İRRİTABLE BARSAK SENDROMLU HASTALARDA QT DİSPERSİYONUNUN DEĞERLENDİRLMESİ

Öz

Amaç: Ortak embiriyolojik bağları nedeniyle irritable barsak sendromu (İBS) olan hastalarda kardiyak etkilenmeyi değerlendirmek ve QT, QTc, QTd, QTcd ile ilişkili intervalde olan değişiklikleri araştırmak.

Metod: Çalışma prospektif olarak çalışıldı. Çalışmaya 01.01.2016-31.12.2018 yılları arasında irritable barsak sendrom tanısı almış 96 hasta dahil edildi. Ayrıca 100 sağlıklı gönüllü ile bir kontrol grubu oluşturuldu. Acil servisimize bu hastalar davet edilerek elektrokardiyogramları çekildi. Hastalarda ve gönüllülerde düzeltilmiş QT süreleri ve QT dispersiyonları Bazzet formülü kullanılarak hesaplandı.

Bulgular: Çalışmaya katılan irritable barsak sendromu tanısı olan gönüllü erkeklerin yaş ortalaması 47,9 ve kadınların ise 40,2 idi. Sağlıklı gönüllülerde kadınların yaş ortalaması 40.7, erkeklerin ise 43.6 idi. Hastaların yaş ortalaması da QT ve QTc’de her hangi bir uzama görülmezken, QTd ve QTcd değerlerinde sağlıklı gönüllülere kıyasla uzama olduğu görüldü.

Sonuç: Sağlıklı gönüllüler ile irritable barsak sendromu tanısı olan hastalar arasında QT ve QTC intervalinde uzama anlamlı olmamasına rağmen QTd ve QTcd anlamlı derecede uzama olduğu görüldü.

Tartışma: Bizim çalışmamız bu hastaların düzeltilmiş QTd ve QTcd dispersiyonları olduğunu gösterdi. Bu sebeple irritable barsak sendromu olan hastalar için acil servislerde kullanılacak veya reçete edilecek ilaçların dikkatli seçilmesi gerekliliğini ortaya koyduk.

Anahtar Kelimeler

• İrritable barsak sendromu,QT dispersiyonu,acil servis,akılcı ilaç kullanımı

EVALUATION OF QT DISPERSION WITH IRRITABLE BOWEL SYNDROME PATIENTS;

Öz

ABSTRACT;

Objectives; Because of common origin in the embryonic development in patients with Irrıtable bowel syndrome(IBS), evaluation of cardiac affects and changes of associated with QT,QTc,QTd and QTcd intervals.

Materials and methods: This study worked as prospectively. 100 patients included to this study who had diagnosed IBS in 2016-2018. Also control group has formed with 100 healty volunteer. These patients was invited to our emergency room for taking their electrocardiograms.Corrected QT intervals and QT dispersion calculated with Bazzet Formula in both IBS patients and volunteers.

Results: 86 IBS patients and 92 healty volunteers included in our study.Average age was 47.9 in men and 40.2 in women.Average age in healty volunteers 40.7,43.6 was in men.Theres no extension in QT and QTc intervals in average age in patients;but there is more extension in QTd and QTcd intervals with IBS patients than healty volunteers.

Conclusion: Although the extension in the QT and QTc intervals between healty volunteers and patients with IBS patients is not significant ; QTd anf QTcd were significantly prolonged.

Dicussıon: Our study showed  that these patients had corrected QTd and QTcd dispersions.Just because of this choosing right medical drugs was important for IBS patients.

Anahtar Kelimeler

• irritable bowel syndrome,QT dispersions,emergency room,rational drug choice

Kaynakça

1. 1. 2015 ESC Guidelinesforthemanagement of patientswithventriculararrhythmiasandtheprevention of suddencardiacdeath: TheTask Force forthe Management of PatientswithVentricularArrhythmiasandthePrevention of SuddenCardiacDeath of theEuropeanSociety of Cardiology (ESC) Endorsedby: AssociationforEuropeanPaediatricandCongenitalCardiology (AEPC) Silvia G Priori CarinaBlomström-Lundqvist AndreaMazzanti NicoBlomMartinBorggrefe John Camm Perry Mark Elliott DonnaFitzsimons Robert HatalaGerhardHindricks.EuropeanHeartJournal, Volume 36, Issue 41, 1 November 2015, Pages 2793–2867,https://doi.org/10.1093/eurheartj/ehv316Published:29 August 2015.
2. 2. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patientswithlong QT intervals. BrHeart J 1990; 63: 342-344 [PMID: 2375895 DOI: 10.1136/hrt.63.6.342]
3. 3. Beyazit Y, Sain-Güven G, İskit AB. Uzun QT sendromu. Hacettepe Tıp Dergisi 2005; 36(1):43-48.4
4. 4. Witchel HJ, Hancox JC. Familialandacquiredlong QT syndromeandthecardiacrapiddelayedrectifierpotassiumcurrent. ClinExpPharmacol P 2000; 27: 753-766.
5. 5. Bednar MM, Harrigan EP, Anziano RJ, Camm AJ, Ruskin JN. The QT interval. ProgCardiovascDis 2001; 43: 11-45.
6. 6. Pope CE II. IrritableBowelSyndrome, In: Sleisenger MH, Fordtran JS, Eds. GastrointestinalandLiverDiseasese, pathophysiology, diagnosis, management. Volume 2. IrritableBowelSyndrome, 9rd ed. Philadelphia. Saunders 2010; 2091-104.
7. 7. Furness, John Barton (15 April 2008). TheEntericNervousSystem. John Wiley&Sons. pp. 35–38. ISBN 978-1-4051-7344-5.
8. 8. Rome III DiagnosticCriteriaforFunctionalGastrointestinalDisorders. Accessed 8/10/16 at: http://www.romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf.

9. 9. Rome IV diagnosticcriteriaforfunctional GI disordersreleased at DDW. June 23, 2016. Accessed 8/11/16 at: http://bit.ly/28QsQMu.
10. 10. Bazett HC. An analysis of the time relations of electrocardiogram. Heart 1920; 7: 53-70.
11. 11. Rautaharju PM, Surawicz B, Gettes LS, et al. AHA/ACCF/HRS recommendationsforthestandardizationandinterpretation of theelectrocardiogram: part IV: the ST segment, T and U waves, andthe QT interval: a scientificstatementfromtheAmericanHeartAssociationElectrocardiographyandArrhythmiasCommittee, Council on ClinicalCardiology; theAmericanCollege of CardiologyFoundation;andtheHeartRhythmSociety. Endorsedbythe International SocietyforComputerizedElectrocardiology. J AmCollCardio 2009; 53: 982-91
12. 12. Malik M, Batchvarov VN. Measurement, interpretationandclinicalpotential of QT dispersion. J AmCollCardiol 2000; 36:1749.
13. 13. Lee KW, Kligfield P, Okin PM, Dower GE. Determinants of precordial QT dispersion in normal subjects. J Electro¬cardiol 1998;31:54-9. http://dx.doi.org/10.1016/S1607-551X(09)70401-2 http://dx.doi.org/10.1016/S0022-0736(98)90305-3
14. 14. Hohnloser SH. Effect of coronary ischemia on QT disper¬sion: J Electrocardiol 1999;32:199-206. http://dx.doi.org/10.1016/S0022-0736(99)90102-4
15. 15. Van de Loo A, Arents PCWP, Hohnloser SH. Variability of QT dispersion measurements in the surface electrocardi¬ogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol 1994;74:1113-18. http://dx.doi.org/10.1016/0002-9149(94)90462-6
16. 16. Doven O, Ozdol C, Sayin T, Oral D. QT interval dispersi¬on: Non-invasive marker of ischemic injury in patients with unstable angina pectoris? Jpn Heart J 2000;41:597-603. http://dx.doi.org/10.1536/jhj.41.597
17. 17. Ciolli A, Di Lorenzo M, Bevilacqua U QT dispersion and early arrhyhmic risk during acute myocardial infarction. G Ital Cardiol ı999;29:ı438-44.
18. 18. Higham BD, Furniss SS, Campbell RW.QT dispersion and components of the QT interval in ischaemia and infarction. Br Heart J ı995;73:32-6.
19. 19. Paventi S, Bevilacqua U, Parafati MA, Di Luzio E, Pelliccioni PR. QT dispersion and early arrhythmic risk during acute myocardial infarction. Angiology ı999;50:209-ı5.
20. 20. Heaton KW, Ghosh S, Braddon FE. How badare the symptomsand boweldys function of patients with the irritable bowe lsyndrome? A prospective, controlledstudywithemphasis on stool form. Gut. 1991;32(1):73-79.
21. 21. Nakagawa M; TakahashiN;Iwao T; Yonemochi H; Ooie T; Hara M; Saikawa T; Ito M. Evalution of autonomicinfluences on QT dispersionusingthehead- uptilt test in healtysubjects. PacingClinElectrophysiol. 1999;22:1158-63
22. 22. Fujimoto S; UemuraS;Tomoda Y; Yamomoto H; Matsukura Y; Horii M; Iwamoto E; Hashimoto T; Dohi K. Effects of exercisetraining on theheart rate variabilityand QT dispersion of patientswithacutemyocardialinfarction. JpnCirc J. 1999;34:242-6
23. 23. Akkuş M.N; Yazar A; Döven Ö; Akbay E.; İrritable Barsak Sendromunda QT Dispersiyonu. Mersin Üniversitesi Tıp Fakültesi Dergisi 2000;1:26-30
24. 24. Yorulmaz E; Sezgin A; Yorulmaz H; Adali G; Ciftci H; prolong QT DİSPERSİON İN İNfammatoryboweldissease. World J Gastroenterol. Jan 7, 2013; 19(1): 65-71Published online Jan 7, 2013. doi: 10.3748/wjg.v19.i1.65
25. 25. Deepak J. P; Rama Dilip Gajulapalli; Kiran Anna; RajaShekharSappatiBiyyani; Prevalence of QT intervalprolongation in inflammatoryboweldisease. Received: September 18, 2015 Accepted: December 24, 2015 Available Online Date: February 05, 2016 © Copyright 2016 byTheTurkishSociety of Gastroenterology • Available online at www.turkjgastroenterol.org DOI: 10.5152/tjg.2015.150349
26. 26. Beyazit Y, Sain-Güven G, İskit AB. Uzun QT sendromu. Hacettepe Tıp Dergisi 2005; 36(1):43-48
27. 27. Zhang QY, Dunbar D, Ostrowska A, Zeisloft S,Yang J, Kaminsky LS. Characterization of humansmallintestinalcytochromes P-450. DrugMetabDispos. 1999; 27: 804-809
28. 28. Elming H, Sonne J, Lublin HK. Theimportance ofthe QT interval: a review of theliterature. ActaPsychiatrScand 2003; 107(2): 96-101
29. 29. Honig P, Wortham D, Zamani K, Conner D, MullinJ, Cantilena L. Terfenadine-ketoconazoleinteraction. Pharmacokineticandelectrcardiographicconsequences. JAMA 1993;269:1513-1518
30. 30. Monahan BP, Ferguson CL, Killeavy ES, Lloyd BK,Troy J, Cantilena LR. Torsades de pointesoccurring in associationwithterfenadinuse.JAMA 1990; 264: 2788-2790