Arda DUMAN, Recep ALP, Dilek YAVUZER, Ülkü Türk BÖRÜ, Oya Uygur BAYRAMİÇLİ, Resat DABAK

Multipl sklerozda barsak hareket bozuklukları ve amiloidoz ile ilişkisi

Amaç: Bağırsak hareket bozuklukları, multipl sklerozlu (MS) hastalarda sık görülmektedir. Bu çalışmanın amacı, kolon geçiş zamanını araştırmak ve bununla birlikte bağırsak motilite bozukluklarının sıklığı, lezyonların yeri ile ilişkisi ve yineleyici multipl skleroz (RR-MS) hastalarında tekrarlayan amiloidoz varlığı ile ilişkisini irdelemektir. Yöntem: Bu çalışmaya klinik kesin yineleyici MS (RR-MS)’i bulunan 18 hasta dahil edildi. Bağırsak motilite bozuklukları ROMAII kriterlerine göre sınıflandırıldı ve tüm hastalara kolonoskopi yapıldı. Kolonoskopik biyopsi örnekleri amiloidoz varlığı açısından değerlendirildi. Colontransit 20 pelet ile kolon geçiş süreleri hesaplandı. Bulgular: Hastaların yaş ortalaması 34,3 yıl idi. Hastaların 12’si kadın ve 6’sı erkekti. Ortalama MS süresi 7,6 yıl ve genişletilmiş özürlülük durumu skoru (EDSS) ortalama 2,0 olarak bulundu. Hastaların 12’sinde kabızlık ve 3’ünde ishal bulundu. Hastalarda bağırsak motilite bozuklukları (kabızlık ve ishal) nükslerden 2±1 gün önce ortaya çıkmakta ve nüksler sırasında da devam etmekte idi. İstatistiksel olarak, bağırsak işlev bozukluğu ile atak sayısı arasında (p = 0,021) korelasyon saptandı. Kolon geçiş süresi ile atak sayısı ve MS süresi (sırasıyla p = 0,013, p = 0,006) arasında istatistiksel olarak anlamlı bir ilişki vardı ve buna ek olarak hiçbir hastanın biyopsisinde amiloidoz saptanmadı. Sonuç: Bu çalışmada, uzun süreli kolon geçiş zamanı ve yineleyici MS hastalarında bağırsak işlev bozukluğu(özellikle kabızlık) varlığını göstermektedir. Patofizyolojisi ise henüz tam bilinmemektedir.

Bowel motility disorders in multiple sclerosis and its relation to amyloidosis

Objective: Bowel motility disorders are frequent in multiple sclerosis (MS) patients. The objectives of this study are to investigate the colon transit time, the frequency of bowel motility disorders, their relation to the location of lesions and the presence of amyloidosis in relapsing remitting multiple sclerosis (RR-MS) patients. Methods: Eighteen patients with clinically defined RR-MS were included in this study. Bowel motility disorders were classified according to ROMA II criteria. All patients underwent colonoscopy. Colonoscopic biopsy specimens were evaluated for the presence of amyloidosis. Colonic transit times were calculated with Colontransit 20 pellets. Results: There were twelve women and six men in the study group with a mean age of 34.3 years. Mean duration of MS was 7.6 years. Median expanded disability state score (EDSS) was 2.0. Twelve multiple sclerosis patients had constipation and three had diarrhea. In eight patients, bowel motility disorders (constipation and diarrhea) appeared 2±1 days before the relapse and persisted during the relapses. Statistically, bowel dysfunction was significantly correlated with the number of relapses (p=0,021). Colon transit time had a statistically significant relation to the number of relapses and the duration of MS (p=0.013, p=0.006; respectively). None of the patients had amyloidosis. Conclusion: This study shows the presence of prolonged colon transit time and bowel dysfunction (especially constipation) in RR-MS patients. The pathophysiology of gastrointestinal motility disorders in MS is still controversial.

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