Çocukluk Çağında Mikroskopik Kolite Yaklaşım

Yıl 2018, Cilt: 16 Sayı: 2, 219 - 229, 01.08.2018

Nafiye Urgancı

Öz

Mikroskopik Kolit; kronik sulu ishal, normal endoskopik ve histopatolojik bulgular ile karakterize inflamatuvar değişiklikler gösteren nadir bir barsak hastalığıdır. Kronik diarenin sık görülen bir nedenidir. Kollajenöz kolit ve lenfositik kolit (LK) olmak üzere iki subtipi mevcuttur. Klinik ve histopatoloik özellikleri benzer olan bu tiplerinin biribirinden ayrı hastalık mı,yoksa aynı hastalığın farklı fenotipleri mi olduğu halen bilinmemektedir. Etyolojisi bilinmemekle birlikte; genetik, otoimmunite, luminal bir antijene karşı (gıda, mikroorgaanizma vs) immunolojik veya inflamatuvar reaksiyon, ilaçlar, bakteriyal infeksiyon ve toksinleri, safra asitleri ve safra asit malabsorbsiyon, bozulmuş sıvı ve elektrolit emilimi ve salınımı, kollajen sentez-degredasyon (parçalanma) dengesi ve nitrik oksit öne sürülen başlıca mekanizmalardır. Erişkin yaş grubunda sıklıkla altıncı ve yedinci dekatlarda daha fazla olmakla birlikte çocuk yaş grubu dahil her yaş grubunda giderek arttığı bildirilmektedir. Çocukluk çağında MK’in sıklığı bilinmemektedir. Klinik bulguları nonspesifik olup ikisinde de kronik veya tekrarlayan sulu, kansız, dehidratasyona neden olmayan şiddetli, gecede olabilen ishal, karın ağrısı, kramplar, kilo kaybı ve fekal inkontinans görülür. Rutin laboratuvar incelemeler genellikle yardımcı değildir Tanı çoğu zaman klinik belirtiler varlığında, alınan biyopsilerle histolojik olarak konulabilmektedir. Bu amaçla çıkan ve sigmoid kolondan biyopsi alınmalıdır. Ayırıcı tanıda, ilaca bağlı mikrosopik kolit ve çölyak hastalığı mutlaka ekarte edilmelidir. Tedavisinde fazla kontrollü çalışma yoktur. En fazla çalışılan ilaç budesoniddir. Hafif vakalarda anti-diareikler genellikle yeterli olmaktadır. Genel olarak MKin uzun süreli izlem sonucunda prognoz oldukça iyidir.

Anahtar Kelimeler

Mikroskopik kolit, Kollajenöz kolit, lenfositik kolit, çocukluk çağı

Kaynakça

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