İrritabl bağırsak sendromu (IBS), gastrointestinal sistem hastalıkları arasında en sık görülen kronik fonksiyonel bozukluklardan biridir. Dünya genelinde prevalansı yüksek olan IBS, hastaların yaşam kalitesini olumsuz yönde etkilemektedir. IBS'nin gelişiminde etkili olan mekanizmalar tam olarak anlaşılamamıştır. Ancak mekanizmasının multifaktöriyel olduğu düşünülmektedir. IBS, karın ağrısı, ishal, kabızlık, gaz ve hazımsızlık gibi belirli semptomlarla karakterizedir. Bununla birlikte, bu semptomlar IBS'ye özgü değildir ve sıklıkla laktoz intoleransı (LI) semptomları ile karşılaşılabilmektedir. Öte yandan İBS hastalarında aynı anda LI görülme olasılığı oldukça yüksektir. IBS hastaları, semptomlarını tetikledikleri düşüncesiyle laktoz içeren gıdaları özellikle süt ve süt ürünlerini kısıtlamakta ve bunun sonucunda kalsiyum eksikliği oluşabilmektedir. Bu hastaların uzun süre yetersiz kalsiyum alması sonucunda osteoporoz ve osteoporotik kırık riski önemli bir sorun haline gelmektedir. Tüm bu faktörler doğrultusunda bu derleme, İBS hastalarında LI varlığına bağlı olarak gelişebilecek osteoporozu incelemeyi ve beslenme önerilerinde bulunmayı amaçlamaktadır.
Algera, J., Colomier, E., Simrén, M. (2019). The dietary management of patients with irritable bowel syndrome: A narrative review of the existing and emerging evidence. Nutrients, 11(9). doi:10.3390/nu11092162
Ali, T., Lam, D., Bronze, M. S., Humphrey, M. B. (2009). Osteoporosis in inflammatory bowel disease. American Journal of Medicine, 122(7), 599-604. doi:10.1016/j.amjmed.2009.01.022
Alkan, B. M., Fidan, F., Tosun, A., Ardıçoğlu, Ö. (2011). Fiziksel Tıp ve rehabilitasyon polikliniğimize başvuran hastalarda osteoporoz insidansı. Turkish Journal of Osteoporosis, 17(1), 0-0.
Almazar, A. E., Chang, J. Y., Larson, J. J., Atkinson, E. J., Locke, G. R., Talley, . . . N. J., Saito, Y. A. (2019). Comparison of lactase variant MCM6 -13910 C>T testing and self-report of dairy sensitivity in patients with irritable bowel syndrome. Journal of Clinical Gastroenterology, 53(6), e227-e231. doi:10.1097/mcg.0000000000001065
Bellini, M., Tonarelli, S., Mumolo, M. G., Bronzini, F., Pancetti, A., Bertani, L., . . . Rossi, A. (2020). Low fermentable oligo- di- and mono-saccharides and polyols (FODMAPs) or gluten free diet: What is best for irritable bowel syndrome? Nutrients, 12(11). doi:10.3390/nu12113368
Bianchi, M. L. (2010). Inflammatory bowel diseases, celiac disease, and bone. Archives of Biochemistry and Biophysics, 503(1), 54-65. doi:10.1016/j.abb.2010.06.026
Black, C. J., Ford, A. C. (2020). Rational investigations in irritable bowel syndrome. Frontline Gastroenterology, 11(2), 140-147. doi:10.1136/flgastro-2019-101211
Campbell, A. K., Matthews, S. B., Vassel, N., Cox, C. D., Naseem, R., Chaichi, J., . . . Wann, K. T. (2010). Bacterial metabolic 'toxins': a new mechanism for lactose and food intolerance, and irritable bowel syndrome.
Toxicology, 278(3), 268-276. doi:10.1016/j.tox.2010.09.001
Cancarevic, I., Rehman, M., Iskander, B., Lalani, S., Malik, B. H. (2020). Is there a correlation between irritable bowel syndrome and lactose intolerance? Cureus, 12(1), e6710. doi:10.7759/cureus.6710
Casellas, F., Burgos, R., Marcos, A., Santos, J., Ciriza de Los Ríos, C., García Manzanares, Á., . . . Vázquez Alférez, M. D. C. (2018). Consensus document on exclusion diets in irritable bowel syndrome (IBS). Revista Espanola de Enfermadades Digestivas, 110(12), 806-824. doi:10.17235/reed.2018.5941/2018
Celebi, S., Acik, Y., Deveci, S. E., Bahcecioglu, I. H., Ayar, A., Demir, A., . . . Durukan, P. (2004). Epidemiological features of irritable bowel syndrome in a Turkish urban society. Journal of Gastroenterology and Hepatology, 19(7), 738-743. doi:10.1111/j.1440-1746.2004.03367.x
Chey, W. D., Keefer, L., Whelan, K., Gibson, P. R. (2021). Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome. Gastroenterology, 160(1), 47-62. doi:10.1053/j.gastro.2020.06.099
Chey, W. D., Kurlander, J., Eswaran, S. (2015). Irritable bowel syndrome: A clinical review. Jama, 313(9), 949-958. doi:10.1001/jama.2015.0954
Compston, J. E. (2013). Bone: Risk of osteoporotic fractures in irritable bowel syndrome. Nature Reviews Endocrinology, 9(1), 8-9. doi:10.1038/nrendo.2012.216
Cozma-Petruţ, A., Loghin, F., Miere, D., Dumitraşcu, D. L. (2017). Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients! World Journal of Gastroenterology: WJG, 23(21), 3771-3783. doi:10.3748/wjg.v23.i21.3771
Dabak, M. R., Küçük, T. A., Tüzün, S., Çetin, H., Ahıshalı, E., Dolapçıoğlu, C. (2019). İrritabl barsak sendromu ve laktoz İntoleransı İlişkisi. Namık Kemal Tıp Dergisi, 7(3), 217-221.
Deng, Y., Misselwitz, B., Dai, N., Fox, M. (2015). Lactose intolerance in adults: Biological mechanism and dietary management. Nutrients, 7(9), 8020-8035. doi:10.3390/nu7095380
Facioni, M. S., Raspini, B., Pivari, F., Dogliotti, E., Cena, H. (2020). Nutritional management of lactose intolerance: the importance of diet and food labelling. Journal of Translational Medicine, 18(1), 260. doi:10.1186/s12967-020-02429-2
Hodges, J. K., Cao, S., Cladis, D. P., Weaver, C. M. (2019). Lactose intolerance and bone health: The challenge of ensuring adequate calcium intake. Nutrients, 11(4). doi:10.3390/nu11040718
Jackson, K. A., Savaiano, D. A. (2001). Lactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-Americans. Journal of the American College of Nutrition, 20(2 Suppl), 198s-207s. doi:10.1080/07315724.2001.10719032
Jansson-Knodell, C. L., Krajicek, E. J., Savaiano, D. A., Shin, A. S. (2020). Lactose intolerance: A concise review to skim the surface. Mayo Clinic Proceedings, 95(7), 1499-1505. doi:10.1016/j.mayocp.2020.04.036
Kumar, S., Ranjan, P., Mittal, B., Singh, R., Ghoshal, U. C. (2012). Lactase persistence/non-persistence genetic variants in irritable bowel syndrome in an endemic area for lactose malabsorption. Journal of
Gastroenterology and Hepatology, 27(12), 1825-1830. doi:10.1111/j.1440-1746.2012.07259.x
Le Morvan de Sequeira, C., Kaeber, M., Cekin, S. E., Enck, P., Mack, I. (2021). The effect of probiotics on quality of life, depression and anxiety in patients with irritable bowel syndrome: A systematic review and meta-
analysis. Journal of Clinical Medicine, 10(16). doi:10.3390/jcm10163497
Lee, H. J., Kim, H. J., Kang, E. H., Jung, K. W., Myung, S. J., Min, Y. W., . . . Park, K. S. (2019). Self-reported food intolerance in Korean patients with irritable bowel syndrome. Journal of Neurogastroenterololgy and Motility, 25(2), 222-232. doi:10.5056/jnm18125
Lee, H. S., Chen, C. Y., Huang, W. T., Chang, L. J., Chen, S. C., Yang, H. Y. (2018). Risk of fractures at different anatomic sites in patients with irritable bowel syndrome: A nationwide population-based cohort study. Archives of Osteoporosis, 13(1), 80. doi:10.1007/s11657-018-0496-7
Lomer, M. C., Parkes, G. C., Sanderson, J. D. (2008). Review article: Lactose intolerance in clinical practice-myths and realities. Alimentary Pharmacology & Therapeutics, 27(2), 93-103. doi:10.1111/j.1365-2036.2007.03557.x
Lopes, S. S., Miszputen, S. J., Sachs, A., Lima, M. M., Ambrogini, O., Jr. (2019). Evaluation of carbohydrate and fiber consumption in patients with irritable bowel syndrome in outpatient treatment. Arquivos de Gastroenterologia, 56(1), 3-9. doi:10.1590/s0004-2803.201900000-12
Lovell, R. M., Ford, A. C. (2012). Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clinical Gastroenterology and Hepatology, 10(7), 712-721.e714. doi:10.1016/j.cgh.2012.02.029
Mądry, E., Fidler, E. (2010). Lactose intolerance–current state of knowledge. Acta Scientiarum Polonorum Technologia Alimentaria, 9(3), 343-350.
Malik, T. F., Panuganti, K. K. (2021). Lactose intolerance. In StatPearls. Treasure Island (FL): StatPearls Publishing.
McKenzie, Y. A., Alder, A., Anderson, W., Wills, A., Goddard, L., Gulia, P., . . . Lomer, M. C. (2012). British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. Journal of Human Nutrition and Dietetics, 25(3), 260-274. doi:10.1111/j.1365-277X.2012.01242.x
Misselwitz, B., Butter, M., Verbeke, K., Fox, M. R. (2019). Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut, 68(11), 2080-2091. doi:10.1136/gutjnl-2019-318404
Monsbakken, K. W., Vandvik, P. O., Farup, P. G. (2006). Perceived food intolerance in subjects with irritable bowel syndrome-etiology, prevalence and consequences. European Journal of Clinical Nutrition, 60(5), 667-
672. doi:10.1038/sj.ejcn.1602367
Özden, A., Köksal, A. Ş., Dilek, O., Çiçek, B., Yılmaz, U., Dağlı, Ü., . . . Özler, J. (2006). Türkiye'de birinci basamak sağlık kurumlarında irritabl barsak sendromu görülme sıklığı. Akademik Gastroenteroloji Dergisi, 5(1):4-15(1), 4-15.
Quigley, E. M., Fried, M., Gwee, K. A., Khalif, I., Hungin, A. P., Lindberg, G., . . . LeMair, A. (2016). World Gastroenterology Organisation Global Guidelines irritable bowel syndrome: A global perspective update
September 2015. Journal of Clinical Gastroenterology, 50(9), 704-713. doi:10.1097/mcg.0000000000000653
Ratajczak, A. E., Rychter, A. M., Zawada, A., Dobrowolska, A., Krela-Kaźmierczak, I. (2021). Lactose intolerance in patients with inflammatory bowel diseases and dietary management in prevention of osteoporosis. Nutrition, 82, 111043. doi:10.1016/j.nut.2020.111043
Savaiano, D. (2011). Lactose intolerance: An unnecessary risk for low bone density. Milk and Milk Products in Human Nutrition, 67, 161-171. doi:10.1159/000325582
Shah-Khan, S. M., Cumberledge, J., Shah-Khan, S. M., Gannon, K., Kupec, J. T. (2019). Improving bone mineral density screening in patients with inflammatory bowel disease: a quality improvement report. BMJ Open Quality, 8(3), e000624. doi:10.1136/bmjoq-2019-000624
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Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients
Irritable bowel syndrome (IBS) is one of the most common chronic functional disorders among gastrointestinal system diseases. IBS, which has a high prevalence worldwide, negatively affects the quality of life of patients. The mechanisms that are effective in the development of IBS has not clearly been defined. However, its mechanism is thought to be multifactorial. IBS is characterized by certain symptoms, such as abdominal pain, diarrhea, constipation, flatulence, and indigestion. Nevertheless, these symptoms aren’t specific to IBS and can often be confused with lactose intolerance (LI) symptoms. On the other hand, the probability of having LI at the same time is quite high in IBS patients. IBS patients restrict lactose-containing foods, especially milk and dairy products, due to the thought that they trigger their symptoms, and thus calcium deficiency may occur as a result. Due to insufficient calcium intake for a long time, the risk of osteoporosis and osteoporotic fractures becomes an important problem. In line with all these factors, this review aims to examine osteoporosis that may develop due to the presence of LI in IBS patients and to make nutritional recommendations.
Algera, J., Colomier, E., Simrén, M. (2019). The dietary management of patients with irritable bowel syndrome: A narrative review of the existing and emerging evidence. Nutrients, 11(9). doi:10.3390/nu11092162
Ali, T., Lam, D., Bronze, M. S., Humphrey, M. B. (2009). Osteoporosis in inflammatory bowel disease. American Journal of Medicine, 122(7), 599-604. doi:10.1016/j.amjmed.2009.01.022
Alkan, B. M., Fidan, F., Tosun, A., Ardıçoğlu, Ö. (2011). Fiziksel Tıp ve rehabilitasyon polikliniğimize başvuran hastalarda osteoporoz insidansı. Turkish Journal of Osteoporosis, 17(1), 0-0.
Almazar, A. E., Chang, J. Y., Larson, J. J., Atkinson, E. J., Locke, G. R., Talley, . . . N. J., Saito, Y. A. (2019). Comparison of lactase variant MCM6 -13910 C>T testing and self-report of dairy sensitivity in patients with irritable bowel syndrome. Journal of Clinical Gastroenterology, 53(6), e227-e231. doi:10.1097/mcg.0000000000001065
Bellini, M., Tonarelli, S., Mumolo, M. G., Bronzini, F., Pancetti, A., Bertani, L., . . . Rossi, A. (2020). Low fermentable oligo- di- and mono-saccharides and polyols (FODMAPs) or gluten free diet: What is best for irritable bowel syndrome? Nutrients, 12(11). doi:10.3390/nu12113368
Bianchi, M. L. (2010). Inflammatory bowel diseases, celiac disease, and bone. Archives of Biochemistry and Biophysics, 503(1), 54-65. doi:10.1016/j.abb.2010.06.026
Black, C. J., Ford, A. C. (2020). Rational investigations in irritable bowel syndrome. Frontline Gastroenterology, 11(2), 140-147. doi:10.1136/flgastro-2019-101211
Campbell, A. K., Matthews, S. B., Vassel, N., Cox, C. D., Naseem, R., Chaichi, J., . . . Wann, K. T. (2010). Bacterial metabolic 'toxins': a new mechanism for lactose and food intolerance, and irritable bowel syndrome.
Toxicology, 278(3), 268-276. doi:10.1016/j.tox.2010.09.001
Cancarevic, I., Rehman, M., Iskander, B., Lalani, S., Malik, B. H. (2020). Is there a correlation between irritable bowel syndrome and lactose intolerance? Cureus, 12(1), e6710. doi:10.7759/cureus.6710
Casellas, F., Burgos, R., Marcos, A., Santos, J., Ciriza de Los Ríos, C., García Manzanares, Á., . . . Vázquez Alférez, M. D. C. (2018). Consensus document on exclusion diets in irritable bowel syndrome (IBS). Revista Espanola de Enfermadades Digestivas, 110(12), 806-824. doi:10.17235/reed.2018.5941/2018
Celebi, S., Acik, Y., Deveci, S. E., Bahcecioglu, I. H., Ayar, A., Demir, A., . . . Durukan, P. (2004). Epidemiological features of irritable bowel syndrome in a Turkish urban society. Journal of Gastroenterology and Hepatology, 19(7), 738-743. doi:10.1111/j.1440-1746.2004.03367.x
Chey, W. D., Keefer, L., Whelan, K., Gibson, P. R. (2021). Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome. Gastroenterology, 160(1), 47-62. doi:10.1053/j.gastro.2020.06.099
Chey, W. D., Kurlander, J., Eswaran, S. (2015). Irritable bowel syndrome: A clinical review. Jama, 313(9), 949-958. doi:10.1001/jama.2015.0954
Compston, J. E. (2013). Bone: Risk of osteoporotic fractures in irritable bowel syndrome. Nature Reviews Endocrinology, 9(1), 8-9. doi:10.1038/nrendo.2012.216
Cozma-Petruţ, A., Loghin, F., Miere, D., Dumitraşcu, D. L. (2017). Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients! World Journal of Gastroenterology: WJG, 23(21), 3771-3783. doi:10.3748/wjg.v23.i21.3771
Dabak, M. R., Küçük, T. A., Tüzün, S., Çetin, H., Ahıshalı, E., Dolapçıoğlu, C. (2019). İrritabl barsak sendromu ve laktoz İntoleransı İlişkisi. Namık Kemal Tıp Dergisi, 7(3), 217-221.
Deng, Y., Misselwitz, B., Dai, N., Fox, M. (2015). Lactose intolerance in adults: Biological mechanism and dietary management. Nutrients, 7(9), 8020-8035. doi:10.3390/nu7095380
Facioni, M. S., Raspini, B., Pivari, F., Dogliotti, E., Cena, H. (2020). Nutritional management of lactose intolerance: the importance of diet and food labelling. Journal of Translational Medicine, 18(1), 260. doi:10.1186/s12967-020-02429-2
Hodges, J. K., Cao, S., Cladis, D. P., Weaver, C. M. (2019). Lactose intolerance and bone health: The challenge of ensuring adequate calcium intake. Nutrients, 11(4). doi:10.3390/nu11040718
Jackson, K. A., Savaiano, D. A. (2001). Lactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-Americans. Journal of the American College of Nutrition, 20(2 Suppl), 198s-207s. doi:10.1080/07315724.2001.10719032
Jansson-Knodell, C. L., Krajicek, E. J., Savaiano, D. A., Shin, A. S. (2020). Lactose intolerance: A concise review to skim the surface. Mayo Clinic Proceedings, 95(7), 1499-1505. doi:10.1016/j.mayocp.2020.04.036
Kumar, S., Ranjan, P., Mittal, B., Singh, R., Ghoshal, U. C. (2012). Lactase persistence/non-persistence genetic variants in irritable bowel syndrome in an endemic area for lactose malabsorption. Journal of
Gastroenterology and Hepatology, 27(12), 1825-1830. doi:10.1111/j.1440-1746.2012.07259.x
Le Morvan de Sequeira, C., Kaeber, M., Cekin, S. E., Enck, P., Mack, I. (2021). The effect of probiotics on quality of life, depression and anxiety in patients with irritable bowel syndrome: A systematic review and meta-
analysis. Journal of Clinical Medicine, 10(16). doi:10.3390/jcm10163497
Lee, H. J., Kim, H. J., Kang, E. H., Jung, K. W., Myung, S. J., Min, Y. W., . . . Park, K. S. (2019). Self-reported food intolerance in Korean patients with irritable bowel syndrome. Journal of Neurogastroenterololgy and Motility, 25(2), 222-232. doi:10.5056/jnm18125
Lee, H. S., Chen, C. Y., Huang, W. T., Chang, L. J., Chen, S. C., Yang, H. Y. (2018). Risk of fractures at different anatomic sites in patients with irritable bowel syndrome: A nationwide population-based cohort study. Archives of Osteoporosis, 13(1), 80. doi:10.1007/s11657-018-0496-7
Lomer, M. C., Parkes, G. C., Sanderson, J. D. (2008). Review article: Lactose intolerance in clinical practice-myths and realities. Alimentary Pharmacology & Therapeutics, 27(2), 93-103. doi:10.1111/j.1365-2036.2007.03557.x
Lopes, S. S., Miszputen, S. J., Sachs, A., Lima, M. M., Ambrogini, O., Jr. (2019). Evaluation of carbohydrate and fiber consumption in patients with irritable bowel syndrome in outpatient treatment. Arquivos de Gastroenterologia, 56(1), 3-9. doi:10.1590/s0004-2803.201900000-12
Lovell, R. M., Ford, A. C. (2012). Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clinical Gastroenterology and Hepatology, 10(7), 712-721.e714. doi:10.1016/j.cgh.2012.02.029
Mądry, E., Fidler, E. (2010). Lactose intolerance–current state of knowledge. Acta Scientiarum Polonorum Technologia Alimentaria, 9(3), 343-350.
Malik, T. F., Panuganti, K. K. (2021). Lactose intolerance. In StatPearls. Treasure Island (FL): StatPearls Publishing.
McKenzie, Y. A., Alder, A., Anderson, W., Wills, A., Goddard, L., Gulia, P., . . . Lomer, M. C. (2012). British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. Journal of Human Nutrition and Dietetics, 25(3), 260-274. doi:10.1111/j.1365-277X.2012.01242.x
Misselwitz, B., Butter, M., Verbeke, K., Fox, M. R. (2019). Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut, 68(11), 2080-2091. doi:10.1136/gutjnl-2019-318404
Monsbakken, K. W., Vandvik, P. O., Farup, P. G. (2006). Perceived food intolerance in subjects with irritable bowel syndrome-etiology, prevalence and consequences. European Journal of Clinical Nutrition, 60(5), 667-
672. doi:10.1038/sj.ejcn.1602367
Özden, A., Köksal, A. Ş., Dilek, O., Çiçek, B., Yılmaz, U., Dağlı, Ü., . . . Özler, J. (2006). Türkiye'de birinci basamak sağlık kurumlarında irritabl barsak sendromu görülme sıklığı. Akademik Gastroenteroloji Dergisi, 5(1):4-15(1), 4-15.
Quigley, E. M., Fried, M., Gwee, K. A., Khalif, I., Hungin, A. P., Lindberg, G., . . . LeMair, A. (2016). World Gastroenterology Organisation Global Guidelines irritable bowel syndrome: A global perspective update
September 2015. Journal of Clinical Gastroenterology, 50(9), 704-713. doi:10.1097/mcg.0000000000000653
Ratajczak, A. E., Rychter, A. M., Zawada, A., Dobrowolska, A., Krela-Kaźmierczak, I. (2021). Lactose intolerance in patients with inflammatory bowel diseases and dietary management in prevention of osteoporosis. Nutrition, 82, 111043. doi:10.1016/j.nut.2020.111043
Savaiano, D. (2011). Lactose intolerance: An unnecessary risk for low bone density. Milk and Milk Products in Human Nutrition, 67, 161-171. doi:10.1159/000325582
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Aycan, M., & Açıkgöz Pınar, A. (2022). Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri Ve Araştırmaları Dergisi, 4(3), 253-260. https://doi.org/10.46413/boneyusbad.1184664
AMA
Aycan M, Açıkgöz Pınar A. Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi. December 2022;4(3):253-260. doi:10.46413/boneyusbad.1184664
Chicago
Aycan, Melis, and Aylin Açıkgöz Pınar. “Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients”. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri Ve Araştırmaları Dergisi 4, no. 3 (December 2022): 253-60. https://doi.org/10.46413/boneyusbad.1184664.
EndNote
Aycan M, Açıkgöz Pınar A (December 1, 2022) Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi 4 3 253–260.
IEEE
M. Aycan and A. Açıkgöz Pınar, “Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients”, Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi, vol. 4, no. 3, pp. 253–260, 2022, doi: 10.46413/boneyusbad.1184664.
ISNAD
Aycan, Melis - Açıkgöz Pınar, Aylin. “Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients”. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi 4/3 (December 2022), 253-260. https://doi.org/10.46413/boneyusbad.1184664.
JAMA
Aycan M, Açıkgöz Pınar A. Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi. 2022;4:253–260.
MLA
Aycan, Melis and Aylin Açıkgöz Pınar. “Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients”. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri Ve Araştırmaları Dergisi, vol. 4, no. 3, 2022, pp. 253-60, doi:10.46413/boneyusbad.1184664.
Vancouver
Aycan M, Açıkgöz Pınar A. Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi. 2022;4(3):253-60.