AHMET UYANIKOĞLU, Filiz AKYÜZ, MEHMET FATİH ERMİŞ, Kadir DEMİR, Sadakat ÖZDİL, Fatih BEŞIŞIK, Sabahattin KAYMAKOĞLU, Güngör BOZTAŞ, Zeynel MUNGAN

İnflamatuvar barsak hastalığının ekstraintestinal tutulumu

Giriş ve Amaç: İnflamatuvar barsak hastalığında ekstraintestinal bulguların sıklığı %6-47 olarak bildirilmiştir. Kliniğimizde takip edilen inflamatuvar barsak hastalarında görülen ekstraintestinal bulguları değerlendirdik. Gereç ve Yöntem:Nisan 1998 ve Ocak 2008 arasında takip edilen hastalar ekstraintestinal bulgular, epidemiyolojik veriler, hastalık süreleri, komplikasyonları açısından retrospektif olarak değerlendirildi. Bulgular:494 hasta (254 erkek, yaş ortalaması 38,63±13,32 yıl, yaş dağılımı 16-78) değerlendirmeye alındı. Bu hastalardan 283'ü (%57,3) ülseratif kolit, 194'ü (%39,3) Crohn hastalığı ve 17'si (%3.4) indetermine kolit idi. Hastalık yaşı ortalama 70,66±75,93 (1-1008) ay idi. Ortalama takip süresi 36,40±45,09 ay (1-288 ay) idi. Tüm inflamatuvar barsak hastalarında ekstraintestinal bulguların sıklığı %19,2 (95/494) olup dağılımı: 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 diğer komplikasyonlar (%2,6)]. Crohn hastalığında komplikasyon oranı ülseratif kolitten fazla idi (%29,3'e %3,6). Ülseratif kolitli hastalarda ekstraintestinal bulgular ile komplikasyon sıklığı arasında (p=0,007, R=0,173), Crohn hastalarında kolonik tutulum ile ekstraintestinal bulgular arasında (p=0,04, R=0,144) pozitif korelasyon tesbit edildi. Sonuç: İnflamatuvar barsak hastalarında en sık ekstraintestinal bulgu seronegatif artrittir. En sık komplikasyon ise abse ve perforasyondur. Ekstraintestinal bulguların varlığı ülseratif kolit seyrinde komplikasyon riskini arttırır. Crohn hastalığında kolonik tutulum, ekstraintestinal bulguların varlığını gösteren prediktif bir faktördür.

Anahtar Kelimeler:

İnflamatuvar barsak hastalığı, ekstraintestinal bulgular

Extraintestinal manifestations of inflammatory bowel diseases

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

Keywords:

Inflammatory bowel disease, extraintestinal manifestation.,

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