00e9valuer l\u2019atteinte (\u00e0 vis\u00e9e diagnostique =topographie et \u00e9tendue des l\u00e9sions) et \u00e9liminer un diagnostic diff\u00e9rentiel (maladie ulc\u00e9reuse gastroduod\u00e9nale, pathologies n\u00e9oplasiques surajout\u00e9es).<\/h6>
\u00a0 \u00a0– Protection digestive par les IPP en cas d\u2019atteinte gastroduod\u00e9nale<\/h6>
\u00a0 \u00a0– \u00c9tudier Balance risque\/b\u00e9n\u00e9fice de l\u2019anticoagulation curative<\/h6>
\u00a0 \u00a0– Importance du Facteur X \u2013 albuminurie<\/h6>
COMPLICATIONS POSSIBLES\u00a0:<\/strong><\/span><\/h6>
\u00a0 \u00a0– Risque d\u2019hypoalbumin\u00e9mie s\u00e9v\u00e8re (formes exsudatives) en absence de syndrome n\u00e9phrotique<\/h6>
\u00a0 \u00a0– Risque h\u00e9morragique (d\u00e9globulisation aigu\u00eb avec h\u00e9morragie ext\u00e9rioris\u00e9e ou d\u00e9globulisation subaigu\u00eb avec an\u00e9mie r\u00e9fractaire)<\/h6>
\u00a0 \u00a0– Possibilit\u00e9 d\u2019h\u00e9mostase endoscopique en cas de saignement aigu\u00eb et de l\u00e9sions limit\u00e9es.<\/h6>
\u00a0 \u00a0– Risque de syndrome sup-occlusif en cas d\u2019atteinte importante (exceptionnel).<\/h6>
\u00a0<\/h6>
L\u2019amylose peut avoir des cons\u00e9quences sur le fonctionnement du tube digestif soit par\u00a0Infiltration de la paroi du tube digestif soit par atteinte du syst\u00e8me nerveux (central, p\u00e9riph\u00e9rique et\/ou ent\u00e9rique) commun\u00e9ment intitul\u00e9e dysautonomie. <\/strong><\/h6>
Bien comprendre le m\u00e9canisme permet de choisir la bonne conduite \u00e0 tenir pour soulager les patients.<\/strong><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Atteintes digestives hautes de cause neurologique<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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SE MANIFESTENT PAR\u00a0:<\/strong><\/span><\/h6>
\u00a0 \u00a0– Troubles de la motricit\u00e9 oesophagienne (dysphagie, r\u00e9gurgitations, pyrosis)<\/h6>
\u00a0 \u00a0– Troubles de la vidange gastrique ou gastropar\u00e9sie (pesanteur \u00e9pigastrique, sati\u00e9t\u00e9 pr\u00e9coce, naus\u00e9es, vomissements, douleurs \u00e9pigastriques)<\/h6>
\u00a0 \u00a0– Troubles de la motricit\u00e9 duod\u00e9nale (s\u00e9miologie similaire aux troubles de la vidange gastrique, rare)<\/h6>
Ces atteintes sont importantes \u00e0 d\u00e9pister car elles sont fr\u00e9quemment responsables d\u2019une r\u00e9duction de l\u2019app\u00e9tit, une r\u00e9duction des ingesta et par voie de cons\u00e9quence une d\u00e9nutrition. Elles sont \u00e0 diff\u00e9rencier des troubles de la d\u00e9glutition int\u00e9ressant plut\u00f4t la sph\u00e8re ORL bien qu\u2019il est possible de voir une association concomitante des deux atteintes.<\/h6>
CONDUITE \u00c0 TENIR\u00a0:\u00a0<\/strong><\/span><\/h6>
\u00a0 \u00a0– Explorations endoscopiques pour \u00e9liminer une pathologie ulc\u00e9reuse ou n\u00e9oplasiques<\/h6>
\u00a0 \u00a0– Evaluer la d\u00e9nutrition (cf. encart).<\/h6>
  • Bain de bouche de bicarbonate de sodium (matin \u2013 midi et soir) car s\u00e9cheresses buccales, changement de gout, mycoses)<\/h6><\/li>
  • Conseils di\u00e9t\u00e9tiques\u00a0(+++): fractionnement des repas et collations, compl\u00e9ments nutritionnels oraux, parfois r\u00e9duction des repas trop riches en lipides<\/h6><\/li>
  • Erythromycine<\/em> 125 \u00e0 250 mg (sachets enfants) 3 fois \/ jour (avant les repas)\u00a0; Si \u00e9chec\u00a0: Motilium<\/em> 10 mg 3 fois \/ jour \u2013 monter jusqu\u2019\u00e0 20 mg 3 fois \/ jour possibilit\u00e9 de combiner les 2 traitements mais faire attention au QT (avant les repas)<\/h6><\/li>
  • Traitement anti-\u00e9m\u00e9tique si naus\u00e9e ou vomissement<\/h6>
    • Metoclopramide (PRIMPERAN\u00ae) 10 mg, domp\u00e9ridone (MOTILIUM\u00ae) 10 mg ou metopimazine (VOGALENE\u00ae) 15 mg, 3 prises par jour (PO, IV ou rectal) [Attention au risque d\u2019allongement du QT, notamment en association \u00e0 l\u2019\u00e9rythromycine]<\/h6><\/li>
    • Ondansetron (ZOPHREN) et aprepitant (EMEND) surtout si chimioth\u00e9rapie associ\u00e9e OU Zyprexa<\/em> \u00e0 5mg \/ jour (arr\u00eat de Primperan<\/em>) \u00e0 utiliser en derni\u00e8re intention en cas de chimioth\u00e9rapies et vomissements ou post-chimioth\u00e9rapies.<\/em><\/h6><\/li><\/ul><\/li><\/ul>
      \u00a0<\/em><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

      Prendre en charge l’atteinte digestive dans l’amylose cardiaque Atteintes infiltratives amylo\u00efdes SE MANIFESTENT PAR\u00a0: \u00a0 \u00a0– Souvent totalement asymptomatique \u00a0 \u00a0– Nodule ench\u00e2ss\u00e9 dans la paroi et\/ou ulc\u00e9rations pouvant se compliquer de : \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 – Saignements (rectorragie, m\u00e9l\u00e9na, an\u00e9mie) \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 – Perforations (douleurs, pneumop\u00e9ritoine\u2026) CONDUITE […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-4867","page","type-page","status-publish","hentry"],"yoast_head":"\nTh\u00e9rapeutique digestive - R\u00e9seau Amylose<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/therapeutique-digestive\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Th\u00e9rapeutique digestive - 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