Ukuphuma Okuphuzi Ngesikhathi Sokukhulelwa: Kufanele Ukhathazeke Na?

Uketshezi oluphuzi ngesikhathi sokukhulelwa lungaba ukudida futhi lukhathaze. Ukukhulelwa kuletha izinguquko eziningi emzimbeni, okuhlanganisa nezinguquko ekuphumeneni koketshezi esithweni sangasese sowesifazane. Kwezinye abantu, akulutho ngaphandle kokuguquka okungenabungozi okubangelwa umsebenzi wama-hormone. Kwezinye, kungaba inkomba yenkinga efihlekile efana nesifo sokutheleleka noma ukuvuza kwamanzi e-amniotic.

Iningi labesifazane abakhulelwe babona ukwanda kokuphuma uketshezi esithweni sangasese sowesifazane, okwaziwa ngokuthi i-leukorrhea, okuvame ukuba mncane, ube sobala noma ube mhlophe njengobisi. Nokho, uma uketshezi seluba nombala ophuzi kancane, kuvusa imibuzo. Kungenzeka yini ukuthi kungukutheleleka? Ingabe kuwuphawu olujwayelekile lokukhulelwa? Noma mhlawumbe uphawu lokuthi sekusondele isikhathi sokubeletha?

Akuzona zonke izimo zoketshezi oluphuzi ezimele isizathu sokukhathazeka, kodwa ukuqonda ukuthi yini evamile nenjengeyona kubalulekile. Umbala, ukujiya, nephunga loketshezi kunganikeza imikhondo ebalulekile mayelana nempilo yesitho sangasese sowesifazane kanye nohlelo lokuzala. Ukwazi ukuthi nini okufanele ubheke usizo lwezokwelashwa kungasiza ukuvimbela izinkinga futhi kuqinisekise ukukhulelwa okuhamba kahle.

Yini Ebanga Uketshezi Oluphuzi Ngesikhathi Sokukhulelwa

Izinto eziningana zingaholela ezinguqukweni ekukhipheni uketshezi esithweni sangasese sowesifazane ngesikhathi sokukhulelwa. Umzimba uba nezinguquko ezinkulu zama-hormone, ezithinta ukukhiqizwa kwe-mucus yomlomo wesibeletho. Amazinga e-estrogen anyukayo angaholela ekukhathaleni ngokweqile, okwenza kube khona uketshezi oluphuzi lapho ukhulelwe amasonto ayi-8 noma ezinye izinhlobonhlobo zombala. Kwezinye izimo, uketshezi oluphuzi kuvamile ngokuphelele, kanti kwezinye kungase kubonise isifo sokutheleleka noma inkinga ngamanzi e-amniotic [1]. Ngaphezu kwalokho, abanye abantu bangase baphawule izinguquko ku-mucus yomlomo wesibeletho futhi bazibuze ukuthi kuhlobene yini nokukhulelwa. Nokho, ukuhlangabezana ne-mucus plug kodwa kungelona ukukhulelwa kungenzeka ngenxa yokuguquguquka kwama-hormone, izifo zokutheleleka, noma ezinye izimo zempilo ezingaphakathi.

Uketshezi Olujwayelekile Ekukhulelweni Nokuthi Nini Olungenabungozi

Ukukhulelwa ngokwemvelo kwandisa uketshezi lwesitho sangasese sowesifazane ukuze kugcinwe uhlelo lokuzala luhlanzekile futhi luvikelwe ezifweni. Ezimweni eziningi, uketshezi oluphuzi alulutho ngaphandle kwe-leukorrhea evamile esuke ishintshe umbala ngenxa yokuhlangana nomoya. Uketshezi oluphuzi olukhanyayo ngesikhathi sokukhulelwa luvamise ukuba lungenabungozi inqobo nje uma lungahambisani nezinye izimpawu ezifana nephunga elinamandla, ukuluma, noma ukungakhululeki.

Ukugcina impilo yesitho sangasese sowesifazane, kunconywa ukuthi uphuze amanzi amaningi, ugqoke izingubo zangaphansi zikakotini eziphefumulayo, futhi ugweme imikhiqizo yokuhlanza enamakha engaphazamisa i-microbiome yesitho sangasese sowesifazane [2].

I-Bacterial Vaginosis Nokuthi Ithinta Kanjani Ukukhulelwa

I-bacterial vaginosis (BV) ingesinye sezizathu ezivame kakhulu zokuphuma uketshezi oluphuzile olukhanyayo ekuqaleni kokukhulelwa nakuyo yonke indawo yokukhulelwa. Yenzeka uma kuba nokungalingani kwamagciwane esithweni sangasese sowesifazane, kuholele ekukhuleni ngokweqile kwamagciwane ayingozi. Lokhu kungabangela uketshezi oluncane, oluwuketshezi, oluphuzi olunamandla nephunga elinjengezinhlanzi.

Abesifazane abahlangabezana nokuphuma uketshezi oluphuzile olukhanyayo ngesikhathi sokukhulelwa kufanele baqaphele ezinye izimpawu ezifana nokucasuka, ukushisa lapho bechama, noma ukungakhululeki esithweni sangasese sowesifazane. Uma kungelashwa, i-BV ingakhuphula ingozi yokubeletha ngaphambi kwesikhathi, isisindo esiphansi sokuzalwa, nezinye izinkinga.

Izifo Zesikhutha Noketshezi Olushunangane Oluphuzile

Izifo zesikhutha zenzeka uma amagciwane e-Candida ekhula ngokweqile endaweni yesitho sangasese sowesifazane. Izinguquko zamahomoni ngesikhathi sokukhulelwa zidalela isikhutha indawo ekahle yokuchuma, kuholele ekuphumeni uketshezi olushunangane oluphuzile ngesikhathi sokukhulelwa. Lokhu ketshezi kuvame ukuba namabhola, kufane nobisi luka-cottage cheese, futhi kungahambisana nokuluma okukhulu nokubomvu.

Kwezinye izimo, uketshezi olushunangane oluphuzile ngesikhathi ukhulelwe lungaba uphawu lwesifo sesikhutha, ikakhulukazi uma luhambisana nokuluma noma ukungakhululeki. Lokhu kuvamile kakhulu esigabeni sesithathu sokukhulelwa, lapho izinguquko zamahomoni ziphezulu khona.

Yize izifo zesikhutha zingeyona ingozi enkulu, zingadala ukungakhululeki futhi ziphazamise impilo yansuku zonke. Ukunciphisa ushukela ekudleni, ukugqoka izingubo ezikhululekile, nokugcina inhlanzeko enhle kungasiza ukuvimbela ukutheleleka okuvame ukuphindaphinda. Uma izimpawu ziqhubeka, kungase kudingeke imithi elwa namagciwane efungal ebekelwe odokotela [3].

Izifo Ezithathelwana Ngocansi Nokuphuma Uketshezi Okungajwayelekile

Ezinye izifo ezithathelwana ngocansi (STIs) zingaholela ekuphumeni uketshezi okungajwayelekile ngesikhathi sokukhulelwa. Izifo ezifana ne-chlamydia, i-gonorrhea, ne-trichomoniasis zivame ukubangela uketshezi oluyinyongo oluphuzile ngesikhathi sokukhulelwa. Lezi zifo zingabuye zibangele uketshezi okuluhlaza okotshani okuphuzile ngesikhathi ukhulelwe, imvamisa kuhambisane nephunga elingathandeki, ukucasuka kwasesithweni sangasese sowesifazane, nobuhlungu lapho uchama [4].

Izifo ezithathelwana ngocansi (STIs) ngesikhathi sokukhulelwa zingaba zimbi, zingaholela ekubeletheni kusenesikhathi, ekulahlekelweni wesisu, noma ekuthelelekeni kwengane ezelwe. Abesifazane abakhulelwe abanezimpawu zokuphuma uketshezi oluphuzile oluhlaza nsundu noma oluhlaza okotshani ngesikhathi bekhulelwe kufanele bafune usizo lwezokwelashwa ngokushesha ukuze kugwemeke izinkinga.

Ukuvuza Koketshezi Lwe-Amniotic Nokuchaza Kwakho

Uma uketshezi lwesitho sangasese sowesifazane seluba manzi kakhulu futhi luqhubeka lugeleza, kungenzeka ukuthi akusilo nhlobo uketshezi olujwayelekile—kungase kube uketshezi lwe-amniotic. Uketshezi lwesitho sangasese emasontweni ayisithupha okukhulelwa oluphuzile ophuzi kancane noma olungenambala futhi olumanzisa ngokuphelele ingubo yangaphansi lungase lukhombise ukuphuka kwama-membrane azungeza ingane esibelethweni. Uketshezi lwe-amniotic ngokuvamile luba nephunga elithambile elimnandi futhi luncane, lunciphe kunoketshezi lwesitho sangasese sowesifazane olujwayelekile.

Ukuchitheka kwamanzi e-amniotic ngaphambi kokubeletha kungase kube yingozi, kuhlanganise nokutheleleka nokuzalwa ngaphambi kwesikhathi. Abesifazane abakhulelwe abasolayo ukuthi ukuchitheka okuphuzi okukhanyayo ngesikhathi bekhulelwe empeleni kungamanzi e-amniotic kufanele baxhumane nodokotela ngokushesha.

Izinguquko Zama-Hormone Nendima Yazo Ekuchithekeni Okuphuzi

Ukuguquguquka kwama-hormone ngesikhathi sokukhulelwa kungathinta umbala nokwakheka koketshezi lwesitho sangasese sowesifazane. Ezinye izifazane zingase zibone ukuchitheka okuphuzi okunsundu ngesikhathi sokukhulelwa noma ukuchitheka okuphuzi okunsundu ngesikhathi bekhulelwe, okungaba yinto engekho yingozi. Lezi zinguquko zingabangelwa ukuguquguquka kwe-estrogen, ukucasuka okuncane komlomo wesibeletho, noma igazi elidala elixubene noketshezi olujwayelekile [5].

Nakuba ukuchitheka okuphuzi okunsundu ngokuvamile kungesona isizathu sokukhathazeka, uma kuhambisana nokubuhlungu kwesisu nokuphuma kancane kwegazi, kungcono uyoboniswa udokotela ukuze kukhishwe noma yiziphi izinkinga.

Ukuchitheka Okuphuzi Ezigabeni Ezingafani Zokukhulelwa

Uketshezi lwesitho sangasese sowesifazane luyashintsha njengoba ukukhulelwa kuqhubeka. Umzimba ukhiqiza i-mucus eningi emlonyeni wesibeletho, kanti ukwakheka, umbala, nenani lokuchitheka kungashintsha kuye ngomsebenzi wama-hormone nakwezinye izinto.

I-Trimester Yokuqala Nokuchitheka Kwangasekuqaleni Kokukhulelwa

Ezinye izinsuku zokuqala zokukhulelwa, izinga le-estrogen liyakhuphuka, okwandisa ukukhiqizwa koketshezi lwesitho sangasese sowesifazane. Ukuchitheka okuphuzi ekuqaleni kokukhulelwa kanye nokuchitheka okuphuzi ekuqaleni kokukhulelwa kujwayelekile ngenxa yezinguquko zama-hormone.

Nakuba ukwanda kokuchitheka kujwayelekile, abesifazane abakhulelwe kufanele baqaphele izinguquko emandleni omphunga nasekubunjweni. Uketshezi olujiyile, olunuka kabi, noma oluphuzi ngokweqile lungase lubonise ukutheleleka okudinga ukunakwa kwezokwelashwa.

I-Trimester Yesibili Nokwanda Koketshezi Lwesitho Sangasese

Ngesikhathi se-trimester yesibili, umlomo wesibeletho ukhiqiza i-mucus eningi njengekhefu lokuvikela ingane. Abesifazane abaningi babika ukuchitheka okuphuzi ngesikhathi sokukhulelwa i-second trimester, okungaba kujwayelekile inqobo nje uma kungekho mphunga nokucasuka.

Nokho, uma ukuchitheka sekujiye ngendlela engajwayelekile, kunuka kabi, noma kuhambisana nokungakhululeki, kungaba uphawu lokutheleleka futhi kufanele kuhlolwe umhlinzeki wezempilo.

I-Trimester Yesithathu Nezimpawu Zokuthi Ukubeletha Sekusondela

Njengoba umzimba ulungiselela ukubeletha, uketshezi lwesitho sangasese sowesifazane lwanda. Ukuchitheka okuphuzi ngesikhathi sokukhulelwa i-3rd trimester kanye nokuchitheka okuphuzi ngesikhathi sokukhulelwa i-third trimester kungenzeka njengoba i-mucus plug iqala ukuwohloka. Lokhu ketshezi kungaba kujiye kunokujwayelekile futhi kwesinye isikhathi kube nombala wegazi kancane, okukhombisa ukuthi umzimba usulungiselela ukubeletha.

Ukuchitheka okuphuzi esikhathini se-trimester yesithathu kuvame ukuba yingxenye evamile yokulungiselela komzimba ukubeletha, kodwa kubalulekile ukuthi kuqaphelwe noma yiziphi izinguquko ezingajwayelekile, njengomphunga onuka kabi noma ukujiya ngokweqile, okungase kubonise ukutheleleka.

Uma i-yellow discharge pregnancy third trimester iba wuketshezi oluningi kakhulu njengamanzi noma ihambisana nokubamba (contractions), kungase kube uphawu lokuthi amanzi asephukile. Noma yimuphi umfula ongazelelwe noma ukuvuza okuqhubekayo koketshezi kufanele kubikwe kudokotela ngokushesha.

Ingabe Uketshezi Oluphuzunyana Luphawu Lokukhulelwa

Abaningi bayazibuza, is yellow discharge a sign of pregnancy? Nakuba uketshezi lwenkezo lungashintsha ekuqaleni kokukhulelwa, i-yellow discharge yodwa ayisona isiqinisekiso esicacile sokukhulelwa. Iningi lezimpawu zokuqala zokukhulelwa libangelwa izinguquko zamahomoni, ikakhulukazi ukwanda kwe-estrogen ne-progesterone, okuyizona futhi ezithinta uketshezi lwenkezo [6].

Ukukhuphuka kwamazinga e-estrogen kukhuphula ukugeleza kwegazi ukuya ezithweni zokuzala, okuholele ekwandeni kokuphuma koketshezi lwenkezo. Lolu ketshezi luvamise ukuba cwebile noma mhlophe, kodwa lungabonakala luphuzunyana kancane uma seluvelelwe umoya. Ezinye izifazane zingabona i-yellow discharge pregnancy emasontweni okuqala, kodwa akusona isibonakaliso esiqinisekile sokukhulelwa.

Indlela Yokugcina Impilo Yenkezo Ngesikhathi Sokukhulelwa

Imvelo yenkezo enempilo ibalulekile ukuvimbela izifo, ukuvuvukala nokungakhululeki ngesikhathi sokukhulelwa. Izinguquko zamahomoni zingenza i-microbiome yenkezo ibe buthaka kalula ekungalinganeni, okwandisa ingozi yezifo eziphendula umbuzo othi is yellowish discharge normal during pregnancy. Ukuhlanzeka okufanele, ukudla okulinganiselayo, namakhiye okudla aqondiswe khona kungasiza ukugcina impilo yenkezo.

Sekela Ibhalansi ye-Vaginal pH Futhi Uvimbele Izifo

I-vaginal pH elinganiselayo ibalulekile ekuvimbeleni izifo eziholela ku-yellow discharge pregnancy sign. I-vagina ngokwemvelo igcina i-pH ene-asidi, okusiza ukulawula amagciwane namagciwane ezikhunta ayingozi. Nokho, izinguquko zamahomoni ngesikhathi sokukhulelwa zingaphazamisa lolu linganiselo, zikhuphule ingozi yezifo ezifana ne-bacterial vaginosis nezifo zesikhunta (yeast infections) [7].

Ukuze kusekelwe i-vaginal pH, kubalulekile ukugwema insipho enolaka, ama-douche, nemikhiqizo yokuhlanza yabesifazane enamakha. Ukuhlanganisa ama-probiotic ekudleni noma ukuthatha ama-supplement e-probiotic kungasiza ukugcina i-flora yenkezo enempilo. Amakhiye okudla anjengevithamini C, i-zinc ne-selenium nawo adlala indima ekusekeleni i-microbiome yenkezo enempilo nasekuvimbeleni izifo.

Khulisa Uhlelo Lokuzivikela Emzimbeni Futhi Wehlise Izingcuphe

Uhlelo lokuzivikela oluqinile lusiza umzimba ulwe nezifo ezingadala umbuzo othi is yellowish discharge normal during pregnancy. Ukukhulelwa ngokwemvelo kwehlisa eminye imisebenzi yohlelo lokuzivikela ukuze kuvikelwe ingane ekhula, okwenza abesifazane abakhulelwe babe sengozini enkulu yokutheleleka.

Amavithamini abalulekile njengavithamini D, insimbi ne-selenium abaluleke kakhulu emsebenzini wohlelo lokuzivikela. Ivithamini D lisiza ukulawula ukusabela kohlelo lokuzivikela, kanti insimbi isekela ukuthuthwa komoya-mpilo (oxygen) nokukhiqizwa kwamandla. I-Selenium isebenza njenge-antioxidant, inciphise ukuvuvukala futhi isekele impilo yokuzalana iyonkana [8].

Thuthukisa Ukujikeleza Kwegazi Nempilo Yokuzalana

Ukugeleza kwegazi okufanele kubalulekile empilweni yokuzala nasekuvimbeleni izinkinga ezifana noketshezi oluphuzi ngesikhathi sokukhulelwa. Ukukhula kokujikeleza kwegazi kuqinisekisa ukuthi umoya-mpilo nezakhi ezibalulekile zifinyelela ezithweni zokuzala, kusekele impilo enhle yesitho sangasese sowesifazane nendawo yesibeletho.

Izakhi ezifana ne-CoQ10, L-arginine, kanye ne-magnesium zidlala indima ebalulekile ekuthuthukiseni ukujikeleza kwegazi. I-CoQ10 iyi-antioxidant enamandla esekela ukukhiqizwa kwamandla kumaseli, kanti i-L-arginine isiza ukunweba imithambo yegazi nokwandisa ukugeleza kwegazi. I-magnesium isekela ukuphumula kwemisipha futhi inciphise ukuqunjelwa, okwesinye isikhathi okungahambisana nezinguquko ekuphumeni koketshezi esithweni sangasese sowesifazane.

Umsebenzi womzimba ojwayelekile, njengokuhamba ngezinyawo noma i-prenatal yoga, nawo ungathuthukisa ukujikeleza kwegazi futhi unciphise ingozi yokugcinwa koketshezi nokuvuvukala. Ukuhlala usebenza kusiza impilo enhle yokuzala futhi kungasiza ukuvimbela izinkinga eziholela ekuphumeni koketshezi okungajwayelekile esithweni sangasese sowesifazane [9].

Nciphisa Ukuvuvukala Ukhuthaze Nokupholisa

Ukuvuvukala endaweni yesitho sangasese sowesifazane nasezimweni zokuzala kungaholela ekucasukeni, ekungakhululeki nasekuthelelekeni. Izakhi ezifana ne-extract kagingqa kanye namafutha amahle e-omega-3 zisiza ukunciphisa ukuvuvukala nokukhuthaza ukupholisa.

Ugingqa (ginger) unezakhiwo zemvelo zokulwa namagciwane nokunciphisa ukuvuvukala, ezingasiza ukusekela impendulo eqinile yokuzivikela emzimbeni nokunciphisa ingozi yokutheleleka okubangela uketshezi olunamafinyila oluphuzi ngesikhathi sokukhulelwa. Amafutha amahle e-omega-3, atholakala ku-fish oil nase-flaxseeds, asiza ekuqiniseni izindonga zamaseli futhi agcine impilo yezicubu zesitho sangasese sowesifazane nezesimiso sokuzala.

Ukufaka i-compress ebandayo noma ukugqoka izingubo ezikhululekile, eziphefumulayo kungasiza ukunciphisa ukucasuka endaweni yesitho sangasese sowesifazane. Ukuphuza amanzi amaningi nokugcina ukudla okunempilo nokulinganiselayo kusisekela kakhulu ikhono lomzimba lokuphulukisa nokugcina uhlelo lokuzala lusesimweni esinempilo.

Inkubela Yokubona Udokotela Ngokuphathelene Noketshezi Oluphuzi

Noma ezinye izinguquko ekuphumeni koketshezi esithweni sangasese sowesifazane zivamile ngesikhathi sokukhulelwa, ukunakwa kwezokwelapha kuyadingeka uma uketshezi oluphuzi olubhekwa njengophawu lokukhulelwa luhambisana nezimpawu ezingaphezu kwazo okulindelekile. Noma yikuphi ukwanda okungazelelwe kokuphuma koketshezi okungathi ngamanzi kufanele kuhlolwe ukuze kukhishwe amathuba okuvuza koketshezi lwe-amniotic.

Izimpawu ezidinga ukuhlolwa udokotela zihlanganisa:

1. Iphunga eliqinile, elibi elihambisana nokuphuma koketshezi
2. Ukwelwa, ukushisa, noma ukuvuvukala endaweni yesitho sangasese sowesifazane
3. Uketshezi olunamafinyila, olunamathumba, noma oluluhlaza-ophuzi
4. Ukuphuma koketshezi okuxutshaniswe negazi, ikakhulukazi ekuqaleni kokukhulelwa
5. Ubuhlungu obungapheli noma ukuqunjelwa okuhambisana nokuphuma koketshezi
6. Ukuvunguza okungazelelwe noma ukuvuza okuqhubekayo koketshezi, okungase kubonise ukuvuza koketshezi lwe-amniotic [10].

Uma yikuphi kwalokhu kuhlolwa okubonakalayo kwenzeka, kumelwe kubonwe umhlinzeki wezempilo ngokushesha okukhulu. Ukutholakala kusenesikhathi nokwelashwa kungavimbela izinkinga futhi kuqinisekise ukukhulelwa okuphephile nokunempilo.

Okubalulekile Ekugcineni

Ukukhishwa okuphuzi ngesikhathi sokukhulelwa kwenzeka kakhulu, kodwa kufanele kuqaphekelwe izinguquko kombala, ukwakheka, nephunga. Ezimweni eziningi, kuyimpendulo ejwayelekile yezinguquko zamahomoni nokwanda kokukhiqizwa kwamafinyila esithweni sangasese sowesifazane. Nokho, uma ukukhishwa kuqina, kunuka kabi, noma kuhambisana nokucasuka, kungase kubonise ukuthi kukhona ukutheleleka okudinga ukwelashwa.

Ukuzilolonga ukuhlanzeka okuhle, ukugcina ukudla okunempilo, nokuthatha izakhamzimba ezibalulekile kungasekela impilo yesitho sangasese sowesifazane neyokuzala. Imikhuba elula efana nokuphuza amanzi anele, ukugqoka izingubo eziphefumulayo, nokugwema imikhiqizo yabesifazane enamakha ingasiza ukuvimbela izifo nokucasuka.

Imibuzo ejwayeleke ukubuzwa

Ingabe ukukhishwa okuphuzi ngesikhathi sokukhulelwa kujwayelekile?

Yebo, uma kukhanyayo, kungekho phunga, futhi kungabangeli ukungakhululeki. Uma kuqina, kuluhlaza, noma kunuka kabi, kungaba uphawu lwesifo.

Kusho ukuthini ukukhishwa okuqina okuphuzi ngesikhathi sokukhulelwa?

Kungaba uphawu lokutheleleka ngogcunsula (yeast infection), i-bacterial vaginosis, noma i-STI. Udokotela kufanele abonwe uma kukhona ukungakhululeki.

Ingabe ukukhishwa okuphuzi kungalimaza ingane?

Izifo ezihlotshaniswa nokukhishwa okuphuzi zingabangela izinkinga, kodwa ukwelashwa kusenesikhathi kwehlisa ubungozi.

Ukukhishwa okuphuzi kusho ukuthi ukusebenza sekuseduze?

Esigabeni sokugcina sokukhulelwa, ukukhishwa okuphuzi kungase kubonise ukuphuma kwe-mucus plug noma ukuvuza kolwelo lwe-amniotic. Uma kuqala ukuqubuka (contractions), ukusebenza kungase kube seduze.

Ukukhishwa okuphuzi kungavinjelwa kanjani?

Ukuhlanzeka okuhle, izingubo eziphefumulayo, nokudla okufanele kusiza ukugcina impilo yesitho sangasese sowesifazane nokuvimbela izifo.

Izinkomba

1. Workowski, K. A., Bolan, G. A., & Centers for Disease Control and Prevention (2015). Iziqondiso zokwelashwa kwezifo ezithathelwana ngocansi, 2015. I-MMWR. Izincomo nemibiko: iMorbidity and Mortality Weekly Report. Izincomo nemibiko. Kutholakala ku: https://pubmed.ncbi.nlm.nih.gov/26042815/
2. Reid G. (2008). I-Probiotic Lactobacilli yezempilo yomgudu womchamo nowesitho sangasese sowesifazane. Ijenali ye-gastroenterology yokwelashwa. Kutholakala ku: https://pubmed.ncbi.nlm.nih.gov/18685506/
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