Akromegali hastalarında üst gastrointestinal system endoskopi taramasının değerlendirilmesi: tek merkez deneyimi

Year 2023, Volume: 48 Issue: 1, 145 - 152, 31.03.2023

Yasemin Emür Günay , Serdar Durak , Ozge Üçüncü , Arif Mansur Coşar

https://doi.org/10.17826/cumj.1162996

Abstract

Amaç: Akromegalik hastalarda üst gastrointestinal sistemdeki prekanser öz veya kanserlilezyonların prevalansıiyi bilinmemektedir. Çalışmamızda Akromegali hastalarının üst gastrointestinal sistem(GİS) endoskopi bulgularının incelenmesi ve patolojik bulguların hastalık ve somatostatin analoğu kullanımı ile ilişkisinin olupol madığının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Ocak 2010 ile Ekim 2021 arasında akromegali tanısı konulan hastalar tıbbi kayıtlar geriye dönük taranarak belirlendi. Bu çalışmayaüst GİS endoskopisiyapılan 49 akromegali hastası dahil edildi. Akromegali hastaları endoskopi anında somatostatin analogu kullanan ve kullanmayanlar olarak iki gruba ayrıldı. Bu iki grup arasında lezyon gelişimi açısından fark olup olmadığı incelendi. Akromegali hastaları ve control grubu endoskopik bulgular ve biyopsi sonuçları açısından karşılaştırıldı.
Bulgular: Hastaların %53'ü (n=26) erkek, %46,9'u (n=23) kadındı. Akromegali hastalarında Helicobakterpilori (HP) insidansı kontrollere göre anlamlı derecede yüksekti. Akromegali grubunda antral ve pangastriti olan 24 hastanın %62,5'i (n=15) somatostatin analoglarıalıyordu. Somatostatin analoglarının kullanımı ile gastrit gelişimi arasında anlamlı bir fark yoktu. Somatostatin analogları kullanan akromegali hastalarında özofajit gelişimi istatistiksel olarak daha yüksek saptandı.
Sonuç: Akromegali hastalarında HP görülmesıklığı normal popülasyona göre yüksek saptanmıştır. Gastrit gelişiminde ise net sonuçlar ortaya konamamıştır. Somatostatin analogları kullananak romegali hastalarında özofajit sıklığı yüksek bulundu. Etyolojisinin hastalık ve kullanılan ilaçlarla ilişkisinin net bir şekilde ortaya konulabilmesi açısından geniş çaplı çalışmalara gereksinim duyulmaktadır.

Keywords

Akromegali, Özofajit, Somatostatin analogları, Üst Gastrointestinal Sistem Endoskopisi.

Evaluation of upper gastrointestinal system endoscopy screening in patients with acromegaly: a single center experience

Abstract

Purpose: The prevalence of precancerous or cancerous lesions in the upper gastrointestinal tract in acromegalic patients is not well known. The aim of this study is to evaluate the endoscopic findings of the upper gastrointestinal system (GIS) of patients with acromegaly and to assess whether the pathological findings are related to the disease and the use of somatostatin analogs.
Materials and Methods: Between January 2010 and October 2021, patients diagnosed with acromegaly were identified by retrospective medical record scanning. This study included 49 patients with acromegaly who underwent upper GIS endoscopy. The acromegaly patients were divided into two groups: those who were taking somatostatin analogs at the time of endoscopy and those who were not. It was investigated whether there was a difference between these two groups in terms of lesion development. The patients with acromegaly and the control group were compared in terms of endoscopic findings and biopsy results.
Results: Of these patients, 53% (n=26) were male and 46.9% (n=23) were female. The incidence of Helicobacter pylori (HP) was significantly higher in the acromegaly patients than in the control subjects. In the acromegaly group, 62.5% (n=15) of the 24 patients with antral and pangastritis were taking somatostatin analogs. There was no significant difference between the use of somatostatin analogs and the development of gastritis. The development of esophagitis was statistically higher in patients with acromegaly taking somatostatin analogs.
Conclusion: The incidence of HP was higher in patients with acromegaly than in the normal population. No clear results were found regarding the development of gastritis. The incidence of esophagitis was high in acromegalic patients taking somatostatin analogs. Large-scale studies are needed to uncover the relationship between the etiology of the disease and the drugs taken.

Keywords

Acromegaly, Esophagitis, Somatostatin analogs, Upper Gastrointestinal System Endoscopy.

References

• Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf). 2010;72:377-82.
• Molitch ME. Clinical manifestations of acromegaly. Endocrinol Metab Clin North Am. 1992;21:597-614.
• Pivonello R, Auriemma RS, Grasso LF, Pivonello C, Simeoli C, Patalano R et al. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities. Pituitary. 2017;20:46-62.
• Bogazzi F, Cosci C, Sardella C, Costa A, Manetti L, Gasperi M et al. Identification of acromegalicpatients at risk of developing colonic adenomas. J Clin Endocrinol Metab. 2006;91:1351-6.
• Ron E, Gridley G, Hrubec Z, Page W, Arora S, Fraumeni JF Jr. Acromegaly and gastrointestinal cancer. Cancer. 1991;68:1673-7.
• J. Dal, M.Z. Leisner, K. Hermansen, D.K. Farkas, M. Bengtsen, C. Kistorp et al. Cancer incidence in patients with acromegaly: a cohort study and meta-analysis of the literature. J Clin Endocrinol. Metab. 2018;103:2182–8.
• Gomes-Porras M, Cárdenas-Salas J, Álvarez-Escolá C. Somatostatin analogs in clinical practice: a review. Int J Mol Sci. 2020;21:1682.
• Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A et al. Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99:3933-51.
• Hasegawa H, Onda M, Matsukura N, Naito Z, Maruyama H, Tokunaga A. Hemorrhagic gastric arcinoma in an acromegalic patient. J Nippon Med Sch. 2001;68:266–70.
• Dixon MF, Genta RM, Yardley JH, Correa P, Batts KP, Dahms BB et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol.1996;20:1161–81.
• Graham DY. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer. World J Gastroenterol. 2014;14;20:5191-204.
• Borch K, Jõnsson KÅ, Petersson F, Redéen S, Mårdh S, Franzén LE. Prevalence of gastroduodenitis and Helicobacter pylori infection in a general population sample: relations to symptomatology and life-style. Dig Dis Sci. 2000;45:1322–9.
• Lamberts SWJ, van der Lely A-J, de Herder WW, Hofland LJ. Octreotide. N Engl J Med .1996;334:246–54.
• Gheorghiu ML, Negreanu F, Fleseriu M. Updates in the medical treatment of pituitary adenomas. Horm Metab Res.2020;52:8–24.
• Plöckinger U, Dienemann D, Quabbe HJ. Gastrointestinal side-effects of octreotide during long-term treatment of acromegaly. J Clin Endocrinol Metab. 1990;71:1658–62.
• Chey WD, Wong BCY. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808–25.
• Ladas SD, Thalassinos NC, Ioannides G, Raptis SA. Does acromegaly really predispose to an increased prevalence of gastrointestinal tumours? Clin Endocrinol (Oxf). 1994;41:597–601.
• Sgouros SN, Bergele C, Viazis N, Avgerinos A. Somatostatin and its analogues in peptic ulcer bleeding: facts and pathophysiological aspects. Dig Liver Dis. 2006;38:143–8.
• Sahin S, Icli TB, Durcan E, Sulu C, Ozkaya HM, Hatemi AI et al. The effect of somatostatin analogs and acromegaly on the upper gastrointestinal system. Pituitary. 2021;24:184–91.
• Jones SL, Patchett S, Anderson J V, Farthing MJG, Besser GM, Wass JAH. Prevalence of Helicobacterpylori in acromegalic patients during treatment with octreotide. Clin Endocrinol (Oxf) .1995;43:683–7.
• Altayar O, Davitkov P, Shah SC, Gawron AJ, Morgan DR, Turner K et al. AGA technical review on gastric intestinal metaplasia— epidemiology and risk factors. Gastroenterology. 2020;158: 732–744.
• Sisman P, Pekgoz M, Bayrakci I, Sisman M, Cander S, Gul OO et al. Evaluation of upper gastrointestinal system in acromegaly. Ann Endocrinol (Paris). 2019;80:196–201.
• Jawiarczyk-Przybyłowska A, Wojtczak B, Whitworth J, Sutkowski K, Bidlingmaier M, Korbonits M et al. Acromegaly associated with GIST, non-small cell lung carcinoma, clear cell renal carcinoma, multiple myeloma, medulla oblongata tumour, adrenal adenoma, and follicular thyroid nodules. Endokrynol Pol. 2019;70:213-217.
• Asai K, Shimoyama S, Sanno N, Kaminishi M, Oohara T. A rare case of gastric cancer in an acromegalic patient. J Gastroenterol. 1997 Aug;32:528-32.
• Dunbar KB, Agoston AT, Odze RD, Huo X, Pham TH, Cipher DJ et al. Association of acute gastroesophageal reflux disease with esophageal histologic changes. JAMA. 2016;315:2104-12.