An Essential Problem in Patients with Hereditary Angioedema: Irritable Bowel Syndrome
Year 2024,
, 229 - 234, 29.09.2024
Mehmet Kılınç
,
Fatih Çölkesen
,
Filiz Sadi Aykan
,
Recep Evcen
,
Eray Yıldız
,
Tuğba Önalan
,
Mehmet Emin Gerek
,
Şevket Arslan
Abstract
Objective: Hereditary angioedema (HAE) is characterized by attacks of subcutaneous and mucosal edema. HAE usually affects the skin or mucosal tissues of the upper respiratory and gastrointestinal tract. Irritable bowel syndrome (IBS) is one of the diseases in which the abdominal symptoms of HAE may be confused. In this study, we aimed to clarify the role of IBS in clinical presentation and diagnostic delay in HAE.
Material and Method: 50 patients with HAE followed in our clinic between January 2013 and April 2023 were included in this study, and hospital records were retrospectively reviewed. Patients with HAE were divided into two groups, those with and without IBS, and evaluated according to Rome IV criteria for diagnosing IBS.
Results: The mean age of the study group was 40 ± 13 years, and 60% (n=30) were female. IBS was observed in 30% (n=15) of the patients, and 60% (n=9) had IBS before diagnosing HAE. The frequency of attacks and history of gastrointestinal tract medical/surgical history were more frequent in HAE patients with IBS (p<0.001, p=0.032, respectively). Abdominal symptoms before the diagnosis of HAE and persistent abdominal symptoms other than attacks after the diagnosis of HAE were more common in HAE patients with IBS (p<0.001, p<0.001, respectively). HAE patients with IBS had a more significant delay in diagnosing HAE (p=0.011).
Conclusion: Clinicians should keep HAE in mind in patients with suspected IBS or patients presenting with recurrent unexplained abdominal pain.
Ethical Statement
ethics approved
Supporting Institution
no
References
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Year 2024,
, 229 - 234, 29.09.2024
Mehmet Kılınç
,
Fatih Çölkesen
,
Filiz Sadi Aykan
,
Recep Evcen
,
Eray Yıldız
,
Tuğba Önalan
,
Mehmet Emin Gerek
,
Şevket Arslan
References
- 1. Longhurst H, Cicardi M. Hereditary angioedema. The Lancet 2012;379(9814):474-481.
- 2. Aktaş H. A severe hereditary angioedema attack rapidly improved with fresh frozen plasma. Selcuk Medical Journal 2015;32(Ek):45-46.
- 3. Lumry WR, Settipane RA. Hereditary angioedema: Epidemiology and burden of disease. Allergy and Asthma Proceedings 2020;41(Suppl 1):S08-s13.
- 4. Aykan FS. Herediter Anjioödem. Mevlana Tıp Bilimleri Dergisi 2022;2(1):27-37.
- 5. Nzeako UC, Frigas E, Tremaine WJ. Hereditary angioedema: a broad review for clinicians. Archives of Internal Medicine 2001;161(20):2417-2429.
- 6. Pappalardo E, Cicardi M, Duponchel C, et al. Frequent de novo mutations and exon deletions in the C1inhibitor gene of patients with angioedema. Journal of Allergy and Clinical Immunology 2000;106(6):1147-1154.
- 7. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clinical Epidemiology 2014:71-80.
- 8. Benrajab KM, Singh G, Obah E. Hereditary angioedema presenting as irritable bowel syndrome: a case of early closure. Journal of Community Hospital Internal Medicine Perspectives 2015;5(5):29114.
- 9. Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology 2016;150(6):1393-1407. e1395.
- 10. Bork K, Meng G, Staubach P, et al. Hereditary angioedema: new findings concerning symptoms, affected organs, and course. The American Journal of Medicine 2006;119(3):267-274.
- 11.Nzeako UC. Diagnosis and management of angioedema with abdominal involvement: a gastroenterology perspective. World Journal of Gastroenterology: WJG 2010;16(39):4913.
- 12. Cao Y, Liu S, Zhi Y. Recurrent and acute abdominal pain as the main clinical manifestation in patients with hereditary angioedema. Allergy and Asthma Proceedings 2021;42(2):131-135.
- 13. Rubinstein E, Stolz LE, Sheffer AL, et al. Abdominal attacks and treatment in hereditary angioedema with C1-inhibitor deficiency. BMC Gastroenterology 2014;14:1-9.
- 14. Ali MA, Borum ML. Hereditary angioedema: what the gastroenterologist needs to know. Clinical and Experimental Gastroenterology 2014:435-445.
- 15.Bork K, Staubach P, Eckardt AJ, et al. Symptoms, course, and complications of abdominal attacks in hereditary angioedema due to C1 inhibitor deficiency. LWW 2006. p. 619-627.
- 16. Ford AC, Lacy BE, Talley NJ. Irritable Bowel Syndrome. New England Journal of Medicine 2017;376(26):2566-2578.
- 17. Brandt LJ, Chey WD, Foxx-Orenstein AE, et al. American College of Gastroenterology Task Force on irritable bowel syndrome. Am J Gastroenterol 2009;104(Suppl 1):S1-S35.
- 18. Börekci E, Celikbilek M, Soytürk M, et al. Functional gastrointestinal disorders in patients with familial Mediterranean fever. International Journal of Rheumatic Diseases 2017;20(12):2101-2105.
- 19. Ni A, Chao L, Chao J. Transcription factor nuclear factor κB regulates the inducible expression of the human B1 receptor gene in inflammation. Journal of Biological Chemistry 1998;273(5):2784-2791.
- 20. Jones MP, Tack J, Van Oudenhove L, et al. Mood and anxiety disorders precede the development of functional gastrointestinal disorders in patients but not in the population. Clinical Gastroenterology and Hepatology 2017;15(7):1014-1020. e1014.
- 21. Abuhandan M. Quality of life and psychiatric properties in children with functional abdominal pain. Selcuk Medical Journal 2013;30(1):15-18.
- 22. Aziz I, Palsson OS, Törnblom H, et al. The prevalence and impact of overlapping Rome IV-diagnosed functional gastrointestinal disorders on somatization, quality of life, and healthcare utilization: a cross-sectional general population study in three countries. Official Journal of the American College of Gastroenterology| ACG 2018;113(1):86-96.
- 23. Alammar N, Stein E. Irritable bowel syndrome: what treatments work. Medical Clinics 2019;103(1):137-152.