Polikistik over sendromlu kadınlarda, Roma III teşhis kriterlerine göre fonksiyonel dispepsi sıklığı

Öz

Giriş ve Amaç: Polikistik over sendromu reprodüktif çağdaki kadınlarda en sık görülen endokrin hastalıktır. Fonksiyonel dispepsi, genel popülasyonda yaygın görülen organik neden olmaksızın dispeptik semptomların eşlik ettiği fonksiyonel gastrointestinal bozukluktur. Daha önceki çalışmalarda polikistik over sendromlu hastalarda fonksiyonel dispepsi sıklığı ve aralarındaki ilişki araştırılmamıştır. Biz bu çalışmada polikistik over sendromlu hastalarda fonksiyonel dispepsi sıklığını ve aralarındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: Çalışmamız prospektif olarak planlandı ve reprodüktif çağdaki 73 polikistik over sendromlu hasta ve 67 sağlıklı kontrol denek alındı. Bu deneklerin gastrointestinal semptomları anketle saptandı.Deneklerin boy, kilo değerleri kayıt edildi ve serum açlık glukoz, insülin, kortizol, prolaktin, troid uyarıcı hormon, folikül uyarıcı hormon, luteinleştirici hormon, total testosteron, dehidroepiandrosteron sülfat düzeylerine bakıldı. Deneklerin insülin direnci ve vücut kitle indeksi değerleri hesaplandı. Bulgular: Çalışmaya alınan polikistik over sendromu ve sağlıklı kontrol grubu arasında yaş açısından anlamlı fark bulunamadı (22.1±4.1 vs. 23.5±5.1 yıl,sırasıyla p > 0.05). Gruplar serum total testosteron, dehidroepiandrosteron sülfat ve luteinleştirici hormon düzeyleri açısından karşılaştırıldığında aradaki fark önemli bulundu (p=0.001, p=0.001, p= 0.038, sırasıyla). Polikistik over sendromlu 73 hastanın 38’inde (%52.1) ve kontrol grubunda 67 deneğin 16’sında (%23.9) fonksiyonel dispepsi mevcut idi. Fonksiyonel dispepsi sıklığı polikistik over sendromu hastalarında sağlıklı kontrol deneklerden daha yüksek bulundu (p=0,006). Fonksiyonel dispepsisi olan polikistik over sendromlu hastalar, fonksiyonel dispepsi subgrupları açısından karşılaştırıldığında postprandiyal distres sendromu sağlıklı kontrol grubuna kıyasla sık (p<0.05) iken epigastrik ağrı sendromu için sağlıklı kontrol grubu ile arasında istatistiksel fark yok idi (p>0.05). Polikistik over sendromu hastalarında vücut kitle indeksi, serum açlık kan glukozu, insülin, kortizol, prolaktin, troid uyarıcı hormon, folikül uyarıcı hormon ve insülin direnci indeksi sağlıklı kontrol grubu ile karşılaştırıldığında aralarında fark bulunamadı (p>0.05). Sonuç: Polikistik over sendromlu hastalarda, fonksiyonel dispepsi ve dispepsi subgrubu olan postprandial distress sendromu sıklığı sağlıklı kontrol grubu ile karşılaştırıldığında yüksek saptandı. Polikistik over sendromlu hastalarda, fonksiyonel dispepsi ve subgrubu olan postprandial distress sendromun sık görülmesinin hiperandojenizm ile ilişkili olduğu düşünüldü.

Anahtar Kelimeler

• Dispepsi,polikistik over sendromu,postprandiyal distres sendromu,epigastrik ağrı sendromu

The prevalence of functional dyspepsia in women with polycystic ovary syndrome according to the Rome III diagnostic criteria

Abstract

Background and Aims: Polycystic ovarian syndrome is the most frequently seen endocrine disease in women of reproductive age. Functional dyspepsia is a functional gastrointestinal disorder that is commonly seen in the general population, accompanied by dyspeptic symptoms without an organic cause. Previous studies have not investigated the frequency of functional dyspepsia in patients with polycystic ovarian syndrome and the relationship between them. In this study, we aimed to determine the frequency of functional dyspepsia in patients with polycystic ovarian syndrome and to investigate the relationship between them. Materials and Methods: Our study was prospectively planned, and 73 patients with polycystic ovarian syndrome and 67 healthy control subjects of reproductive age were included. Gastrointestinal symptoms were detected via survey conducted on these subjects. Height and weight values of the subjects were recorded, and serum fasting glucose, insulin, cortisol, prolactin, thyroid stimulating hormone, follicle stimulating hormone, luteinizing hormone, total testosterone, and dehydroepiandrosterone sulfate levels were measured. Homeostasis model assessment of insulin resistance and body mass index values of the subjects were calculated. Results: There was no significant difference in age between the study group and the healthy control group (22.1±4.1 vs. 23.5±5.1 years, respectively, p > 0.05). When the groups were compared in terms of serum total testosterone, dehydroepiandrosterone sulfate, and luteinizing hormone levels, the differences were found to be statistically significant (p = 0.001, p = 0.001, and p = 0.038, respectively). Functional dyspepsia was present in 38 (52.1%) of the 73 patients with polycystic ovarian syndrome and 16 of the 67 (23.9%) patients in the control group. The frequency of functional dyspepsia was higher in patients with polycystic ovarian syndrome than in healthy control subjects (p = 0.006). In patients with polycystic ovarian syndrome with functional dyspepsia, when functional dyspepsia subgroups were compared, postprandial distress syndrome was more frequent than in the healthy control group (p < 0.05), while no statistically significant difference was found between the healthy control group and the group with epigastric pain syndrome (p > 0.05). There was no significant difference in body mass index, serum fasting glucose, insulin, cortisol, prolactin, thyroid stimulating hormone, follicle stimulating hormone, and homeostasis model assessment of insulin resistance index in polycystic ovarian syndrome when patients were compared with the healthy control group (p > 0.05). Conclusion: In patients with polycystic ovarian syndrome, the frequency of functional dyspepsia and its subgroup, postprandial distress syndrome, was found to be higher than in the healthy control group. In patients with polycystic ovarian syndrome, the cause of the frequent cooccurrence of functional dyspepsia and its subgroup, postprandial distress syndrome, was thought to be hyperandrogenism.

Keywords

• Dyspepsia,polycystic ovarian syndrome,postprandial distress syndrome,epigastric pain syndrome

Kaynakça

1. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;18(6):1-13.
2. Setji TL, Brown AJ. Polycystic ovary syndrome: update on diagnosis and treatment. Am J Med. 2014;127(10):912-9.
3. Trikudanathan S. Polycystic ovarian syndrome. Med Clin North Am. 2015; 99(1):221-35.
4. Mahadeva S, Goh KL. Epidemiology of functional dyspepsia: a global perspective. World J Gastroenterol. 2006;12(17):2661-6.
5. Tack J, Talley NJ. Functional dyspepsia symptoms, definitions and validity of the Rome III criteria. Nat Rev Gastroenterol Hepatol. 2013;10(3):134-41.
6. Tack J, Masaoka T, Janssen P. Functional dyspepsia. Curr Opin Gastroenterol. 2011; 27(6): 549-57.
7. Rotterdam ESHRE/ASRM-Sponsored PKOSConsensus Workshop Group. Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19–25.
8. Fruzzetti F, Campagna AM, Perini D, Carmina E. Ovarian volume in normal and hyperandrogenic adolescent women. Fertil Steril. 2015; 104(1):196-9.

9. Karamanolis GP, Tack J. Current management of functional dyspepsia: impact of Rome III subdivision. Ann Gastroenterol. 2012;25(2):96-99.
10. Wilder-Smith CH, Li X, Shen L, Cao Y, Ho KY, Wong RK. Dysfunctional endogenous pain modulation in patients with functional dyspepsia. Neurogastroenterol Motil. 2014; 26(4): 489-98.
11. Saruc M, Ozden N, Turkel N, Ayhan S, Demir MA, Tuzcuoglu I, Akarca US, Yuceyar H. Functional dyspepsia: relationship between clinical subgroups and Helicobacter pylori status in Western Turkey. Braz J Med Biol Res. 2003; 36(6): 747-51.
12. Mahadeva S, Ford AC. Clinical and epidemiological differences in functional dyspepsia between the East and the West. Neurogastroenterol Motil. 2015;. doi: 10.1111/nmo.12657. [Epub ahead of print]
13. Olafsdottir LB, Gudjonsson H, Jonsdottir HH, Thjodleifsson B. Natural history of functional dyspepsia: a 10-year population-based study. Digestion. 2010;81(1):53-61.
14. El-Serag HB, Talley NJ. Health-related quality of life in functional dyspepsia. Aliment Pharmacol Ther 2003; 18: 387–93.
15. Lacy BE, Weiser KT, Kennedy AT, Crowell MD, Talley NJ. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther 2013; 38: 170–7.
16. Miwa H, Watari J, Fukui H, Oshima T, Tomita T, Sakurai J, Kondo T, Matsumoto T. Current understanding of pathogenesis of functional dyspepsia. J Gastroenterol Hepatol. 2011; 26(3): 53-60.
17. Talley NJ. Functional dyspepsia and the Rome criteria: a success story. Neurogastroenterol Motil. 2015;27(8):1052-6.
18. Le Pluart D, Sabaté JM, Bouchoucha M, Hercberg S, Benamouzig R, Julia C. Functional gastrointestinal disorders in 35,447 adults and their association with body mass index. Aliment Pharmacol Ther. 2015;41(8):758-67.
19. Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. The Rome III criteria for the diagnosis of functional dyspepsia in secondary care are not superior to previous definitions. Gastroenterology. 2014;146(4):932-40.
20. Talley NJ, Locke GR, Lahr BD, Zinsmeister AR, Tougas G, Ligozio G, Rojavin MA, Tack J. Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut. 2006;55(7):933-9.
21. Mayer EA, Naliboff B, Lee O, Munakata J, Chang L. Review article: gender- related differences in functional gastrointestinal disorders. Aliment Pharmacol Ther. 1999;13 Suppl 2: 65-9.
22. Bouchoucha M, Fysekidis M, Julia C, Airinei G, Catheline JM, Cohen R, Benamouzig R Body mass index association with functional gastrointestinal disorders: differences between genders. Results from a study in a tertiary center.J Gastroenterol. 2015 Aug 12. [Epub ahead of print])
23. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981-1030.
24. Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev. 2013;14(2):95-109.
25. Ma J, Lin TC, Liu W. Gastrointestinal hormones and polycystic ovary syndrome. Endocrine. 2014;47(3):668-78.
26. Khoo J, Rayner CK, Feinle-Bisset C, Jones KL, Horowitz M. Gastrointestinal hormonal dysfunction in gastroparesis and functional dyspepsia. Neurogastroenterol Motil. 2010; 22 (12):1270-8.
27. Vrbikova J, Hill M, Bendlova B, Grimmichova T, Dvorakova K, Vondra K, Pacini G. Incretin levels in polycystic ovary syndrome. Eur J Endocrinol. 2008;159(2):121-7.
28. Lin T, Li S, Xu H, Zhou H, Feng R, Liu W, Sun Y, Ma J. Gastrointestinal hormone secretion in women with polycystic ovary syndrome: an observational study. Hum Reprod. 2015;30(11):2639-44.
29. Moran LJ, Noakes M, Clifton PM, Wittert GA, Tomlinson L, Galletly C, Luscombe ND, Norman RJ. Ghrelin and measures of satiety are altered in polycystic ovary syndrome but not differentially affected by diet composition. J Clin Endocrinol Metab. 2004;89(7):3337-44.
30. Pagotto U, Gambineri A, Vicennati V, Heiman ML, Tschöp M, Pasquali RPlasma ghrelin, obesity, and the polycystic ovary syndrome: correlation with insulin resistance and androgen levels. J Clin Endocrinol Metab. 2002;87(12):5625-9.
31. Schöfl C, Horn R, Schill T, Schlösser HW, Müller MJ, Brabant G. Circulating ghrelin levels in patients with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002; 87(10):4607-10.
32. Repaci A, Gambineri A, Pagotto U, Pasquali R. Ghrelin and reproductive disorders. Mol Cell Endocrinol. 2011;340(1):70-9.
33. Panidis D, Asteriadis C, Georgopoulos NA, Katsikis I, Zournatzi V, Karkanaki A, Saltamavros AD, Decavalas G, Diamanti-Kandarakis E. Decreased active, total and altered active to total ghrelin ratio in normal weight women with the more severe form of polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2010;149(2):170-4.