Feryal İLKOVA, Kadir BAL, Rıza Umar GÜRSU, Ahmet DOBRUCALI, Ergun OKTAY, Arzu GÜNTÜRK, M. Murat TUNCER

Böbrek transplantasyonlu hastalarda gastrointestinal sisteme ait komplikasyonlar

Kronik böbrek yetersizliği hastalarında; mide kanaması başta, olmak üzere, artmış gastrointestinal komplikasyonlar gözlenmektedir. Gastrointestinal komplikasyonlar böbrek transplant alıcılarında morbidite ve mortalitede de önemli rol almaktadırlar. Çalışmamızda; Cerrahpaşa Tıp Fakültesi İç Hastalıkları Ana Bilim Dalı Transplantasyon bölümü tarafından izlenen ve 1985-1999 yılları arasında böbrek transplantasyonu geçiren 103 erkek, 37 kadın toplam 140 hasta retrospektif olarak incelenmiştir. Ortalama takip süresi 46.35±43.80 (1-156) aydı. 15 hastada (%10.71) sigara anamnezi saptandı. Hastaların hiçbir alkol kullanmamakta idi. 4 hastanın (%2.85) düzenli olarak NSAID kullandığı saptandı. Transplantasyon öncesi 23 hastada (%16.42) gastrointestinal sisteme ait yakınmalar mevcuttu. En çok görülen yakınma 14 hastada görülen karın ağrısı idi (%60.86). Transplantasyona hazırlık sırasında izlenen hastaların 71'i-ne (%50.71) üst GİS endoskopisi uygulandı. 22 hastanın (%30.98) endoskopik incelemesi normal sınırlarda idi. Endoskopik incelemede patoloji saptanan 49 hastanın (%69.01) 12'sinde (%24.48) gastroduodenit, 9'unda (% 18.36) duodenal ülser, 8'inde (% 16.32) gastrit, 6'sında (% 12.24) antral gastrit, 5'inde (% 10.20) duodenit, 4'er hastada (%8.16) gastroözefajiyal reflü ve peptik ülser, 2 vakada ise (%4.08) anemi saptandı. Yakınması olmayan hastalardan endoskopi yapılan 56 hastanın 38'inde (%67.85) patoloji gösterilmiştir. Transplantasyon öncesi 72 hastaya (%51.42) profilaktik olarak medikal tedavi başlanmış. En sık kullanılan ilaç 44 hastaya uygulanan bir H2 reseptör antagonisti olan famotidin idi (%61.11). Tedavi uygulanan hastaların 33'ünde (%45.83) transplantasyon sonrası gastrointestinal sisteme ait yakınmaları mevcut idi. Tedavi uygulanmayan 68 hastanın 12'inde (% 17.64) de bu tür yakınmalar saptandı. Bu iki verinin karşılaştırılması profilaktik tedavi verilmesi aleyhine bir sonuç çıkmıştır. Sonuç: Böbrek transplantasyonuna hazırlanan hastalarda sigara, alkol ve NSAID kullanımı ile gastrointestinal şikayetler arasında bir bağlantı mevcut değildir. Transplantasyona hazırlanan tüm hastalarda gizli GİS patolojileri atlanmaması için; semptom olsun olmasın endoskopik inceleme yapılmalı. Proflaktik olarak tedavi başlanmasının transplantasyon sonrası GİS semptomlar üzerine etkisinin olmaması nedeniyle; transplantasyon öncesi mutlaka mevcut GİS patolojinin tedavisinin tamamlanması ya da transplantasyon sonrasına ertelenmesi düşünülmelidir.

Gastrointestinal complications in renal transplant patients

Background and Design.- Gastrointestinal complications are very important in morbidity and mortality of renal transplant receivers in developed countries. In our study we retrospectively examined 140 patients (103 male and 37 female) who had renal transplantation from 1985 to 1999 in Cerrahpaşa Medical Faculty, Internal Medicine Department, Transplantation section. Results.- There were 15 patients who smoked cigarette continuously (10.71%). None of the patients had a story of alcohol using and 4 of them (2.85%) used analgesic drugs regularly. Story of gastrointestinal disturbances were found in 23 patients (16.42 %) before transplantation. Stomachache (14 patients) was the most seen disturbances in these patients (60.86%). During the preparation period for the transplantation; gastrointestinal endoscopy was made to 71 patients (50.71%), 22 of them (30.98%) was found to be normal. Pathologies found in 49 (69.01%) patients were; gastroduodenitis (12, 24.48%), duodenal ulcer (9, 18.36%), gastritis (8, 16.32%) antral gastritis (6, 12.24 %) duodenitis (5, 10.20%), gastrooesaphageal reflux and peptic ulcer (4 each, 8-16%). In 38 of 56 (67.85%) patients who had no complaints before transplantation, pathologies were found by endoscopic examination. Prophylactic medical treatment were given to 72 patients (51.42%) before transplantation. The most used drugs were H2 receptor antagonists. Conclusion.- In our study we found that there is no relationship between gastrointestinal complaints and smoking, alcohol drinking and analgesic using in chronic renal patients who were preparing for transplantation. To find gastrointestinal pathologies; endoscopic examination must be performed to every patient whether they have complaints or not and the pathology must be cured before the transplantation in order to prevent post transplant complications.

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