NALAN GÜLŞEN ÜNAL, Ali ŞENKAYA, Ferit ÇELİK, Seymur ASLANOV, Ahmet Ömer ÖZÜTEMİZ

Klinik remisyondaki ülseratif kolit hastalarında anemi sıklığı, sebepleri ve ilişkili faktörler

Amaç: Ülseratif kolit (ÜK) inflamatuar bağırsak hastalığı alt tipidir. Anemi, ÜK’de en sık görülen ekstraintestinal bulgudur. Bu çalışmada amaç klinik remisyondaki ÜK hastalarında anemi sıklığı, sebepleri ve ilişkili faktörlerin saptanmasıdır. Gereç ve Yöntem: Bu çalışma kesitsel bir çalışmadır. Ocak-Temmuz 2019 arasında Gastroenteroloji kliniğinde ÜK tanısı ile ayaktan takip edilen ve klinik remisyonda 265 ÜK hastası çalışmaya alınmıştır. Klinik remisyon, parsiyel Mayo skoru 2'den küçük olarak kabul edilmiştir. Ülseratif kolit tutulumu Montreal’e göre E1, E2 ve E3 olarak gruplanmıştır. Yeni tanı ÜK, 18 yaş'tan küçük, klinik aktivite ve gebe olanlar çalışmadan dışlanmıştır. Demografik, klinik ve laboratuvar veriler kaydedilmiştir. Anemi tanısı, DSÖ’ye göre; hemoglobin, erkeklerde 13 g/dL'den küçük, kadınlarda 12 g/dL'den küçük olarak kabul edilmiştir. ECCO kılavuzuna göre, aktif hastalığı olmayanlarda serum ferritin 30 μg/L'den küçük demir eksikliği anemisi (DEA), ferritin 100μg/L'den büyük ve transferrin %20'den küçük kronik hastalık anemisi (KHA), ferritin 30-100 μg/L DEA+KHA, B12/folat eksikliği ile MCV 100 fL'den büyük megaloblastik anemi olarak tanımlanmıştır. Anemi olmaksızın serum demir, B12 ve folatın normalin alt sınırı altında olması eksiklik olarak tanımlanmıştır. Bulgular: Hastaların ortalama yaşı 48,2±15,2 yıl, 154'ü (% 58) erkek, ortalama hastalık süresi 11,4±7 yıl, 98'inde (%37) anemi, 76'sında (%28,7) anemisiz demir, B12 veya folat eksikliği vardı. Hastaların 63’ü (%23,8) DEA, 4’ü (%1,5) KHA, 19’u (%7,2) DEA+megaloblastik anemi, 12’si (%4,5) DEA+KHA, 67’si (%25,2) demir eksikliği, 7’si (%2,6) B12, 2’si (%0,75) folat eksikliğidir. Anemi olan ve olmayan gruplar arasında cinsiyet, hastalık süresi, tutulum, tedavi, CRP ve albümin düzeyleri arasında anlamlı fark saptandı (p küçük 0,05). Sonuç: Bu çalışma aneminin klinik remisyondaki ÜK hastalarında bile sık olduğunu ve kılavuzlara göre taranması gerekliliğini vurgulamıştır.

Anahtar Kelimeler:

inflamatuar, bağırsak hastalığı, ülseratif kolit, remisyon, anemi

ANEMIA PREVALENCE, CAUSES AND RELATED FACTORS AMONG ULCERATIVE COLITIS PATIENTS IN CLINICAL REMISSION

Objective: Ulcerative colitis (UC) is a subtype of inflammatory bowel disease. Anemia is the most common extraintestinal finding in UC. The aim of this study is to determine the frequency, causes and related factors of anemia in UC patients with clinical remission. Materials and Methods: This is a cross-sectional study. Total 265 UC patients followed up in Gastroenterology Unit between January-July 2019 were included. Clinical remission was defined as partial Mayo scores less than 2. Ulcerative colitis extention was grouped as E1, E2 and E3 according to Montreal. New diagnose, less than 18 years, clinical activity, pregnancy were excluded. According to WHO; Hb less than 13 g/dL in men and less than 12 g/dL in women were accepted as anemia. According to ECCO guidelines, anemia was categorized as follows; serum ferritin less than 30 μg/L iron deficiency anemia (IDA), ferritin greater than 100 μg/L and transferrin less than 20% chronic disease anemia (CDA), ferritin 30-100 μg/L IDA+CDA, MCV greater than 100 fL with B12/folate deficiency megaloblastic anemia. Serum iron, B12, folate deficiencies were defined as levels under the lower limit of normal without anemia. Results: Mean age was 48.2±15.2, mean disease duration was 11.4±7 years, 154(58%) were male. Total 98 (37%) patients had anemia, 76(28.7%) had iron, B12 or folate deficiency. Total 63 (23.8%) patients had IDA, 4 (1.5%) CDA, 12 (4.5%) IDA+CDA, 19 (7.2%) IDA+megaloblastic anemia. Deficiencies of iron, B12 and folate without anemia were defined in 67(25.2%), 7 (2.6%) and 2 (0.75%) patients consecutively. There were significant differences between anemic and non-anemic groups according to gender, disease duration, extention, treatment, CRP and albumin levels (p less than 0.05). Conclusion: These study results show that anemia is frequent among UC patients even in clinical remission. Anemia should be screened according to guidelines.

Keywords:

Inflammatory bowel disease, ulcerative colitis, remission, anemia,

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