Hepatosteatoz Tanısı ile Çocuk Gastroenteroloji Kliniğinde Değerlendirilen Obez Hastalarda Gastrointestinal ve Hepatolojik Sorunların Değerlendirilmesi

Year 2020, Volume: 73 Issue: 2, 130 - 134, 21.07.2020

Suna Selbuz

Abstract

Amaç: Obezitenin doğrudan neden olduğu alkole bağlı olmayan yağlı karaciğer hastalığı (NAYKH) veya reflü özofajiti ve safra kesesi taşları gibi önemli bir risk faktörü olduğu birçok gastrointestinal (GI) ve hepatolojik hastalık vardır. Bu çalışmada; çocuk gastroenteroloji kliniğine başvuran, obezite ve hepatosteatozu olan çocuk hastalarda GI hastalıkların sıklığının araştırılması ve hepatosteatoz ve/veya transaminaz yüksekliği olan hastalarda kronik karaciğer hastalığı etiyolojisine yönelik yapılan tanısal tetkiklerin verimliliğinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Bu çalışma; Ocak - Aralık 2018 tarihleri arasında Sağlık Bilimleri Üniversitesi, Keçiören Eğitim ve Araştırma Hastanesi Çocuk Gastroenteroloji Polikliniği’nde, obezite [vücut kitle indeksi (VKİ) ≥%95] ve hepatosteatoz tanılarıyla değerlendirilen 201 çocuk hastaya ait tıbbi verilerin geriye yönelik olarak taranmasıyla gerçekleştirilen bir çalışmadır.

Bulgular: Yaş ortalaması 12,9±3,4 yıl olan 201 [%55,2’si (n=111) erkek] hasta çalışmaya dahil edilmiştir. Hastaların VKİ ortalaması 29,8, VKİ standart sapma skoru 2,69’du. Hastaların 23’ünün (%11,4) gastro özofajial reflü hastalığı, 23’ünün (%11,4) kabızlık, 13’ünün (%6,5) fonksiyonel karın ağrısı ve/veya huzursuz bağırsak sendromu ve 13’ünün (%6,5) ise gastrit ile uyumlu yakınmaları vardı. Hepatosteatozu ve transaminaz yüksekliği olan hastalardan birine otoimmün hepatit bir diğerine de alfa-1 antitripsin eksikliği tanısı koyuldu.

Sonuç: Sonuç olarak dünyada ve ülkemizde giderek artan sıklıkta görülen obezite ve obeziteye bağlı morbiditeler çocukluk yaş grubundan itibaren
önemli bir sağlık sorunudur. Obez hastalarda GI hastalıklar oldukça sık görülmektedir. Obez hastaların takiplerinde tedavi edilebilir diğer karaciğer
hastalıkları nedenleri de değerlendirilmelidir. Bu hastalarda multidisipliner obezite yönetimi açısından çocuk gastroenteroloji takibi mutlaka
gerekmektedir.

Keywords

Obezite, Yağlı Karaciğer Hastalığı, Çocukluk Dönemi

Ethical Statement

Etik Kurul Onayı: Araştırma için Sağlık Bilimleri Üniversitesi Tıp Fakültesi Etik Kurulu’na başvurularak etik kurul onayı alındı (tarihi: 31.01.2020 ve no: 929-E.323). Hasta Onayı: Retrospektif bir çalışma olduğu için gerek görülmedi. Hakem Değerlendirmesi: Editörler kurulunun dışından olan kişiler tarafından değerlendirilmiştir. Finansal Destek: Yazarlar tarafından finansal destek almadıkları bildirilmiştir.

Supporting Institution

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Project Number

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Thanks

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Evaluation of Gastrointestinal and Hepatological Problems in Obese Patients Evaluated in the Pediatric Gastroenterology Clinic with the Diagnosis of Hepatosteatosis

Abstract

Objectives: There are many gastrointestinal (GI) and hepatic diseases for which obesity is the direct cause (eg, nonalcoholic fatty liver disease) or is a significant risk factor, such as reflux esophagitis and gallstones. In our study; we aimed to investigate the incidence of GI diseases in pediatric patients with obesity and hepatosteatosis and to evaluate the efficacy of diagnostic investigations for etiology in patients with hepatosteatosis and/or elevated transaminases.

Materials and Methods: This study was retrospectively conducted in 201 pediatric patients who were diagnosed with obesity [body mass index (BMI) ≥95%] and hepatosteatosis between January and December 2018.

Results: A total of 201 [55.2% (n=111) male] patients with a mean age of 12.9±3.4 years were included in the study. The mean BMI of the patients was 29.8 and the BMI standard deviation score was 2.69. Twenty-three (11.4%) of the patients had gastro esophageal reflux disease, 23 (11.4%) had constipation and 13 (6.5%) had functional abdominal pain and/or irritable bowel syndrome and 13 (6.5%) had symptoms compatible with gastritis. One of the patients with hepatosteatosis and elevated transaminases was diagnosed with autoimmune hepatitis and the other was diagnosed with alpha-1 antitrypsin deficiency.

Conclusion: Consequently, obesity and obesity-related morbidities, which are increasing in the world and in our country, are an important health problem since childhood. GI diseases are quite common in obese patients. Other treatable causes of liver diseases should be evaluated in the followup of obese patients. In these patients, pediatric gastroenterology follow-up is absolutely necessary for multidisciplinary obesity management.

Keywords

Obesity, Fatty Liver Disease, Childhood

Ethical Statement

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Supporting Institution

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Project Number

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Thanks

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