İnflamatuvar Bağırsak Hastalıkları ve Anemi İlişkisi

İnflamatuvar bağırsak hastalıkları (İBH), temelde ülseratif kolit (ÜK) ve Crohn hastalığını (CH) içermektedir. Genellikle genetik olarak duyarlı kişilerde ortaya çıkan, etiyolojisi tam olarak bilinmeyen, primer olarak gastrointesinal (GI) sistemi tutan, kronik seyirli, bir tablodur. Anemi, İBH hastalarında sıklıkla göz ardı edilen yaygın bir komplikasyondur ve patogenezi (inflamasyon, demir, B12 ve folik asit eksikliği, myelosupresyon) multifaktöriyeldir. Inflamatuvar bağırsak hastalarında kronik hastalıklar anemisinin (KHA) etiyolojisi eritropoezin farklı düzeylerde bozulmasıdır. Kronik hastalıklar anemisi, eritrositlerin parçalanması ile ortaya çıkan demirin retiküloendotelyal sistemdeki (RES) makrofajlar ve dentritik hücreler tarafından tutulması ve eritroid öncül hücrelere sunulamamasıyla meydana gelmektedir. Tüm bu mekanizmalar fonksiyonel demir eksikliğine neden olmakta, vücutta demir olmasına rağmen eritropoezis için kullanılamamaktadır. Bunun nedeni olarak vücuta kronik bir inflamasyon olması ve bu hastalığın tedavisinde kullanılan ilaçların olumsuz etkilerinin neden olduğu bildirilmektedir. Son yıllarda bu hastalıklarda belirgin bir artış dikkati çekmektedir ve deneysel anlamda bir çok çalışma yapılmasına rağmen, klinik pratikte tam bir tedavi sağlayabilen ajan bulunamamıştır. İBHnin tedavisi büyük oranda medikal tedavidir ve kanıt düzeyinde protokol oluşturulan bir tıbbi beslenme tedavisi henüz yoktur. Bu derleme makalede, ÜK ve CH seyrinde sıklıkla ortaya çıkan anemi patogenezinin yanısıra, hastalığın remisyonunda önerilen tıbbi beslenme tedavisinin literatür verileri ışığında gözden geçirilmesi amaçlanmıştır.

Relationship Between Inflammatory Bowel Diseases and Anemia

Inflammatory bowel diseases (IBD) comprise two main distinct clinical entities: Crohns disease (CD) and ulcerative colitis (UC). These diseases occur in genetically susceptible individuals,influence gastrointestinal system are generally idiopatic. Anemia, a frequent systemic complication in patients with inflammatory bowel disease (IBD), has a complex and multifactorial pathogenesis (inflammation, iron, B12 and folic acid deficiencies, myelosuppression). Etiology of anemia of chronic disease in IBD is corruption at different levels of erythropoiesis. Anemia of chronic disease occurs when iron formed after destruction of erythrocytes is held in macrophages and dendritic cells in the reticuloendothelial system (RES) instead of being transferred to the erythroid progenitor cells. All these mechanisms are functional iron deficiency causes. Although in this case the iron in the body is not available for erythropoiesis. It was reported that presence of chronic inflammation in the body and negative effects of the drugs used in the treatment cause this situation. Recently there is a significant increase in prevalence of IBD but although many experimental studies have been performed, no agent could be found providing a complete cure in clinical practice. Treatment of IBD is mostly medical; there isnt any evidence based protocol for medical nutrition therapy. In this review article , we aimed to evaluate the pathogenesis of anemia which frequently appears in the course of UC and CH and also medical nutrition treatment advised in remission of the disease in the light of the literature data.

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