M. Çağdaş EKER, Elmas KASAP, HAYRİYE ELBİ, Serhat BOR

İrritabl barsak sendromu hastalarında cinsel-fiziksel istismar sıklığı ve majör depresif bozukluk öyküsü tanı ilişkisi

Amaç: İşlevsel bir barsak hastalığı olan irritabl barsak sendromu (İBS) gastroenterologlara en sık başvuru nedenlerindendir. İBS�nin etiyolojisine ilişkin birçok açıklamanın yanı sıra, başta majör depresif bozukluk (MDB) olmak üzere birçok psikiyatrik bozuklukla olan birlikteliğine dikkat çekilmektedir. Cinsel ve fiziksel istismara uğramış olmanın da İBS riskini artırdığı öne sürülmektedir. Yöntem: Bu çalışmada İBS hastaları ile İBS olmayan kontrol olguları arasında cinsel ve fiziksel istismar öyküsü veya MDB öyküsünün sıklığı açısından fark olup olma-dığı araştırılmıştır. Çalışmaya 54 İBS hastası ile 30 kişilik kontrol grubu alınmıştır (Ortalama yaş İBS grubunda 41±11, kontrol grubunda 34±12 yıl; p0.05) veya fiziksel istismar (İBS grubunda %19, s=10; kontrol grubun-da %13, s=4); p>0.05) öyküsü bakımından iki grup arasında fark saptanmamıştır. Tartışma: İBS�na MDB sıklıkla eşlik etmektedir, bu birliktelik iki bozukluğun etiyopatogenezlerinde ortak noktalar olabileceğini düşündürmektedir. Cinsel ve fiziksel istismar öyküsünün ise bu birlikteliğe katkısı tartışmalıdır. Çalışmamızda cinsel ve fiziksel istis-mara uğrama öyküsünün İBS hastalarında daha sık saptanmamış olması, istismarın İBS gelişiminde bizim hasta larımız için birincil önem taşımadığını düşündürmüştür.

The frequency of sexual-physical abuse history in irritabl bowel syndrome patients and diagnostic relation with major depressive disorder history

Objective: IBS is a functional disorder which is one of the most common causes of gastroentrology doctor visits. Besides multiple factors suggested for the etiology of IBS, the co-morbidity of psychiatric illnesses, of which MDD is most the frequent, is also noted. Being exposed to sexual or physical abuse is also considered as a risk factor for the development of IBS. Methods: In this study the differences between IBS patients and non-IBS control cases are evaluated regarding the history of major depressive disorder and sexual or physical abuse. Fiftyfour IBS and thirty control cases (mean age for IBS patients 41±11; for control group 34±12 years; p<0.05) were recruited for the study. Results: IBS patients had a history of MDD more frequently than the control cases (69% for the IBS group, n=37; 30% for the control group, n=9; p<0.001]. However, two groups did not differ regarding the history of sexual abuse (20% for the IBS group, n=11; (13% for the control group, n=4; p>0.05) or physical abuse (19% for the IBS group, n=10; 13% for the control group, n=4; p>0.05). Discussion: IBS and MDD are frequently co-morbid and this co-morbidity suggests a possible common point for the etiopathogenesis for both disorders. Nevertheless, the contribution of sexual or physical abuse to the co-morbidity of these disorders seems to be inconclusive. It can be suggested that sexual and physical abuse history do not have fundemental importance for the development of IBS in our patients.

___

1.Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther 1997; 11:1019-1030.
2.Garakani A, Win T, Virk S, Gupta S, Kaplan D, Masand PS. Comorbidity of irritable bowel syndrome in psychiatric patients: a review. Am J Ther 2003; 10:61-67.
3.Talley NJ. Irritable Bowel Syndrome. Intern Med J 2006; 36:724-728.
4.Celebi S, Acik Y, Deveci SE, Bahcecioglu IH, Ayar A, Demir A, Durukan P. Epidemiological features of irritable bowel syndrome in a Turkish urban society. J Gastroenterol Hepatol 2004; 19:738-743,
5.Yilmaz S, Dursun M, Ertem M, Canoruc F, Turhanoğlu A. The epidemiological aspects of irntable bowel syndrome in Southeastern Anatolia: a stratified randomised community-based study. Int J Clin Pract 2005; 59:361-369.
6.Talley NJ, Spiller R. Irntable bowel syndrome: a little understood organic bowel disease? Lancet 2002; 360:555-564.
7.Spiller R. Serotonin, inflammation, and IBS: fitting the jigsaw together? J Pediatr Gastroenterol Nutr 2007; 45:S115-119.
8.Piche T, Saint-Paul MC, Dainese R, Marine-Bar-joan E, lannelli A, Montoya ML, et al. Mast cells and cellularity of the colonic mucosa correlated with fatigue and depression in irritable bowel syndrome. Gut 2008; 57:468-473.
9.Creed F ve Guthrie E. Psychological factors in the irritable bowel syndrome. Gut 1987; 28:1307-1318.
10.Lydiard B. Irntable bowel syndrome, anxiety, and depression: what are the links? J Clin Psychiatry 2001; 62(Suppl. 8):38-45.
11.Mertz H. Role of the brain and sensory pathways in gastrointestinal sensory disorders in humans. Gut 2002; 51(Suppl.1):i29-33.
12.Leserman J, Drossman DA. Relationship of abuse history to functional gastrointestinal disorders and symptoms: some possible mediating mechanisms. Trauma Violence Abuse 2007; 8:331-843.
13.Kocacık F, Doğan O. Domestic violence against women in Sivas, Turkey: survey study. Croat Med J 2006; 47:742-749.
14.Akyüz G, Kuğu N, Doğan O, Özdemir L. Bir psikiyatri polikliniğine bşvuran evli kadın hastalarda aile içi şiddet, evlilik sorunları, başvuru yakınması ve psikiyatrik tanı. Yeni Symposium 2002; 40:41-48.
15.Şar V, Akyüz G, Kundakçi T, Kızı İtan E, Doğan 0. Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry 2004; 161:2271-2276.
16.Vahip I, Doğanavşargil 0. Aile içi fiziksel şiddet ve kadın hastalarımız. Türk Psikiyatri Derg 2006; 17:107-114.
17.Yildizhan R, Adali E, Kolusari A, Kurdoglu M, Yildizhan B, Şahin G. Domestic violence against infertile women in a Turkish setting. Int J Gynaecol 0bstet2009; 104:110-112.
18.Amerikan Psikiyatri Birliği. Mental Bozuklukların Tanısal ve Sayımsal El Kitabı, dördüncü baskı (DSM-IV). E Köroğlu (Çev. Ed.), Ankara, Hekimler Yayın Birliği, 1995.
19.Özkürkçügil A, Aydemir Ö, Yıldız M, Esen Danacı A, Köroğlu E. DSM-IV eksen I bozuklukları için yapılandırılmış klinik görüşmenin Türkçe'ye uyarlanması ve güvenilidik çalışması. İlaç ve Tedavi Dergisi 1999; 12:233-236.
20.Leserman J, Drossman DA, Li Z. The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders. BehavMed 1995; 21:141-150.
21.Leserman J, Drossman DA, Li Z, Toomey TC, Nachman G, Glogau L. Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med 1996; 58:4-15.
22.Leserman J, Li Z, Drossman DA, Toomey TC, Nachman G, Glogau L. Impact of sexual and physical abuse dimensions on health status: development of an abuse severity measure. Psychosom Med 1997; 59:152-160.
23.Talley NJ, Boyce PM, Jones M. Predictors of health care seeking for irntable bowel syndrome: a population based study. Gut 1997; 4:394-8.
24.Guthrie E, Creed F, Fernandes L, Ratcliffe J, Van Der Jagt J, Martin J, et al. Cluster analysis of symptoms and health seeking behaviour differentiates subgroups of patients with severe irntable bowel syndrome. Gut 2003; 52:1616-1622.
25.Koloski NA, Talley NJ, Boyce PM. A history of abuse in community subjects with irritable bowel syndrome and functional dyspepsia: the role of other psychosocial variables. Digestion 2005; 72:86-96.
26.Wittchen HU, Fröhlich C. Epidemiology of depression. S Kasper (Ed.), A New Pharmacological Approach to the Treatment of Major Depression, Paris, Elsevier SAS, 2006, p.27-56.
27.Blanchard EB, Scharff L, Schwarz SP, Suls JM, Barlow DH. The role of anxiety and depression in the irritable bowel syndrome. Behav Res Ther 2005; 28:401-405.
28.Toner BB, Garfinkel PE, Jeejeebhoy KN. Psychological factors in irritable bowel syndrome. Can J Psychiatry 1990; 35:158-161.
29.Lydiard RB, Fossey MD, Marsh W, Ballenger JC. Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics 1993; 34:229-234.
30.Walker EA, Gelfand AN, Gelfand MD, Katon WJ. Psychiatric diagnoses, sexual and physical victimization, and disability in patients with irritable bowel syndrome or inflammatory bowel disease. Psychol Med 1995; 25:1259-1267.
31.Ladep NG, Obindo TJ, Audu MD, Okeke EN, Malu AO. Depression in patients with irritable bowel syndrome in Jos, Nigeria. World J Gastroenterol 2006; 12:7844-7847.
32.Creed F. The relationship between psychosocial parameters and outcome in irritable bowel syndrome. Am J Med 1999; 107(5A):74S-80S.
33.Mayer EA, Craske M, Naliboff BD. Depression, anxiety, and the gastrointestinal system. J Clin Psychiatry 2001; 62(Suppl.8):28-36.
34.North CS, Hong BA, Alpers DH. Relationship of functional gastrointestinal disorders and psychiatric disorders: implications for treatment. World J Gastroenterol 2007; 13:2020-2027.
35.Henningsen P, Zimmermann T, Sattel H. Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psycho-som Med 2003; 65:528-533.
36.Henningsen P, Herzog W. Irritable bowel syndrome and somatoform disorders. J Psychosom Res 2008; 64:625-629.
37.Weston AP, Biddle WL, Bhatia PS, Miner PB Jr. Terminal ileal mucosal mast cells in irritable bowel syndrome. Dig Dis Sci 1993; 38:1590-1595.
38.Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walters SJ, Underwood JE, Read NW. The role of psychological and biological factors in postinfective gut dysfunction. Gut 1999; 44:400-406.
39.Wang LH, Fang XC, Pan GZ. Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut 2004; 53:1096-1101.
40.Castagliuolo I, Lamont JT, Qiu B, Fleming SM, Bhaskar KR, Nikulasson ST, Kornetsky C, Pothoulakis C. Acute stress causes mucin release from rat colon: role of corticotropin releasing factor and mast cells. Am J Physiol 1996; 271(5Pt1):G884-892.
41.Anisman H, Merali Z, Poulter MO, Hayley S. Cytokines as a precipitant of depressive illness: animal and human studies. Curr Pharm Des 2005; 11:963-972.
42.Varghese AK, Verdú EF, Bercik P, Khan Wl, Blennerhassett PA, Szechtman H, Collins SM. Antidepressants attenuate increased susceptibility to colitis in a murine model of depression. Gastroenterology 2006;130:1743-1753.
43.Weaver ICG, Diorio J, Seckl JR, Szyf M, Meaney M. Early environmental regulation of hippocampal glucocorticoid receptor gene expression. Characterization of intracelluar mediators and genomic target sites. Ann NY Acad Sci 2004; 1024:182-212.
44.Korosi A, Baram TZ. The central corticotropin releasing factor system during development and adulthood. Eur J Pharmacol 2008; 583:204-214.
45.Martinez V, Taché Y. CRF1 receptors as a therapeutic target for irritable bowel syndrome. Curr Pharm Des 2006; 12:4071-4088.
46.Mayer EA. Commentary on peripheral and central contributions to hyperalgesia in irritable bowel syndrome. J Pain 2006; 7:539-541.
47.Mayer EA, Tillisch K, Bradesi S. Review article: modulation of the brain-gut axis as a therapeutic approach in gastrointestinal disease. Aliment Pharmacol Ther 2006; 24:919-933.
48.Stam R, Croiset G, Akkermans LM, Wiegant VM. Sensitization of the colonic response to novel stress after previous stressful experience. Am J Physiol 1996; 271 (5Pt2):R1270-1273.
49.Fukudo S, Nomura T, Hongo M. Impact of corticotropin-releasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome. Gut 1998; 42:845-849.
50.Nadelson CC. Vulnerability and response to trauma in women: developmental issues. E Nersessian, RG Kopff Jr. (Ed.), Textbook of Psychoanalysis, Washington DC, American Psychiatric Press, 1996, p. 669-690.