Mikroskopik kolit ve diyare baskın irritabl barsak sendromu tanısı almış hastaların klinik ve laboratuvar olarak karşılaştırılması

Yıl 2022, Cilt: 21 Sayı: 2, 89 - 96, 25.08.2022

Atilla Bulur 2. uğuray Payam Hacısalihoğlu

Öz

Giriş ve Amaç: Mikroskopik kolit ve diyare baskın irritabl barsak sendromlu hastalarda başta sulu diyare ve karın ağrısı olmak üzere benzer semptomlar görülür. Mikroskopik kolitin toplumda sıklığı göreceli olarak azdır ve kesin tanı kolonoskopik incelemeyle alınan biyopsilerin histopatolojik değerlendirilmesi ile konur. Muhtemelen bir kısım mikroskopik kolit hastası kolonoskopi yapılmadığı ve semptom örtüşmeleri nedeniyle diyare baskın irritabl barsak sendromu tanısı ile takip edilmektedir. Bu çalışmada histopatolojik olarak mikroskopik kolit ve diyare baskın irritabl barsak sendromu tanısı almış hastalarımızı klinik ve laboratuvar olarak karşılaştırmayı ve iki grup arasında benzer ve ayrışan yönleri araştırmayı amaçladık. Gereç ve Yöntem: Çalışmamıza Eylül 2016 ile Şubat 2022 tarihleri arasında gastroenteroloji kliniğimizde takip edilen 41 mikroskopik kolit ve 41 diyare baskın irritabl barsak sendromlu hasta dahil edildi. Her iki grup hastaya da kolonoskopik inceleme yapılmış, biyopsiler alınmış ve histopatolojik değerlendirme yapılmıştı. Bu iki grubun klinik, laboratuvar, kolonoskopik ve histopatolojik verileri retrospektif olarak incelenerek karşılaştırıldı. Bulgular: Çalışmaya alınan her iki grup hastanın demografik verileri benzerdi (yaş ortalamaları; mikroskopik kolit: 50.96 yıl, diyare baskın irritabl barsak sendromu: 51.45 yıl, kadın/erkek oranları her iki grup için: 1.56). Merkezimizin mikroskopik kolit prevalansı her 100 hastada 1.67 idi. Mikroskopik kolit hastalarının %41.46’sı diyare baskın irritabl barsak sendromu için Roma IV kriterlerini karşılamaktaydı. Mikroskopik kolit hastalarında; kronik ishal %78.05, kilo kaybı %19.51, B12 vitamini eksikliği %12.20, çölyak hastalığı birlikteliği %4.88, karın ağrısı %41.46 oranında izlenirken, bu oranlar diyare baskın irritabl barsak sendromlu hastalarda sırası ile %43.90, %9.76, %0.00 ve %78.05 olarak saptandı. Sonuç: Mikroskopik kolit hastalığı toplumda sanıldığından daha sık görülmektedir. Ancak birçok mikroskopik kolit hastasının semptomların benzerliği nedeniyle diyare baskın irritabl barsak sendromu tanısı ile takip edildiği düşünülmektedir. Çalışmamızda kronik sulu diyare, kilo kaybı, B12 vitamin eksikliği ve çölyak hastalığı birlikteliğinin mikroskopik kolit hastalarımızda; karın ağrısının ise diyare baskın irritabl barsak sendromu hastalarımızda daha sık olduğunu saptadık. Bu sayılan semptom ve bulgularla karşılaşıldığında mikroskopik kolit tanısı akla gelmelidir ve bu hastalara kolonoskopik inceleme yapılmalıdır.

Anahtar Kelimeler

Mikroskopik kolit, diyare baskın irritabl bağırsak sendromu, semptom, örtüşme, kolonoskopi

Clinical and laboratory comparison of patients diagnosed with microscopic colitis and diarrhea-predominant irritable bowel syndrome

Öz

Background and Aims: Patients with microscopic colitis and diarrhea-predominant irritable bowel syndrome have similar symptoms, primarily watery diarrhea and abdominal pain are observed in patients with microscopic colitis and diarrhea-predominant irritable bowel syndrome. Probably some microscopic colitis patients are followed up with the diagnosis of diarrhea-predominant irritable bowel syndrome because colonoscopy is not performed and symptoms overlap. In this study, we aimed to compare our patients with histopathological diagnosis of microscopic colitis and diarrhea-predominant irritable bowel syndrome patients clinically and laboratoryly, and to investigate the similarities and differences between the two groups. Materials and Methods: 41 microscopic colitis and 41 diarrhea-predominant irritable bowel syndrome patients followed up in our gastroenterology clinic between september 2016 and february 2022 were included in our study. Colonoscopy was performed, biopsies were taken, and histopathological examination was performed in both groups of patients. The clinical, laboratory, colonoscopic and histopathological data of these two groups were analyzed retrospectively and compared. Results: Demographic data of both groups of patients included in the study were similar (mean age: microscopic colitis: 50.96 years, diarrhea-predominant irritable bowel syndrome: 51.45 years, female/male ratios for both groups: 1.56). The prevalence of microscopic colitis in our center was 1.67 per 100 patients. 41.46% of microscopic colitis patients met the Rome IV criteria for diarrhea-predominant irritable bowel syndrome. While chronic diarrhea prevalance was 78,05%, weight loss: 19.51%, vitamin B12 deficiency: 12.20%, coexistence with Celiac disease: 4.88%, abdominal pain: 41.46% in microscopic colitis patients; these rates were found to be 43,90%, 9.76%, 0.00% and 78.05%, respectively in diarrhea-predominant irritable bowel syndrome patients. Conclusion: microscopic colitis is encountered more frequently than it is thought, in the population. Many microscopic colitis patients are followed up with the diagnosis of diarrhea-predominant irritable bowel syndrome due to the similarity of symptoms. In our study, we determined that the association of chronic watery diarrhea, weight loss, vitamin B12 deficiency and Celiac disease was more common in patients with microscopic colitis whereas abdominal pain was more common in patients with
diarrhea-predominant irritable bowel syndrome. When these symptoms and signs are encountered in patients, the diagnosis of microscopic colitis should be considered and colonoscopic examination should be performed.

Anahtar Kelimeler

Microscopic colitis, diarrhea-predominant irritable bowel syndrome, symptom, overlap, colonoscopy

Kaynakça

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