Selen ŞİPAL, Mesut SEZİKLİ, Gökhan DİNDAR

Çölyak hastalarında depresyon ve cinsel disfonksiyon sıklığı, hormonal dengenin cinsel disfonksiyonun üzerine etkilerinin belirlenmesi

Giriş ve Amaç: Çölyak hastalığı; genetik olarak yatkın bireylerde gluten içeren buğday, arpa, çavdar gibi gıdaların alınmasıyla tetiklenen immün aracılı bir enteropati olup hastalarda intestinal ve ekstraintestinal problemlere yol açar. Bu çalışmada, çölyak hastalarında hem sıkı glutensiz diyetin hem de glutenle tetiklenen kronik inflamasyonun erişkin yaşlarda getirebileceği seksüel ve psikolojik disfonksiyonların saptanması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya en az 1 yıllık çölyak hastalığı tanısı olup takipte olan 79 hasta ile (53 kadın 26 erkek) yaş ve cins uyumlu 48 sağlıklı kontrol grubu (29 kadın 19 erkek) dahil edildi. Tüm katılımcılardan Beck Depresyon Anketini ve uygun olan katılımcılardan Kadın Seksüel Fonksiyon İndeks ve Ereksiyon İşlevi Uluslararası Değerlendirme Formunu doldurmaları istendi. Cinsel işlev formunu dolduracak olan katılımcılardan total testesteron, dehidroepiandrosteron, folikül stimüle edici hormon, lüteinize edici hormon, tiroid stimulan hormon, estradiol ve prolaktin ölçümleri için kan örnekleri alındı. Bulgular: Beck Depresyon Anketini doğru ve eksiksiz dolduran hasta grubundaki 70 katılımcının %33’ünde (n=23) kontrol grubundaki ise 38 katılımcının 11’inde (%30) depresif semptomlar tespit edilmiş olup hasta ve kontrol grubundaki depresyon oranları benzerdi. Kontrol grubunun üre, ferritin, hemoglobin ve total kolesterol düzeyleri hasta grubuna göre daha yüksekken (sırasıyla p=0,019 p=0,03 p=0,010 p=0,02) bütün katılımcıların hemoglobin düzeyleri ile Beck Depresyon Skorları arasındaki negatif korelasyon dikkat çekti (p=0,03). Katılımcılardancinsel aktif olan hasta grubundaki 30 kadın ile kontrol grubundaki 12 kadın Kadın Seksüel Fonksiyon İndeksi anketine göre değerlendirildiğinde cinsel disfonksiyon açısından benzer bulundu (sırasıyla %30, %42, p>0,05). Kadınlardaki cinsel disfonksiyon ile hastalık aktivitesi, hormonal denge ve depresyon arasında bir ilişki bulunamadı. Yine hasta (n=15) ve kontrol (n=7) grubundaki cinsel aktif erkek katılımcıların Ereksiyon İşlevi Uluslararası Değerlendirme Formu anketine göre erektil disfonksiyon açısından aralarında istatiksel fark bulunamazken (sırasıyla %53, %28,6 p>0,05) hasta grubundaki total testesteron düzeyi sağlıklı kontrol grubuna göre daha yüksek (p=0,030) estradiol düzeyi ise daha düşük saptandı (p=0,039). Yine hastalık aktivitesi, hormonal denge ve depresyon ile erktil disfonksiyon arasında ilişki bulunamadı.Sonuç: Çölyak hastaları ile kontrol grubundaki depresyon oranları benzer olmakla birlikte hemoglobin düzeylerindeki düşüklüğün hastalıktan bağımsız olarak depresyon skorlarını etkilediği görülmektedir. Cinsel aktif erkek ve kadınlardaki cinsel disfonksiyon oranları her iki grupta da benzer iken çölyaklı erkeklerdeki total testesteron düzeylerindeki yüksekliğin androjen direnci ile ilgisi olabileceği düşünüldü. Sonuç olarak çölyaklı kadın ve erkeklerde cinsel disfonksiyon ve hormonal denge ile ilgili daha çok katılımcı ile yapılacak büyük çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Çölyak hastalığı, depresyon, cinsel disfonksiyon

Frequency of depression and sexual dysfunction in celiac patients: Identification of the effects of hormonal balance on sexual dysfunction

Background and Aims: Celiac disease is an immune enteropathy triggered by the ingestion of gluten-containing foods such as wheat, barley, and rye in genetically predisposed individuals and the cause of intestinal and extraintestinal symptoms. In this study, we aimed to detect sexual and psychological dysfunction, which can be brought on by both a strict gluten-free diet and gluten-triggered chronic inflammation in adulthood in celiac patients. Material and Methods: In this study, 79 patients (53 female) who were diagnosed with celiac disease and followed for at least 1 year and 48 age- and sex-matched healthy controls (29 female) were included. All the participants were asked to complete the Beck Depression Questionnaire and eligible participants were asked to fill out Female Sexual Function Index and International Index of Erectile Function forms. Blood samples were collected for measurement of total testosterone, dehydroepiandrosterone sulfate, follicle-stimulating hormone, luteinizing hormone, thyroid stimulating hormone, estradiol, and prolactin. Results: Depression was detected in 33% (n = 23) of 70 participants in the patient group and in 11 (30%) of 38 participants in the healthy control group who filled out the Beck Depression Questionnaire completely and accurately, and depression rates were similar in both groups. While the control group’s urea, ferritin, hemoglobin, and total cholesterol levels were higher than those in the patient group (p = 0.019, p = 0.03, p = 0.010, p = 0.02, respectively), a strong negative correlation between all participants’ hemoglobin levels and Beck Depression scores (p = 0.03) was found. When sexually active female participants were evaluated (30 females in the patient group and 12 females in the control group) according to the Female Sexual Function Index questionnaire, sexual dysfunction rates were similar in the two groups (30%, 42%, p > 0.05, respectively). There was no relationship between the women’s sexual dysfunction and disease activity, hormonal balance, or depression. Similarly, when sexually active male participants were evaluated (15 males in the patient group and 7 males in the control group) according to the Female Sexual Function Index questionnaire, there was no statistically significant difference between the two groups in the rate of erectile dysfunction (53%, 28.6%, p > 0.05, respectively), despite the higher total testosterone levels (p = 0.030) and lower estradiol levels (p = 0.039) in the patient group. There was also no relationship found between erectile dysfunction and disease activity, hormonal balance, or depression. Conclusion: Although depression rates were similar between celiac patients and controls, it was shown that low hemoglobin levels affected depression scores independently of the disease. Although sexually active women and men had similar sexual dysfunction rates in both groups, higher total testosterone levels in male participants with celiac disease might be evidence of androgen resistance. As a result, larger studies with more participants are needed in women and men with celiac disease, examining sexual dysfunction and hormonal balance.

Keywords:

Celiac disease, depression, sexual dysfunction,

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