ÖMER YILMAZ, Refik Ali SARI, HAKAN DURSUN, Bülent AYDINLI, Nesrin GÜRSAN, Nihat OKÇU

Behçet hastalığında üst gastrointestinal sistem bulguları ve Helikobakter pilori sıklığı

Giriş ve amaç: Behçet hastalığı ağız mukozasında ülserasyonlar, göz lezyonları, genital ülserasyonlar ve paterji testi pozitifliği ile karakterize, etyolojisi kesin olarak belli olmayan, kronik tekrarlayıcı bir hastalıktır. Hastalık ağızdan anüse kadar gastrointestinal kanalın herhangi bir kısmını etkileyebilir. Helikobakter pilori (Hp) enfeksiyonu, dünyadaki en yaygın bakteriyel gastrointestinal hastalık olup, duodenal ve mide ülserinin patogenezinde rol oynamaktadır. Bizim amacımız bölgemizde yaşayan behçetli hastalardaki endoskopik olarak gastrointestinal patolojilerin sıklığını ve Hp ile ilişkisini araştırmaktır. Gereç ve yöntem: Çalışmamıza Behçet hastalığı tanısı almış 21 hasta (12 erkek, 9 kadın) dahil edildi. Dispeptik yakınmaları sebebiyle tüm hastalara üst gastrointestinal sistem endoksopisi uygulandı. Hp varlığını gösterebilmek amacıyla mide antrum, angulus yayı ve korpustan biyopsiler alındı. Bulgular: Hastalarımızın yaş ortalaması 36±7.7 yıl (24-52), ortalama hastalık süresi 60.5±75.8 ay (1-324) idi. Endoskopik inceleme sonucu hastalarımızın tümünde gastrit (% 100), 3'ünde (% 14.2) özofajit. 5'inde (% 23.8) mide ülseri, 11' inde duodenit (% 52.3) tespit ettik. Histopatolojik inceleme sonucu 16 hastada (% 76.1) Hp pozitif kronik gastrit, 5 hastada (% 23.8) Hp negatif kronik gastrit bulundu. Kontrol grubunun 9'unda (% 42.8) tespit edilebilen Hp pozitiflik oranı ile aralarında istatistiksel olarak anlamlı ilişki tespit edildi.(p:0.028) Hastalığın aktif dönemde olduğu 6 hastanın hepsinde histopatolojik olarak Hp (+) kronik aktif gastrit tespit edildi. Sonuç: Behçet tanısıyla takip edilen ve dispeptik şikayetleri olan hastalara üst gatsrointestinal sistem endoskopisi yapılmalıdır. Hastalığı aktif dönemde olan dispeptik şikayetlere sahip hastalara, eğer endoskopi ihtimali yoksa Hp eradikasyonu uygulanmalıdır.

Anahtar Kelimeler:

Behçet hastalığı, endoskopik bulgular, Helikobakter pilori

Upper gastrointestinal system findings and Helicobacter pylori frequency in patient's with Behçet's disease

Background/aim: Behçet's disease (BD) is a chronic recurrent systemic disease of unknown etiology characterized by the presence of oral ulceration, eye lesions, and positive pathergy test. Gastrointestinal system involvement may affect all areas from the esophagus to the anus. Helicobacter pylori (Hp) infection is the most common bacterial gastrointestinal infection worldwide and has a role in duodenal and gastric ulcer disease. In this study, we aimed at studying the frequency of gastrointestinal pathologies endoscopically and that of Hp in patients with Behçet's disease living in our region. Materials and methods: Twenty one patients (12 male, 9 female) who met the diagnostic criteria of the international study group for Behçet's disease were included in our study. Upper gastrointestinal endoscopy was performed in all patients because of dyspeptic complaints. Biopsies were taken to indicate the occurrence of Hp from gastric antrum, corpus and angulus. Results: The mean age of patients was 36±7.7 years (24-52). Their mean disease intervals were 60.5±75.8 months (1-324). Endoscopic examinations showed esophagitis in 3 patients (14.2%), gastric ulcer in 5 patients (23.8%), duodenitis in 11 patients (52.3%), and gastritis in all patients (100%). Histopathological investigations revealed Hp-positive chronic active gastritis in 16 patients (76.1%), and Hp-negative chronic gastritis in 5 patients (23.8%). There was a statistically significant relation when patients were compared with Hp positivity rate detected in 9 of control group. Histopathologically Hp (+) chronic gastritis was detected in all 6 patients with active disease. Conclusion: Upper gastrointestinal endoscopy should be done in Behçet's disease patients with dyspeptic complaints. Hp eradication should be applied to patients with dyspeptic complaints and with active disease if there is no opportunity for endoscopy.

Keywords:

Behçet disease, endoscopic findings, Helicobacter pylori,

PDF

___

Shimizu T, Ehrlich GE, Inaba G, et al. Behçet’s disease (Behçet syndrome). Semin Arthritis Rheum 1979; 8: 223–60.
Sakane T, Takeno M, Suzuki M, et al. Behçet’s disease. N Engl J Med 1999; 341: 1284-91.
Örmeci N. Behçet hastalarında özefagus tutulumu. MN Klinik Bilim- ler Dergisi 1995; 1: 102-4.
Houman MH, Ghorbel IB, Lamloum M ,et al. Esophageal involvement in Behçet’s disease. Yonsei Med J 2002; 43: 457-60.
Gürler A, Boyvat A, Tursen U. Clinical manifestations of Behçet’s di- sease: An Analysis of 2147 Patients. Yonsei Med J 1997; 38: 423-7.
Lakhanpal S, Tani K, Lie JT, et al. Pathologic features of Behçet’s syndrome: a review of Japanese autopsy registry data. Hum Pathol 1985; 16: 790-5.
Zouboulis CC. Epidemiology of Adamandiates-Behçet’s disease. Ann Med Interne 1999; 150: 488-98.
Bayraktar Y, Özaslan E, Van Thiel DH. Gastrointestinal manifesta- tions of Behçet’s disease. J Clin Gastroenterol 2000; 30: 144-54.
Özden A. Helicobacter pylori. Memik F (yazar). İçinde: Klinik Gast- roenteroloji. İstanbul: Nobel Tıp Kitapevleri Ltd. Şti., 2004: 160-74.
Choi J, Yoon SH, Kim JE, et al. Gene-specific oxidative DNA dama- ge in Helicobacter pylori-infected human gastric mucosa. Int J Can- cer 2002; 99: 485-90.
Sugiyama T. Development of gastric cancer associated with Helico- bacter pylori infection. Cancer Chemother Pharmacol 2004; 54 Suppl 1: 12-20.
Uzunalimoğlu Ö, Aydındağ O. Gastrointestinal sistemde Behçet Hastalığı. Türkiye Klinikleri 1985; 5: 403-9.
Şahin Ş, Lawrence R, Direskenli H, et al. Monocyte activity in Beh- çet’s Disease. Br J Rheum 1996; 35: 424-9.
International Study Group for Behçet’s Disease. Criteria for diag- nosis of Behçet’s disease. Lancet 1990; 335: 1078-80.
Gürler A. Behçet Hastalığında Tanı Kriterleri ve Klinik Gözlemler. Türkiye Klinikleri 1985; 12: 403-9.
Adinolfi M, Lehner T. Acute phase proteins and C9 in patients with Behçet’s Syndrome and aphthous ulcers. Clin Exp Immunol 1976; 25: 36-9.
Dixon MF, Genta RM, Yardley JH, et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-81.
Tursen U, Gürler A, Boyvat A. Evaluation of clinical findings accor- ding to sex in 2313 Turkish patients with Behçet’s disease. Int J Der- matol 2003; 42: 346-51.
Örmeci N, Uzunalimoğlu Ö, Gürler A, et al. Esophageal involve- ment in Behçet’s disease. In: Wechsler B, Godeau P, eds. Behçet’s disease. International congress. Amsterdam: Exceptra Medica; 1993, 261-4.
Bang D, Yoon KH, Chung HG, et al. Epidemiological and clinical fe- atures of Behçet’s disease in Korea. Yonsei Med J 1997; 38: 428-36.
Chen YG, Chang HW. Clinical characteristics of Behçet’s disease in southern Taiwan. J Microbial Immunol Infect 2001; 34: 207-10.
Jiang M, Zhu LP, Lin XY. Textbook of rheumatology. Beijing: Sci- ence Pres; 1995: 1219-36.
Shimizu T, Inaba G. Epidemiology of Behçet’s disease: status of Behçet’s disease in Japan. Ryumachi 1976: 16; 224-33.
Aksoz MK, Unsal B, Zeren I, et al. The upper gastrointestinal endos- copic and rectosigmoidoscopic findings in Behçet’s disease. Turk J Gastroentorol 1995; 6: 172- 4.
Morimoto Y, Tanaka Y, Itoh T, et al. Esophagobronchial fistula in a patient with Behçet’s disease: Report of a case. Surg Today 2005; 35: 671-6.
Chang HK, Kim JW. The clinical features of Behçet’s disease in yongdong districts: Analysis of a cohort followed from 1997 to 2001. J Korean Med Sci 2002; 17: 784-9.
Ormeci N, Gürler A, Cakir M, et al. Prevalence of H. Pylori in Beh- çet’s disease. VIIth. International Conference on Behçet’s Disease (abstract J14). Rev Rheum Engl Ed 1996; 63: 558.
Bottomley WW, Dakkak M, Walton S, et al. Esophageal involvement in Behçet’s disease. Is endoscopy necessary? Dig Dis Sci 1992; 37: 594-7.
Zhang ZW, Patchett SE, Farthing MJ. Role of Helicobacter pylori and p53 in regulation of gastric epithelial cell cycle phase progres- sion. Dig Dis Sci. 2002; 47: 987-95.
Oksanen A, Sipponen P, Karttunen R, et al. Atrophic gastritis and Helicobacter pylori infection in outpatients referred for gastros- copy. Gut. 2000; 46: 460-3.
Roe I, Nam S, Kim J, et al. Association of the myeloperoxidase - 463G-->A polymorphism with development of atrophy in Helicobacter pylori- infected gastritis. Am J Gastroenterol. 2002; 97(7): 1629-34.
Şahin S, Akoğlu T, Direskeneli T, et al. Neutrophil adhesion to endotelial cells and factors affecting adhesion in patients with Behçet’s disease. Ann rheum Dis 1996; 55: 128-33.
Avcı O, Ellidokuz E, Şimşek İ, et al. Helicobacter pylori and Behçet’s Disease. Dermatology 1999; 199: 140-3.
Ertuğrul C, Süleymanlar İ, Alpsoy İ, et al. Helicobacter pylori sıklığı ve klinik önemi. XVI. Ulusal Gastroenteroloji Kongresi, Antalya. Turk J Gastroenterol, Bildiriler Kitapçığı. 10-15 Ekim 1999, 102.