Emre GERÇEKER, Serkan CERRAH, Ahmed Ramiz BAYKAN

Helicobacter pylori ve inflamatuvar bağırsak hastalığı arasındaki ilişki

Giriş ve Amaç: Kronik Helicobacter pylori enfeksiyonunun, sistematik immün toleransı indükleyerek ve inflamatuvar tepkileri baskılayarak inflamatuvar bağırsak hastalığına karşı korumada bir rol oynadığı ileri sürülmektedir. Çalışmanın birincil amacı inflamatuvar bağırsak hastalığı olgularında Helicobacter pylori sıklığını saptamaktır. İkincil amacı ise inflamatuvar bağırsak hastalığı ve Helicobacter pylori enfeksiyonu arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntem: İnflamatuvar bağırsak hastalığı tanısı ile takip edilen, dispepsi nedeni ile üst gastrointestinal sistem endoskopisi yapılan 18 yaş üzeri hastaların verileri retrospektif olarak incelenerek olgular çalışmaya dahil edildi. Kontrol grubu inflamatuvar bağırsak hastalığı tanısı olmayan ve dispepsi nedeni ile üst gastrointestinal sistem endoskopisi yapılan olgulardan oluşturuldu. Tüm hastaların yaş, cinsiyet, üst gastrointestinal sistem endoskopide alınan biyopsi örneklerinin patolojik değerlendirme sonucundaki Helicobacter pylori varlığı, atrofik gastrit ve intestinal metaplazi varlığı bulguları kaydedildi. Her iki grup Helicobacter pylori sıklığı ve histopatolojik bulgular (intestinal metaplazi ve atrofik gastrit varlığı) yönünden karşılaştırıldı. Bulgular: Yüz altmış inflamatuvar bağırsak hastası ve 60 kontrol olmak üzere toplam 220 olgu çalışmaya dahil edildi. İnflamatuvar bağırsak hastalığı olgularının %53.8’i (n=86) ülseratif kolit, %46.2’si (n=74) Crohn hastalığı tanılı olgulardı. İnflamatuvar bağırsak hastalığı grubunda Helicobacter pylori oranı kontrol grubu ile karşılaştırıldığında anlamlı olarak daha düşük saptandı (%52.5’e karşı %73.3 ve p = 0.005). İnflamatuvar bağırsak hastalığı grubunda atrofik gastrit oranı kontrol grubu ile karşılaştırıldığında anlamlı olarak daha düşük bulundu (%3.1’e karşı %15 ve p = 0.001). İnflamatuvar bağırsak hastalığı grubunda intestinal metaplazi oranı kontrol grubu ile karşılaştırıldığında anlamlı olarak daha düşüktü (%1.9’a karşı %11.7 ve p = 0.002). Sonuç: İnflamatuvar bağırsak hastalığı grubunda anlamlı olarak daha düşük oranda Helicobacter pylori pozitifliği saptanmıştır. Aynı şekilde, inflamatuvar bağırsak hastalığı grubunda daha düşük oranda atrofik gastrit ve intestinal metaplazi varlığı saptanmıştır. İnflamatuvar bağırsak hastalığı olgularında tedavide kullanılan antibiyotiklerin Helicobacter pylori sıklığını azaltarak daha az sıklıkta atrofik gastrit ve intestinal metaplazi gelişimine yol açtığını düşünmekteyiz.

Anahtar Kelimeler:

Crohn hastalığı, Helicobacter pylori, inflamatuvar bağırsak hastalığı, ülseratif kolit

Relationship between Helicobacter pylori infection and inflammatory bowel disease

Background and aims: It has been suggested that chronic Helicobacter pylori infection plays a protective role against inflammatory bowel disease by inducing systemic immune tolerance and suppressing inflammatory responses. The primary aim of the study was to determine the frequency of Helicobacter pylori in inflammatory bowel disease patients. A secondary aim was to investigate the relationship between inflammatory bowel disease and Helicobacter pylori infection. Materials and Methods: Patients over 18 years of age who were in follow-up with a diagnosis of inflammatory bowel disease and who underwent upper gastrointestinal system endoscopy for dyspepsia were included in the study and their data retrospectively analyzed. The control group consisted of patients who were not diagnosed with inflammatory bowel disease and had upper gastrointestinal system endoscopy for dyspepsia. For all patients, age; gender; and the presence of Helicobacter pylori, atrophic gastritis, and intestinal metaplasia as a result of pathological evaluation of biopsy samples taken by upper gastrointestinal system endoscopy were recorded. Both groups were compared in terms of Helicobacter pylori frequency and histopathological findings (presence of intestinal metaplasia and atrophic gastritis). Results: A total of 220 cases, including 160 inflammatory bowel disease and 60 controls, were included in the study. In all, 53.8% (n = 86) of inflammatory bowel disease patients were diagnosed with ulcerative colitis and 46.2% (n = 74) with Crohn’s disease. The rate of Helicobacter pylori was found to be significantly lower in the inflammatory bowel disease group compared with the control group (52.5% versus 73.3% and p = 0.005). The rate of atrophic gastritis was significantly lower in the inflammatory bowel disease group compared with the control group (3.1% vs 15% and p = 0.001). The intestinal metaplasia rate was significantly lower in the inflammatory bowel disease group compared with the control group (1.9% vs 11.7% and p = 0.002). Conclusion: Helicobacter pylori positivity was found at a significantly lower rate in the inflammatory bowel disease group. The presence of atrophic gastritis and intestinal metaplasia was found to be lower in the inflammatory bowel disease group. We believe that antibiotics used in the routine treatment of inflammatory bowel disease patients decrease the frequency of Helicobacter pylori and lead to less frequent development of atrophic gastritis and intestinal metaplasia.

Keywords:

Crohn, Helicobacter pylori, inflammatory bowel disease, ulcerative colitis,

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