Filiz EREN, Erhun KASIRGA, Semin AYHAN, Gülseren ŞAHİN, Ayşegül CEBE, Fatih ÜNAL

Ülseratif kolit tanılı olgularımızın retrospektif olarak değerlendirilmesi

Giriş: İnflamatuvar barsak hastalıkları (İBH), gastrointestinal kanalın remisyon ve alevlenmeler ile seyreden kronik inflamatuvar hastalıklarıdır. Çalışmamızda İBH tanısı ile izlediğimiz hastaların klinik ve laboratuvar özelliklerinin geriye dönük olarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çocuk gastroenteroloji bölümlerimizce 7 yıldır İBH tanısı ile izlemleri yapılan 18 hastanın başvuru yakınmaları, demografik özellikleri ve beraberinde bulunan hastalıklar kayıtlardan incelendi. Fizik bakıda saptanan olağan dışı bulgular endoskopik bulgular, histopatolojik bulgular ve uygulanan tedaviler gözden geçirildi. Bulgular: Çalışmamıza alınan 18 hastanın tanı yaşı ortalamaları 13,6±2,9 yıl (10K, 8E) ve semptomların başlangıcından tanıya kadar geçen süre ortalama 6,9±4,5 aydı. Onyedi hasta ülseratif kolit (ÜK) ve bir hasta da intermediate kolit (İK) tanısı almıştı. İki hastada (%11) hastalık açısından pozitif aile öyküsü vardı. Tanı anında en sık başvuru yakınmaları karın ağrısı (%100), kanlı ishal (%94,5) ve tenezm (%44,4) olarak bulundu. Laboratuvar bulgularından CRP pozitifliği (%89), sedimantasyon yüksekliği (%83,3) ve demir eksikliği anemisi (DEA) (%77,7) en sık rastlanan bulgulardı. Kolonoskopik olarak en sık pankolit (%66,6) tutulumuna rastlandı. İBH’na eşlik eden diğer hastalıklar ise ailevi Akdeniz ateşi (FMF) (%11), çölyak hastalığı (ÇH) (%5,5) ve Helikobakter pylori gastriti (Hp) (%11) olarak bulundu. Pankolit tutulumu olan medikal tedaviye yanıtsız bir hastamıza (%5,5) ise kolektomi uygulandı. Sonuç: Ülkemizde çocukluk çağında İBH tanısı alan hasta sayısı her geçen gün artmaktadır. Yine de nonspesifik semptomlar ile seyreden hastaların tanınması güç olabilmekte ve tanı gecikmelerine neden olabilmektedir. İBH’nın otoimmün hastalıklar ile birlikteliği nedeniyle uygun tedaviye rağmen remisyon sağlanamayan hastalarda gastrointestinal inflamasyonla giden FMF gibi hastalıklar da araştırılmalıdır. (Güncel Pediatri 2012; 10: 17-23)

Retrospective evaluation of cases diagnosed with ulcerative colitis

Introduction: Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal canal characterised by remissions and exacerbations. This study aimed to make a retrospective evaluation of clinical and laboratory findings of patients being monitored with a diagnosis of IBD. Materials and Methods: Medical records of 18 patients with a diagnosis of IBD and 7 years of follow-up at our pediatric gastroenterology departments were investigated with respect to demographic data, complaints on presentation and accompanying diseases. Unusual findings from physical examination, endoscopic findings, histopathological findings and the applied treatments were examined. Results: The 18 patients (10 female, 8 male) included in this study had a mean age of 13.6±2.9 years and the mean time from onset of symptoms to diagnosis was 6.9±4.5 months. Seventeen patients were diagnosed with ulcerative colitis and 1 patient with intermediate colitis. There was a positive family history of the disease in 2 patients (11%). At the time of diagnosis, the most common complaints on presentation were found to be abdominal pain (100%), bloody diarrhea (94.5%) and tenesmus (44.4%). The most frequent laboratory findings were CRP positivity (89%), increased sedimentation rate (83.3%) and iron-deficient anaemia (77.7%). On colonoscopy, pancolitis involvement (66.6%) was most frequently encountered. Accompanying diseases to IBD were found to be familial Mediterranean fever (FMF) (11%), celiac disease (5.5%) and Heliobacter pylori gastritis (5.5%). One patient (5.5%) who did not respond to medical treatment for pancolitis involvement underwent a colectomy. Discussion: The number of diagnoses of IBD in childhood is gradually increasing. Nonetheless, it can be difficult to define diseases with non-specific symptoms and this may cause a delay in diagnosis. Because of the association of autoimmune diseases with IBD, despite appropriate therapy, diseases with no remission which lead to gastrointestinal inflammation, such as FMF, should be further investigated. (Journal of Current Pediatrics 2012; 10: 17-23)

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