KRONİK İSHAL NEDENİYLE BAŞVURAN HASTALARDA ENDOSKOPİ VE ENDOSKOPİK BİYOPSİ SONUÇLARININ DEĞERLENDİRİLMESİ

Abstract

Çalışmamızda kronik ishal etyolojisini belirlemede üst gastrointestinal sistemin endoskopik görüntüleme bulgularını ve duodenum mukozasından alınan biyopsi materyallerinin histopatolojik sonuçlarını değerlendirmeyi amaçladık. Kliniğimizde kronik ishal nedeni ile üst gastrointestinal sistem endoskopisi yapılan 45 hasta çalışmaya alındı. Çalışmaya alınan tüm hastaların laboratuar parametreleri, endoskopik inceleme ve patoloji sonuçları hastane elektronik veritabanından geriye dönük tarama ile elde edildi. Çalışmaya alınan 45 hastanın 25’i (%55,6) erkek ve 20’si (%44,4) kadın olup yaş ortalaması 37,5 ±16,1 yıl (18-68) idi. Duodenal biyopsilerin histopatolojik değerlendirilmesinde 34 hastada (%75,6) duodenit (non spesifik duodenitten kronik duodenite kadar değişen) ve 8 hastada (% 17,8) Giardia tespit edildi. Üç hastada (%6,7) normal histopatolojik bulgular saptandı. Ülkemiz gibi paraziter enfeksiyonların sık rastlanıldığı bölgelerde gaita direk incelemesinde parazit saptanamayan kronik ishalli hastalara üst gastrointestinal sistem endoskopisi yapılması, duodenumun endoskopik görünümü normal olsa bile histopatolojik değerlendirmesi G. Lamblia enfeksiyonunun saptanmasında yararlı olacaktır. Dr. Atilla AYBAR Dr. Tuncer KILIÇ Dr. Ünal KILIÇ Dr. Aydan KILIÇARSLAN Dr. Fatma Ebru AKIN Dr. Reyhan ERSOY Dr. Osman ERSOY Dr. Bekir ÇAKIR

Keywords

• Kronik ishal
• endoskopi
• histopatoloji

AN EVALUATION OF ENDOSCOPIC FINDINGS AND ENDOSCOPIC BIOPSY RESULTS OF THE PATIENTS WITH CHRONIC DIARRHEA

Abstract

In our study, we aimed to evaluate the endoscopic imaging findings of upper gastrointestinal tract to determine the etiology of chronic diarrhea and the histopathological results of biopsy materials conducted on the duodenal mucosa. Forty five patients of our clinic who underwent upper gastrointestinal tract endoscopy due to chronic diarrhea were included in the study. The data about laboratory parameters, endoscopic examination and pathology reports were obtained from the electronic databases of our hospital, retrospectively. Twenty five (55.6 %) of the patients were male and twenty of them were female; as the mean age of all was 37,5 ± 16,1 years (18-68). Histopathological examination demonstrated duodenitis (varying from nonspecific to chronic) in 34 (75.6 %) patients and Giardiazis in 8 (17.8 %) patients. There were no abnormal histopathologic findings in 3 (6.7 %) patients. Through such regions like our country parasitic infections are so common, it would be useful to perform upper gastrointestinal tract endoscopy to patients who have chronic diarrhea even if no parasites were detected by direct microscopy of the faeces and carry out histopathological examination although the duodenum seems to be normal endoscopically in order to identify G. Lamblia infections.

Keywords

• Chronic diarrhea
• endoscopy
• histopathology

References

1. 1. Schiller LR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am. 2009; 38(3):481-502.
2. 2. Talley NJ, O’Keefe EA, Zinsmeister AR, et al. Prevalence of gastrointestinal symptoms in the elderly: a population-based study. Gastroenterology 1992;102:895-901.
3. 3. Talley NJ, Weaver AL, Zinsmeister AR, et al. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol 1992; 136:165-77.
4. 4. Zollinger RM, Ellison EH. Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas. Ann Surg 1955; 142: 700-28.
5. 5. Akhrass, R, Yaffe, MB, Fischer, C, et al. Small-bowel diverticulosis: Perceptions and reality. J Am Coll Surg 1997; 184: 383.
6. 6. Afridi, SA, Fichtenbaum, CJ, Taubin, H. Review of d uodenal diverticula. Am J Gastroenterol 1991; 86: 935.
7. 7. Leivonen, MK, Halttunen, JA, Kivilaakso, EO. Duodenal diverticulum at endoscopic retrograde cholangiopancreatography analysis of 123 patients. Hepatogastroenterology 1996; 43: 961. KAYNAKLAR
8. 8. Türkiyede Sık Rastlanan Barsak Parazitozları: AN KEM Derg 2006; 20 (Ek 2): 165-181.

9. 9. Wahnschaffe U, Ignatius R, Loddenkemper C, Liesenfeld O, Muehlen M, Jelinek T, et al. Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas. Scandinavian Journal of Gastroenterology, 2007; 42:391-6.
10. 10. Demirçeken FG, Soykan I, Kuloğlu Z, Çetin-kaya H, özden A. Dispepsili hastalarda Gi-ardiazis sıklığı: Akademik Gastroenteroloji Dergisi, 2007; 6 (3): 132-6.
11. 11. Yakoob J, Jafri W, Abid S, et al. Giardiasis in patients with dyspeptic symptoms. World J Gastroenterol 2005; 11: 6667-70.
12. 12. Goka AKJ, Rolston DDK, Mathan VI, et al. The relative merits of faecal and duodenal juice microscopy in the diagnosis of giardiasis. Trans R Soc Trop Med Hyg 1990; 84: 66-7.
13. 13. Hopper AD, Cross SS, McAlindon ME, et al. Symptomatic giardiasis without diarrhea: further evidence to support the routine duodenal biopsy? Gastrointest Endosc 2003; 58: 120-2.
14. 14. Taylan Aö, Mungan M, KılıçS, et al. Giardiasis tanısında Giardia/Cryptosporidium DFA yönteminin kullanımı. IV. Ulusal Sindirim Yolu İle Bulaşan Infeksiyonlar Sempozyumu Kitabı, 16-20 Mayıs 2005, Mersin, Türkiye; 344.
15. 15. Gupta SK, Croffie JM, Pfefferkom MD, et al. Diagnostic yield of duodenal aspirate for G. lamblia and comparison to duodenal mucosal biopsies. Dig Dis Sci 2003; 48: 605-7.
16. 16 Wahnschaffe U, Ignatus R, Loddenkemper C, et al. Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas. Scand J Gastroenterol 2007; 42: 391-6.
17. 17. Giboda M, Hildebrand T. Detection of giardia intestinalis in duodenal aspirates and in the stool. (Abstract) Folia Parasitol 1983; 30:181-3.
18. 18. Caeiro, JP, Mathewson, JJ, Smith, MA, et al. Etiology of outpatient pediatric nondysenter-ic diarrhea: A multicenter study in the United States. Pediatr Infect Dis J 1999; 18:94-7.
19. 19. Alonso Cotoner C, Casellas Jordâ F, Chicharro Serrano ML, de Torres Ramirez I, Mal-agelada Benapres JR. Iron deficiency: not always blood losses. An Med Interna. 2003 May;20(5):227-31.