İrritabl barsak sendromlu hastalarda mikroskopik (lenfositik ve kollajenöz) kolit sıklığı ve sitokin düzeyleri
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2017
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info:eu-repo/semantics/openAccess
Özet
Giriş: Mikroskopik kolit karın ağrısı ve ishal ile karakterize olan, endoskopik incelemede mukozanın hemen her zaman normal olarak saptandığı ancak alınan biyopsi örnekleri ile tanı konan klinik tablodur. İshal ve kronik karın ağrısı ile başvuran bir hastada şüphe edilmeyip biyopsi alınmadığında bu hastalara irritabl barsak sendromu tanısı konabilir. Bu da hastaya yaklaşımı olumsuz yönde etkiler. Amaç: Roma III kriterlerine göre tanı almış olan ishal ve kabızlık baskın İBS hastalarında mikroskopik kolit sıklığını saptamak ve sitokin düzeyleri ile İBS tipi ve MK varlığı arasındaki ilişkiyi araştırmaktır. Hastalar ve yöntem: Bu çalışmaya İBS tanısı konulan hastalar alındı. Bu hastalar Roma III kriterleri ve Bristol Dışkı Şekli Değerlendirme Skalası (BDŞDS) kullanılarak İBS-D daire baskın İBS (İBS-D) ve kabızlık baskın İBS (İBS-K) gruplarına ayrıldı. Tüm hastalara kolonoskopi uygulanarak beş farklı lokalizasyondan (çekum, çıkan kolon, transvers kolon, inen kolon ve rektosigmoid bölge) biyopsiler alınarak histopatolojik incelemeler yapıldı. Ayrıca hastaların periferik kan örneklerinden serum TNF-?, serum IL-1ß ve IL-6 düzeyleri çalışıldı. Bulgular: Çalışmaya alınan 89 İBS'li hastanın 40'ı İBS-D, 49'u İBS-K idi. İBS-D ile İBS-K grubu karşılaştırıldığında yaş ve cinsiyet bakımından anlamlı bir fark yoktu. Hastaların İBS semptomlarının süresi mikroskopik kolit saptanmayanlarda 50.67±50.72 ay iken mikroskopik kolit saptanan hastalarında 28.89±14.80 ay idi. İBS-D'li hastaların 9'unda (%22.5), İBS-K'lu hastaların 10'unda (%20.4) MK saptandı. Mikroskopik kolit tanısı alan hastaların hiçbirinde rektosigmoid bölgeden alınan biyopsilerde tutulum saptanmadı. Sonuç: Çalışmamızda sitokinler IL-1ß, IL-6 ve TNF-? düzeyleri ile MK arasında istatistiksel olarak anlamlı ilişki saptanmadı. TNF-? düzeyleri İBS-K grubunda daha yüksek olup fark istatistiksel olarak anlamlı idi (p= 0.013). Tartışma: İBS hastalarında MK sıklığı normal popülasyondaki sıklığına göre yüksektir. Çalışmamızda diare ve kabızlık baskın İBS semptomları olan hastalarda mikroskopik kolit saptanma sıklığı açısından fark saptanamamıştır. Semptom süresi uzun olan hastalarda mikroskopik kolit sıklığı daha fazla olup MK tanısını dışlamak için rektosigmoid bölgeden biyopsi alınması yeterli değildir. Anahtar kelimeler: rritabl Barsak Sendromu, Mikroskopik kolit, Sitokinler
Introduction: Microscopic colitis characterised by abdominal pain and diarrhea, is a clinical entity diagnosed only by biopsy due to mucosa is always totally normal in endoscopic investigation. If biopsy wasn?t taken when patients refer to hospital with symptoms of abdominal pain and diarrhea, the irritable bowel syndrome can be diagnosed in those patients. These effects negatively to patient approach. Aim: Our aim is to investigate the frequency of microscopic colitis in constipation and diarrhea dominat IBS patients diagnosed according to Roma III criteria and the relation between cytokine levels in microscopic colitis and IBS subtypes. Patients and Methods: In this study, patients diagnosed as IBS were included. These patients were divided into two category as IBS diarrhea dominant (IBS-D) and IBS constipation dominant (IBS-C) according to Roma III criteria and the Bristol stool scala. All patients were went to colonoscopy and biopsies were taken from five different regions (caecum, ascending colon, transverse colon, descending colon and rectosigmoid region) and histopathological investigation were made. In addition to this, patient?s peripheric blood samples were taken for serum TNF-?, IL-1ß and IL-6. Findings: From 89 patients taken to the study, 40 were IBS-D and 49 were IBS-C. When IBS-D and IBS-C grups were compared, there were no statistically significant difference with age and sex. Although patient?s IBS symptom time was 28.89±14.80 months in microscopic colitis diagnosed group, in the microscopic colitis undiagnosed group the time was 50.67±50.72 months. Nine (22,5%) patients in IBS-D group and 10 (20,4%) patients in IBS-C group, microscopic colitis were diagnosed. In all patients diagnosed as microscopic colitis, rectosigmoidal region was uninvolved. Results: In our study, between IL-1ß, IL-6 ve TNF-? levels and microscopic colitis, no statistically significant difference were found. TNF-? leves were statistically significantly high in IBS-C group (p=0,013). Discussion: In IBS patients MC frequency are high according to normal population. In our study, diarrhea and constipation symptom dominant IBS patients, there were no significant difference for microscopic colitis diagnosis. Since in long-time symptomatic patients, microscopic colitis frequency are high, rectosigmoidal regional biopsy is not enough to exclude diagnosis. Key words: Irritable Bowel Syndrome, Microscopic colitis, Cytokines
Introduction: Microscopic colitis characterised by abdominal pain and diarrhea, is a clinical entity diagnosed only by biopsy due to mucosa is always totally normal in endoscopic investigation. If biopsy wasn?t taken when patients refer to hospital with symptoms of abdominal pain and diarrhea, the irritable bowel syndrome can be diagnosed in those patients. These effects negatively to patient approach. Aim: Our aim is to investigate the frequency of microscopic colitis in constipation and diarrhea dominat IBS patients diagnosed according to Roma III criteria and the relation between cytokine levels in microscopic colitis and IBS subtypes. Patients and Methods: In this study, patients diagnosed as IBS were included. These patients were divided into two category as IBS diarrhea dominant (IBS-D) and IBS constipation dominant (IBS-C) according to Roma III criteria and the Bristol stool scala. All patients were went to colonoscopy and biopsies were taken from five different regions (caecum, ascending colon, transverse colon, descending colon and rectosigmoid region) and histopathological investigation were made. In addition to this, patient?s peripheric blood samples were taken for serum TNF-?, IL-1ß and IL-6. Findings: From 89 patients taken to the study, 40 were IBS-D and 49 were IBS-C. When IBS-D and IBS-C grups were compared, there were no statistically significant difference with age and sex. Although patient?s IBS symptom time was 28.89±14.80 months in microscopic colitis diagnosed group, in the microscopic colitis undiagnosed group the time was 50.67±50.72 months. Nine (22,5%) patients in IBS-D group and 10 (20,4%) patients in IBS-C group, microscopic colitis were diagnosed. In all patients diagnosed as microscopic colitis, rectosigmoidal region was uninvolved. Results: In our study, between IL-1ß, IL-6 ve TNF-? levels and microscopic colitis, no statistically significant difference were found. TNF-? leves were statistically significantly high in IBS-C group (p=0,013). Discussion: In IBS patients MC frequency are high according to normal population. In our study, diarrhea and constipation symptom dominant IBS patients, there were no significant difference for microscopic colitis diagnosis. Since in long-time symptomatic patients, microscopic colitis frequency are high, rectosigmoidal regional biopsy is not enough to exclude diagnosis. Key words: Irritable Bowel Syndrome, Microscopic colitis, Cytokines
Açıklama
Bu çalışma Yan Dal Uzmanlık tezi olarak hazırlanmıştır.
Anahtar Kelimeler
İrritabl barsak sendromu (IBS), Mikroskopik kolit, Sitokinler, Irritable Bowel Syndrome (IBS), Microscopic colitis, Cytokines
