Gastroenterit sonrasi irritabl barsak sendromu sikligi ve risk faktörleri
Prevalence of irritable bowel syndrome after gastroenteritis and risk factors
Özet
Giris ve amaç: Bakteriyel gastroenterit atagindan sonra irritabl barsak sendromu (IBS) riskinin arttigini gösteren çalismalar mevcuttur. Son zamanlarda, bu hastalarin kolon mukozasinda inflamatuvar degisiklikler gösterilmistir. Bu çalismada, akut bakteriyel gastroenterit geçiren hastalarda IBS semptomlarinin gelisip gelismedigini ve bunu etkileyen faktörlerin incelenmesi amaçlanmistir. Gereç ve yöntem: Bir yil içinde bakteriyel gastroenterit nedeniyle yatarak tedavi gören 112 hastaya ait kayitlar, infeksiyondan ortalama 8 ay sonra retrospektif olarak incelendi. Telefon görüsmesinde, enfeksiyon öncesi ve sonrasinda, Roma 2 kriterlerine göre IBS semptomlari, IBS’nun alt gruplari, Beck ölçegine göre anksiyete skorlarinin bulunup bulunmadigi kaydedildi. Telefonla yeterli bilgi alinabilen ve alarm semptomu olmayan 90 hasta çalismaya alindi. Bulgular: Hastalarin 42’si erkek, 48’i kadin, yas ortalamalari sirasi ile 38,4±14 ve 37,9±16 yildi. Gastroenteritten 8 ay sonra, erkeklerin %14,2’sinde, kadinlarin %35,4’ünde IBS tespit edildi (p<0,05). Postinfektif IBS (PI-IBS) orani, önceki IBS sikligina göre belirgin olarak yüksekti (%17,8 vs %7,8; p<0,01). PI-IBS daha çok non konstipe IBS tipindeydi (p<0,05), kadinlarda daha sikti (p<0,05) ve genç yasta gelisme egilimindeydi (p<0,05). Infeksiyon süresi IBS gelisme riskini etkilemedi. PI-IBS’lu hastalarin altisinda (%37,5), digerlerinin sadece yedisinde (%9,5) anksiyete vardi (p<0,01). Sonuç: Akut gastroenterit IBS gelismesinde rol oynar. Kadin cinsiyet, anksiyete bozuklugu ve genç yas PI-IBS riskini arttirmaktadir. Inflamasyon, psikolojik yapi ve cinsiyet faktörlerinin barsak nöro endokrin fonksiyonlarini etkileyen ortak bir mekanizma ile mi IBS gelisimine yol açtigi daha genis çalismalarla arastirilmali dir.
Abstract
Background and aims: A number of studies have shown an increased risk of irritable bowel syndrome after bacterial gastroenteritis. Recently, some inflammatory changes have been demonstrated in colon mucosa of these patients. The aim of this study was to investigate whether irritable bowel syndrome symptoms develop in patients after gastroenteritis and the risk factors leading to this condition. Material and methods: The medical records of 112 patients, hospitalized for acute bacterial gastroenteritis, were evaluated eight months after the infection. Presence of irritable bowel syndrome symptoms according to Rome II criteria clinical subtypes and anxiety scores according to Beck’s anxiety scale were recorded before and after the infection via telephone interview. Ninety patients with no from alarm symptoms, from whom adequate information could be obtained by telephone, were included in the study. Results: There were 42 males and 48 females, with mean ages of 38.4±14 and 37.9±16 years, respectively. Irritable bowel syndrome was found in 14.2% of the men and 35.4% of the women eight months after the gastroenteritis episode. The postinfective irritable bowel syndrome (PI-IBS) rate was significantly higher than the irritable bowel syndrome rate. PIIBS was non-constipated type, more frequent in females and tending to develop of a younger age (for each p<0.05). Duration of infection did not affect the risk of irritable bowel syndrome. Six of the patients with PIIBS (37.5%) and only seven of the others (9.5%) could be defined as clinically anxious. Conclusions: Acute gastroenteritis plays a role in the development of irritable bowel syndrome. With female gender, anxiety disorder and younger age increase the risk of PI-IBS. Larger studies should be undertaken to evalvate whether inflammation, psychological condition and gender influence the development of irritable bowel syndrome by a collaborative mechanism that affects enteric neuro-endocrine functions.
