Kronik kabızlık ve diyet

Kabızlık bir hastalık olmayıp çeşitli belirti-bulgularla seyreden ve sindirim sistemini etkileyen önemli bir problemdir. Hekimler genellikle konstipasyonu dışkı sayısında azalma olarak tanımlarken, hastalar ise defekasyon ile ilgili yakınmalarının hepsini kabızlık olarak adlandırmaktadırlar. Ancak Roma III kriterlerine ve fizyopatolojisine göre kesin ve tam bir tanımlama yapılabilmiştir. Fizyopatolojik olarak; Çekuma ulaşan materyalin azlığı, kolonun ilerletici (propülsif) hareketinin bozulması ve defekasyonun bozulmasına yol açan nedenlerle kabızlık gelişmektedir. Kabızlığın oluşum mekanizmasına bağlı olarak kesin bir ayırım yapılamasa da; Kabızlıkla birlikte olan irritable barsak sendromu (Normal Geçişli), yavaş geçişli kabızlık ve defekasyon bozuklukları olarak 3 tipe ayrılmaktadır. Kabızlık etiyolojisinde nörotransmiterler, stres, medikal tedaviler, uyku düzeni ve diyet gibi birçok etken rol oynamaktadır. Posalı-lifli gıdalar çekuma ulaşan barsak içeriğini arttırarak kabızlığı engellemektedir. Bunun için bu derlemeden amacımız, kabızlığın 1 ve 2. tiplerinde diyetin önemini vurgulamaktır. Yavaş geçişli kabızlık hastaların %13-15’de, normal geçişli kabızlık ise hastaların %59’da görülmektedir. İyi bir anamnezle kabızlığa yol açan sekonder nedenler ortaya konulabilir. Batın ve anorektal bölge muayenesinden sonra özellikle kolon geçiş zamanı başta olmak üzere bazı radyolojik tetkikler yapılarak kesin tanı konulabilir. Tedaviye altta yatan sekonder nedenler düzeltildikten sonra başlanmalıdır. Hastalara verilecek medikal tedaviler yanında, lifli-posalı diyet, yeterli sıvı alımı ve egzersiz önerilmelidir. Yavaş geçişli kabızlıkta laksatiflerin yanında son zamanlarda geliştirilen Lubiprostone ve Tegaserod gibi ilaçlar kullanılmaya başlanmıştır. Ancak bu tedavilere rağmen kabızlığı düzelmeyen hastalara son çözüm yolu olarak özellikle son zamanlarda başarılı şekilde uygulanan laparoskopik cerrahi önerilmektedir.

[Chronic constipation and diet]

Constipation presented a lof of sign-symptoms is not a single disease and a disorder that affect colonic and anorectal function. Constipation is defined as decreased of defecation number by physicians and all of problems relation with defecation by patients. But a accurate and correct defitinition giving base on patophyslogically by Rome III criteria. As patophyslogically, constipation is improved by decreased material that will be reached cecum, decreased motility of colon and multiple results improving defecation disorders. Constipation can be divided irratable bowel syndrome with constipation (normal transit), slow transit constipation and defecation disorders but there is no accurate border in this classification. Neurotransmitters, stress, medical therapies, sleep and meals are association with etiology of constipation. A high fiber diet can reach easily to cecum and prevent constipation. Therefore aim of this review is to stress effect of fiber diet in the first and second type of constipation. Slow transit constipation in 13-15% patients and irratable bowel sendrom with constipation (normal transit) in 59% patients has being diagnosed. Seconder causes of constipation can be found with a good history taking from patients. Accurate diagnosis can be find with colon transit time followed by abdominal and pelvic examinitian. Treatment should be begin after correction of seconder causes. It should be recommendation to patients a high fiber diet, exercise, appropriate fluid with medical therapy. Lubiprostone and Tegaserod are used to begin for treatment of slow transit constipation. Laparoscopic surgery is recommened to patients not recoveried by medical therapy.

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