Nisan 2014
Inflamatuvar barsak hastaliginin ekstraintestinal tutulumu
Extraintestinal manifestations of inflammatory bowel diseases
- Ana Sayfa
- Sayılar
- Nisan 2014
- Inflamatuvar barsak hastaliginin ekstraintestinal tutulumu
...
Department of 2 Gastroenterohepatology, Istanbul University, Istanbul School ofMedicine, Istanbul
Department of 3 Gastroenterology, Düzce University School of Medicine, Düzce
Özet
Giris ve Amaç: Inflamatuvar barsak hastaliginda ekstraintestinal bulgularin sikligi %6-47 olarak bildirilmistir. Klinigimizde takip edilen inflamatuvar barsak hastalarinda görülen ekstraintestinal bulgulari degerlendirdik. Gereç ve Yöntem:Nisan 1998 ve Ocak 2008 arasinda takip edilen hastalar ekstraintestinal bulgular, epidemiyolojik veriler, hastalik süreleri, komplikasyonlari açisindan retrospektif olarak degerlendirildi. Bulgular:494 hasta (254 erkek, yas ortalamasi 38,63±13,32 yil, yas dagilimi 16-78) degerlendirmeye alindi. Bu hastalardan 283’ü (%57,3) ülseratif kolit, 194’ü (%39,3) Crohn hastaligi ve 17’si (%3.4) indetermine kolit idi. Hastalik yasi ortalama 70,66±75,93 (1-1008) ay idi. Ortalama takip süresi 36,40±45,09 ay (1-288 ay) idi. Tüm inflamatuvar barsak hastalarinda ekstraintestinal bulgularin sikligi %19,2 (95/494) olup dagilimi: seronegatif artrit 32 (%6,5), hepatik tutulum 13 (%2,6), deri tutulumu 13 (%2,6), kombine 16 (%3,2), renal kalkül 12 (%2,4), tromboemboli 5 (%1), göz tutulumu 4 (%0,8) idi. 78 hastada (%15,8) komplikasyon görüldü: [29 abse (%5,9), 15 perforasyon (%3), 5 malignite (%1), 1 toksik megakolon (%0,2) ve 15 diger komplikasyonlar (%2,6)]. Crohn hastaliginda komplikasyon orani ülseratif kolitten fazla idi (%29,3’e %3,6). Ülseratif kolitli hastalarda ekstraintestinal bulgular ile komplikasyon sikligi arasinda (p=0,007, R=0,173), Crohn hastalarinda kolonik tutulum ile ekstraintestinal bulgular arasinda (p=0,04, R=0,144) pozitif korelasyon tesbit edildi. Sonuç: Inflamatuvar barsak hastalarinda en sik ekstraintestinal bulgu seronegatif artrittir. En sik komplikasyon ise abse ve perforasyondur. Ekstraintestinal bulgularin varligi ülseratif kolit seyrinde komplikasyon riskini arttirir. Crohn hastaliginda kolonik tutulum, ekstraintestinal bulgularin varligini gösteren prediktif bir faktördür.
Abstract
Background and Aims: The reported frequency of extraintestinal manifestations in inflammatory bowel disease varies from 6% to 47%. We evaluated extraintestinal manifestations of inflammatory bowel disease patients who were followed up in our clinic.Materials and Methods: The epidemiological findings, disease duration, extraintestinal manifestations, and complications were evaluated between April 1998 and April 2008, retrospectively. Results:Four hundred and ninety-four patients (254 males; mean age, 38,63±13,32 years; range, 16-78) were evaluated: 283 (57,3%) with ulcerative colitis, 194 (39,3%) with Crohn’s disease and 17 (3.4%) with indeterminate colitis. The mean disease duration was 70,66±75,93 months (1-1008 months), and the mean follow-up was 36,40±45,09 months (1-288 months). The extraintestinal manifestation rate was 19.2% (95/494) in the whole group, and included arthritis in 32 (6,5%), hepatobiliary in 13 (2,6%), skin in 13 (2,6%), multiple extraintestinal manifestations in 16 (3,2%), renal calculus in 12 (2,4%), thromboembolic events in 5 (1%), and eye involvement in 4 (0,8%). Complications were observed in a total of 78 patients (15,8%). Complication rates were as follows: 29 (5,9%) abscess, 15 (3%) perforation, 5 (1%) malignancy, 1 (0,2%) toxic megacolon, and 15 (2,6%) others. The complication rate was higher in Crohn’s disease than ulcerative colitis (29,3% vs 3,6%). There was a positive correlation between extraintestinal manifestations and the complication rate in ulcerative colitis (p=0,007, r=0,173), and a positive correlation was observed between colonic involvement and extraintestinal manifestations in Crohn’s disease (p=0,04, r=0,144). Conclusions: The most common extraintestinal manifestation was arthritis, and the most frequently seen complications were abscess and perforation. The complication rate was higher in Crohn’s disease than ulcerative colitis. Extraintestinal manifestations may enhance the complication rate in UC. In Crohn’s disease, the extraintestinal manifestations rate is higher in colonic involvement than in ileocolonic and ileal involvement. Colonic involvement in Crohn’s disease is a predictive factor for extraintestinal manifestations
