Aile Hekimliği Polikliniği’ne Başvuran Hastalarda İrritabl Barsak Sendromu Sıklığı ve Bu Hastaların Sosyodemografik, Klinik ve Yaşam Tarzı Özellikleri

Öz

Amaç: İrritabl Barsak Sendromu (İBS) genel populasyonun %20’sinden fazlasını etkileyen genellikle 40

yaşından sonra görülen kronik bir hastalıktır. Bu çalışma Aile Hekimliği polikliniğine başvuran

hastalarda İBS sıklığı ve bu hastalarda sosyodemografik, klinik ve yaşam tarzı özelliklerini ve yeme

alışkanlıklarını değerlendirmek amacıyla yapılmıştır.

Materyal ve Metot: Çalışmaya Aile Hekimliği Polikliniği’ne herhangi bir nedenle başvuran bireyler

arasından rastgele seçilen, anketi cevaplamayı kabul eden 115 kişi dâhil edildi. Ankette sosyodemografik

özellikler, beslenme ve barsak alışkanlıkları, kronik hastalıklar, eşlik edebilecek semptomlar ve Roma

III kriterleri sorgulandı. Verilerin analizinde SPSS 16.00 programında Ki‐kare ve frekans kullanılarak,

p<0.05 anlamlı kabul edildi.

Bulgular: Çalışmaya alınan 115 kişinin yaş ortalaması 38,23±15,33 (min=14, maks=82) olup 74’ü (%64,34)

kadın, 41’i (%35,66) erkekti. Roma III kriterlerine göre 115 kişinin 28’inde (%24,34) İBS olduğu saptandı.

İBS pozitif hastaların en sık şikâyeti (%71,42; n=20) kabızlık, en sık başvuru nedenleri sosyal yaşamı

etkileme (%21,42; n=6) ve stresti (%17,85; n=5). İBS şikâyetleri nedeniyle en sık aile hekimliği ve dâhiliye

polikliniklerine başvuruluyordu. En sık yapılan tetkikler ise “Ayakta Direkt Batın Grafisi (ADBG)” ve

“gastrointestinal sistem endoskopisi” idi. Roma III kriterleri ile İBS tanısı alan hastalara en sık baş

ağrısının eşlik ettiği ve bunun da sıklıkla gerilim tipi baş ağrısı ile uyumlu olduğu gözlendi. Roma III

kriteri pozitif olanların kabızlık semptomu ile ilişkisi anlamlı bulunmuştur (p<0,001). Roma III kriteri

pozitif olanların ishal semptomu ile ilişkisi yine anlamlı bulundu (p=0,020). Roma III kriterleri arasında

en az rastlanılan semptom mukuslu gaitaydı (%14,28; n=4). İBS hastalarının sadece %7,14’sinin (n=2)

tedavi için ilaç kullandığı belirlendi.

Sonuç: İBS toplumumuzda yaklaşık her dört kişiden birini etkileyen ve günlük yaşam kalitesini bozan

bir rahatsızlıktır. Tüm hekimlerin, özellikle de birinci basamak hekimlerinin, İBS’nin tanı kriterlerini

dikkatli sorgulaması, doğru tedavi için hastalarını yönlendirmeleri ve takip etmeleri büyük önem

taşımaktadır

Anahtar Kelimeler

• İrritabl Barsak Sendromu,Roma III Kriterleri,yaşam tarzı,aile hekimliği

Irritable Bowel Syndrome Prevalence and Sociodemographic, Clinical and Lifestyle Features of Patients Admitted to Family Medicine Policlinic

Abstract

Abstract

Objectives: Irritable bowel syndrome (IBS) is a chronic disease that affect more than 20% of general population and mostly seen after 40 years old. In this study, it was aimed to investigate IBS prevalence in people applied to Family Medicine Policlinics, and their socio-demographic, clinical and lifestyle features.
Materials and Methods: This study was performed to 115 patients who accepted to answer the questionnaire and selected randomly among people who applied to Medicine Policlinic for any reason. The questionnaire consisted of socio-demographic data, dietary and bowel habits,chronic diseases,concomitant symptoms and Rome III criteria. The data was analyzed by SPSS 16.00 program, using Chi-Square and p<0,005 was accepted statistically significant.

Results: Mean age of 115 participants was 38.23±15.33 (min: 14, max: 82) and 74 of them were women (64.34%), 41 were men (35.66%). IBS was determined in 28 of (24.34%) participants, according to Rome III criteria. Most common problem of IBS positive patients’ was constipation (71.42%; n=20), most common reason to come hospital was the IBS’s effect on social life (%21.42; n=6) and stress (17.85%; n=5). They mostly applied to Family Medicine and Internal Medicine policlinics. Also the most common tests were abdominal x-ray and gastrointestinal endoscopy. In IBS patients, who diagnosed via Rome III criteria, frequently had tension-type headache.Relation of constipation symptoms to those with positive Rome III criteria was significant (p<0,001). Relation of diarrhea symptoms to those with positive Rome III criteria was significant again (p=0,020). Mucoid feces was the least common (14.28%; n=4) symptom among Rome III criteria positive patients. It has been determined that just 7.14% (n=2) of IBS patients take medicine for the treatment.

Conclusion: IBS is a disease that affects nearly one of four people in our population and worsen the life quality. It is very important to pay attention to query the diagnostic criteria of IBS, to motive the patients for the right treatment and to follow up them for all the physicians, especially who work in primary care.

Keywords

• Irritable Bowel Syndrome,Rome III Criteria,lifestyle,family medicine

Kaynakça

1. 1. Olden KW. Diagnosis of irritable bowel syndrome. Gastroenterology 2002;122:1701-14.
2. 2. Drosman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review of irritable bowel syndrome. Gastroenterology 2002;123:2108-31.
3. 3. Özden A, Köksal AŞ, Oğuz D. ve ark. Türkiye’de Birinci Basamak Sağlık Kurumlarında İrritabl Barsak Sendromu Görülme Sıklığı. Akademik Gastroenteroloji Dergisi 2006;5(1):4-15.
4. 4. Drossman DA, Whitehead WE, Camilleri M. American Gastroenterological Association Patient Care Committee. Irritable bowel syndrome: A technical review for practice guideline development. Gastroenterology 1997;112:2120-37.
5. 5. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology 1990;99:409-15.
6. 6. Çelebi S, Demirdağ K, Özden M, Yalnız M, Bahçecioğlu İH,Demir A. Gastroenterit sonrası irritabl barsak sendromu sıklığı ve risk faktörleri. Akademik Gastroenteroloji Dergisi 2003;2(2):54-9.
7. 7. Manning AP, Thompson WG, Heaton KW, et al. Towards positive diagnosis of irritable bowel. BMJ; 1978:653-4.
8. 8. Drossman DA, Li Z, Andruzzi E, et al. US householder survey of functional gastrointestinal disorders. Prevalance, sociodemography, and health impact. Dig Dis Sci 1993;38:1569-80.

9. 9. Merain F, Badia X, Balboa A, et al. Irritable bowel syndrome prevalance varies enormously depending on the employed diagnostic criteria: comparison of Rome II versus previous criteria in a general population. Scand J Gastroenterol 2001;36:1155-61.
10. 10. Gwee KA, Wee S, Wong ML, et al. The prevalance, symptom characteristics, and impact of irritable bowel syndrome in an Asian urban community. Am J Gastroenterol 2004;99:924-31.
11. 11. Ho KY, Kang JY, Seow A. Prevalance of gastrointestinal symptoms in a multi-racial Asian population with particular reference to reflux-type symptoms. Am J Gastroenterol 1998;93:1816-22.
12. 12. Çelebi S, Açık Y, Deveci SE, et al. Epidemiological features of irritable bowel syndrome in a Turkish urban society. J Gastroenterol Hepatol 2004;19:738-43.
13. 13. Yılmaz Ş, Dursun M, Ertem M, et al. The epidemiological aspects of irritable bowel syndrome in Southeastern Anatolia: a stratified randomised community-based study. Int J Clin Pract 2005;59: 361-9.
14. 14. Drossman DA, Creed FH, Olden KW et al. Psychosocial aspects of the functional gastrointestinal disorders. Gut 1999;45:25-30.
15. 15. Kruszewska K, Lan J, Lorca G et al. Selection of lactic acid bacteria as probiotic strains by in vitro tests. Microecology and Therapy 2002;29:37-51.
16. 16. İlkgül Ö, Modern tıpta prebiyotikler ve probiyotikler. Ulusal Cerrahi Dergisi 2005;21(1):47-9.
17. 17. Finegold SM, Sutter VL, Mathisen GE. Normal indigenous intestinal flora. In H entges DJ (ed). Human intestinal microflora in health and disease, London: Academic Press; 1983:3-31.
18. 18. Karabayraktar T, Ahıshalı E, Dolapçıoğlu C. ve ark. Obezite ve İrritabl Bağırsak Sendromu. J Kartal TR 2014;25(2):127-32.
19. 19. Chang FY, Lu CL, Chen TS. The current prevalence of irritable bowel syndrome in Asia. J Neurogastroenterol Motil 2010;16:389-400.
20. 20. Okami Y, Kato T, Nin G. et al. Lifestyle and psychological factors related to irritable bowel syndrome in nursing and medical school students. J Gastroenterol 2011;46:1403-10.
21. 21. Thompson WG, Heaton KW, Smyth GT, et al. Irritable bowel syndrome in general practice: prevalance, characteristics, and referral. Gut 2000;46:78-82.
22. 22. Dainese R, Galliani EA, De Lazzari F, et al. Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients. Am J Gastroenterol 1999;94:1892-7.
23. 23. van der Horst HE, van Dulman AM, Schellevis FG, et al. Do patients with irritable bowel syndrome in primary care differ from outpatients with irritable bowel syndrome? Gut 1997;41:669-74.
24. 24. Koloski NA, Tally NJ, Boyce PM. Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: a critical review of the literature on symptom and psychosocial factors. Am J Gastroenterol 2001;96:1340-9.
25. 25. Talley NJ, Zinsmeister AR, Melton LJ. Irritable bowel syndrome in a community: symptom subgroups, risk factors and health care utilization. Am J Epidemiol 1995;142:76-83.
26. 26. Talley NJ, Boyce PM, Jones M. Predictors of health care seeking for irritable bowel syndrome: a population-based study. Gut 1997;41:394-8.
27. 27. Hungin APS, Chang L, Locke GR, et al. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther 2005;21:1365-75.
28. 28. Akyüz F. İrritabl Barsak Sendromu. Güncel Gastroenteroloji Dergisi 2016;20(4):415-20.
29. 29. Mendall MA, Kumar D. Antibiotic use, childhood affluence and irritable bowel syndrome. Eur J Gastroenterol Hepatol 1998;10:59-62.
30. 30. Howell S, Talley NJ, Quine S, et al. The irritable bowel syndrome has origins in the childhood socioeconomic environment. Am J Gastroenterol 2004;99:1572-8.
31. 31. Ünal HÜ. İrritabl Barsak Sendromu. Güncel Gastroenteroloji Dergisi 2012;16(3):213-7.
32. 32. Coşkun T. Pro-Pre ve Sinbiyotikler. Çocuk Sağlığı ve Hastalıkları Dergisi 2006;49:128-48.
33. 33. Whelan K. Mechanism and effectiveness of prebiotics in modifying the gastrointestinal microbiota for the management of digestive disorders. ProctNutrSoc 2013;72:288-98.
34. 34. Özdemir M, Perktaş G. İrritabl Barsak Sendromunda Diyet. Güncel Gastroenteroloji Dergisi 2016;20(3):274-9.
35. 35. Gürsoy O, Kınık Ö, Gönen İ. Probiyotikler ve Gastrointestinal Sağlığa Etkileri. Türk Mikrobiyoloji Cemiyeti Dergisi. 2005;35:136-48.
36. 36. Soares RL. Irritable bowel syndrome: a clinical review. World J Gastroenterology 2014;20:12144-60.
37. 37. Can G, Yılmaz B. İrritabl Barsak Sendromunun Tanı ve Tedavisinde Yaklaşımlar. Güncel Gastroenteroloji Dergisi 2015;16(3):171-81.
38. 38. Hong-Yan Q, Chung-Wah C, Xu-Dong T, Zhao-Xiang B. Impact of psychological stress on irritable bowel syndrome. World Journal of Gastroenterology. 2014;20(39):14126–31.
39. 39. Anamaria Cozma-P, Felicia L, Doina M, Dan Lucian D. Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients! World Journal of Gastroenterology. 2017;23(21):3771-83.
40. 40. Kewin T. H. Siah, Reuben K. Wong, William E. Whitehead. Chronic Constipation and Constipation Predominant IBS: Separate and Distinct Disorders or a Spectrum of Disease? Gastroenterology & Hepatology. 2016;12(3):171-8.
41. 41. Kızılaslan N, Solak İ. Yoğurt ve İnsan Sağlığı Üzerine Etkileri. Gaziosmanpaşa Bilimsel Araştırma Dergisi 2016;(12):52-9.