Renal Transplant Alıcılarında Gastroözefageal Reflü Hastalığı Belirtilerinin Değerlendirilmesi

Öz

Gastrointestinal semptomlar, özellikle retrosternal yanma ve regürjitasyon, son dönem böbrek  hastalarında (SDBH)  ve renal transplant alıcılarında sık görülen bulgulardır. Kronik böbrek hastalarında ve böbrek nakli yapılan hastalarda gastroözofageal reflü hastalığının (GÖRH) prevalansı son birkaç yıldır tartışılmaya başlamıştır. Ülkemizde renal transplant alıcılarında GÖRH prevelansı araştırılmamıştır. Bu çalışmada renal transplant alıcılarında GÖRH sıklığını ve ilişkili olduğu faktörleri araştırmayı amaçladık. Kesitsel tipteki bu çalışmaya 69 fonksiyone grefte sahip renal transplant alıcısı hasta dahil edildi. Hastaların gastrointestinal sistem şikayetleri, özgeçmiş özellikleri ve kullandıkları ilaçlar yüz yüze görüşme yöntemi ile elde edildi. Anket formu, bireylerin sosyodemografik özelliklerini, GÖRH ile ilişkili olduğu düşünülen bazı faktörler ile ilgili soruları içermekteydi. Çalışmada GÖRH’ün değerlendirilmesinde National İnstitutes of Health (NIH) PROMİS GERD Ölçeği kullanıldı. Çalışmaya dahil edilen hastaların 32’si (%46.4) erkek, 37’si (%53.6) ise kadındı. Hastaların yaşları 22-66 arasında değişmekte olup, yaş ortalamaları 44.86±11.26 yıl idi. Hastalarda GÖRH sıklığı %21.7 oranında tespit edildi. Hastaların %79.7’si gastroprotektif ajan kullanmakta idi. GÖRH olanlarla olmayanlar arasında yaş, cinsiyet, vücut kitle indeksi, glomeruler filtrasyon hızı (eGFR), sigara kullanımı, medeni durum, gastroprotektif ilaç kullanımı, nonsteroid antienflamatuar ilaç kullanımı, donor kaynağı (canlı, kadavra), nakil öncesi diyaliz süresi, eğitim durumu açısından fark bulunmadı (p>0.05). Renal transplant alıcılarında GÖRH sıklığı %21.7 bulunmuş olup, bu oranın genel Türk popülasyonu ile karşılaştırıldığında (%33.9) düşük, Türk hemodiyaliz hasta popülasyonu ile karşılaştırıldığında(%14) yüksek olduğu tesbit edilmiştir.

Anahtar Kelimeler

• Gastroözefageal reflü; renal transplantasyon; hemodiyaliz

Evaluation of Gastroesophageal Reflux Disease Symptoms in Renal Transplant Recipients

Öz

Gastrointestinal symptoms, especially heartburn and regurgitation, are common findings in end-stage renal disease (ESRD) and renal transplant recipients. The prevalence of gastroesophageal reflux disease (GERD) in patients with chronic kidney disease and renal transplantation has been debated over the last few years. In our country, the prevalence of GERD in renal transplant recipients has not been investigated. In this study, we aimed to investigate the frequency and associated factors of GERD in renal transplant recipients. 69 renal transplant recipients patients who have funtional graft included in this cross-sectional study. Gastrointestinal complaints of the patients, resume characteristics and the medication they used were obtained by face to face interview method. The questionnaire included questions about the sociodemographic characteristics of individuals and some factors that were thought to be related to gastroesophageal reflux disease (GERD). The National Institute of Health (NIH) PROMIS GERD Scale was used to assess gastroesophageal reflux disease in the study. 32 patients (46.4%) were male and 37 (53.6%) were female in this study. The ages of the patients ranged from 22 to 66 years and the mean age was 44.86 ± 11.26 years. The incidence of GERD was 21.7% in patients. 79.7% of the patients were using gastroprotective agent. There was no difference among those who have GERD and not in terms of age, sex, body mass index, glomerular filtration rate (eGFR), smoking status, marital status, gastroprotective drug use, nonsteroidal antiinflammatory drug use, donor source (live, cadaver) ), duration of dialysis before transplantation, education status (p>0.05). GERD frequency in renal transplant recipients was found to be 21.7% and when compared with the general Turkish population (33.9%) it is low, when compared with the Turkish hemodialysis patient population (14%) it is high.

Anahtar Kelimeler

• Gastroesophageal reflux; renal transplantation; hemodialysis

Kaynakça

1. KAYNAKLAR1.Kamar N, Oufroukhi L, Faure P, et al. Questionnaire-based evaluation of gastrointestinal disorders in de novo renal-transplant patients receiving either mycophenolate mofetil or enteric-coated mycophenolate sodium. Nephrol Dial Transplant .2005; 20: 2231.2. Budde K, Curtis J, Knoll G, et al. Enteric-coated mycophenolate sodium can be safely administered in maintenance renal transplant patients:Results of a 1-year study. Am J Transplant.2004; 4: 237.3. Salvadori M, Holzer H, de Mattos A, et al. Enteric-coated mycophenolate sodium is therapeutically equivalent to mycophenolate mofetil in de novo renal transplant patients. Am J Transplant. 2004; 4: 231.4.Bayerdoerffer E, Miehlke S, Lehan E. Chronic type B gastritis as an important denominator of peptic ulcer healing. Eur J Gastroenterol Hepatol. 1993;5:99-105.5. Ala-Kaila K. Upper gastrointestinal findings in chronic renal failure. Scand J Gastroenterol. 1987;22:372-6.6. Abdulrahman IS, Al-Quorain AA. Prevalence of gastroesophageal reflux disease and its association with Helicobacter pylori infection in chronic renal failure patients and in renal transplant recipients.Saudi J Gastroenterol. 2008 Oct;14(4):183-6. 7. Spiegel BM, Hays RD, Bolus R, Melmed GY, Chang L, Whitman C, et al. Development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) gastrointestinal symptom scales. Am J Gastroenterol. 2014;109:1804–14.8. Özseker B, Yasar NF, Bilgin M, Kurt Y, Balcioglu H, Bilge U. Turkish validation of National Institutes of Health (NIH) patient- reported outcomes measurement information system (PROMISÂŪ) Gastroesophageal Reflux Disease (GERD) scale. Biomedical Research.2016;27:577–81.9. Helderman JH, Goral S. Gastrointestinal complications of transplant immunosuppression. J Am Soc Nephrol. 2002; 13: 277.10. Oğuz D, Köksal AŞ, Özden A. The frequency of gastroesophageal reflux disease in patients admitting to primary health care centers in Turkey. Akademik Gastroenteroloji Dergisi. 2008;7:137–43.11.Fock KM, Talley N, Hunt R, Fass R, Nandurkar S, Lam SK, et al. Report of the Asia-Pacific consensus on the management of gastroesophageal reflux disease. J Gastroenterol Hepatol. 2004;19:357-67.12. Segal I. The gastro-oesophageal reflux disease complex in sub-Saharan Africa. Eur J Cancer Prev. 2001;10:209–12. 13. Fung WP. Gastric acid secretion in Chinese with particular reference to the dose of histamine required for maximal stimulation. Gut. 1970;11:955–61. 14. El-Serag HB, Sonnenberg A, Jamal MM, Inadomi JM, Crooks LA, Feddersen RM. Corpus gastritis is protective against reflux oesophagitis. Gut. 1999;45:181–5. 15. Kang JY, Ho KY. Different prevalences of reflux oesophagitis and hiatus hernia among dyspeptic patients in England and Singapore. Eur J Gastroenterol Hepatol. 1999;11:845–50.16. Bor S, Mandiracioglu A, Kitapcioglu G, Caymaz-Bor C, Gilbert RJ. Gastroesophageal reflux disease in a low-income region in Turkey. Am J Gastroenterol. 2005;100(4):759-65.17. Luca Neri, Lisa A. Rocca Rey, Brett W. Pinsky, Krista L. Et.al. Increased Risk of Graft Failure in Kidney Transplant Recipients After a Diagnosis of Dyspepsia or Gastroesophageal Reflux Disease. Transplantation. 2008;85: 344–352.18. Sultan Özkurt, Yasemin Sağlan, Handan Gölgeli, Ramazan Sağlan, Hüseyin Balcıoğlu, Uğur Bilge, İlhami Ünlüoğlu. Hemodiyaliz Hastalarında Gastroözefageal Reflü Hastalığı Sıklığının Değerlendirilmesi. Haydarpasa Numune Med J. 2017;57(3):167–171. 19. Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ.Locke GR . Risk factors associated with symptoms of gastroesophageal reflux. AmJ Med. 1999;106(6):642-9.20. Bortolotti M, Labriola E, Bacchelli S, et al. “Oesophageal angina” in patients with angina pectoris: A possible side effect of chronic therapy with nitroderivates and Ca-antagonists. Ital J Gastroenterol. 1992;24(7):405-8.