Diyaliz hastalarında irritabl barsak sendromu ve psikolojik belirti (SCL90-R) taraması
Küçük Resim Yok
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Cumhuriyet Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İrritabl Barsak Sendromu toplumda sık rastlanan, hayatı tehdit etmeyen, hayat kalitesini bozan ve ciddi ekonomik kayıplara yol açan, fonksiyonel bir barsak hastalığıdır. Kronik ve tekrarlayıcı karın ağrısı, diyare, kabızlık ve/veya karında şişkinlik ile tanımlanan bir gastrointestinal bozukluktur. İrritabl Barsak Sendromu prevalansı dünyada yaklaşık %10-15 kadardır. Diyaliz hastalarında gastrointestinal sistem semptomları ve genel semptomların oranı yüksektir. Bu gastrointestinal semptomlar arasında İrritabl Barsak Sendromu semptomları genel popülasyondan daha sıktır ve hemodiyaliz hastalarının %11-44' ünde görülür. Diyaliz hastaları diyalizin olağan sürecinde psikolojik stres altındadırlar. Majör depresyon ve anksiyetenin kronik böbrek hastalığı olan hastalarda yaygın olduğu bilinir. İrritabl Barsak Sendrom'lu hastalarda da psikiyatrik bozukluk sıklığı artmıştır. Bu çalışmada diyaliz hastalarında İrritabl Barsak Sendromu prevalansı, İrritabl Barsak Sendromu ile ilişkili faktörler ve hastalardaki psikopatolojilerin araştırılması amaçlandı. Çalışmaya hemodiyaliz ya da periton diyalizi programında olan 80 (%53,3) erkek, 70 (%46,7) kadın olmak üzere toplam 150 hasta dahil edildi. Hastaların 142(%94,6)'si hemodiyaliz ve 8(%5,4)'i periton diyalizi programındaydı. Çalışmada yer alan hastaların yaş ortalamaları 59,07±16,76 idi. Erkeklerin yaş ortalaması 58,50±17,08 ve kadınların yaş ortalaması 59,72±16.48 idi. Çalışmaya kilo kaybına eşlik eden gaitada gizli kan varlığı ya da ailede kolon kanseri öyküsü, kolon kanseri, son 1 ayda antibiyotik kullanımı, Crohn hastalığı, Ülseratif kolit, Çölyak hastalığı gibi bilinen gastrointestinal hastalığı olanlar dahil edilmedi. Ayrıca iskemik ayak ülseri ya da extremite iskemisi nedeniyle amputasyon öyküsü olanlar, son 6 ayda koroner revaskülarizasyon prosedürü uygulananlar, anjina pektoris, myokard enfarktüsü geçirenler ya da İrritabl Barsak Sendromu ayırıcı tanısındaki alarm semptom ve bulgularından herhangi birine sahip bireyler de çalışmaya dahil edilmedi. Hastaların sosyodemografik ve klinik özellikleri ile laboratuar sonuçları kaydedildi. İrritabl Barsak Sendromu tanısında Roma III tanı kriterleri kullanıldı. Hastalar tarafından Psikolojik Belirti Tarama Anketi dolduruldu. Puan hesaplamaları yapıldı. Veriler SPSS 22 programına yüklenerek istatistiksel analizler yapıldı. Çalışmada yer alan 150 diyaliz hastasının 59'unda (%39,3) İrritabl Barsak Sendromu bulundu. Çalışmadaki hemodiyaliz hastalarının 56'sında (%39,4) İBS var, 86'sında (%60,6) İBS yoktu. Periton diyalizi programındaki hastalardan 3'ünde (%37,5) İBS var, 5'inde (%62,5) İBS yoktu. İBS prevalansı açısından hemodiyaliz ve periton diyalizi hastaları arasında anlamlı fark yoktu (p>0.05). İrritabl Barsak Sendromu prevalansı kadın cinsiyette anlamlı olarak daha yüksek bulundu (p<0,05). Hastalar sosyodemografik özelliklerine göre değerlendirildiğinde anlamlı farklılığa neden olan başka bir parametreye rastlanmadı. Klinik özelliklerine göre değerlendirildiğinde İrritabl Barsak Sendrom'lu hastalarda Koroner Arter Hastalığı varlığı ya da eritropoietin kullanımı anlamlı oranda yüksek bulundu (p<0,05). Hastalarda İrritabl Barsak Sendromu prevalansıyla laboratuar parametreleri arasında anlamlı bir ilişki bulunamadı. İrritabl Barsak Sendromu olanlarla olmayanlar Psikolojik Belirti Tarama Anketi'nden aldıkları puanlara göre karşılaştırıldı. İrritabl Barsak Sendromu olanlarla olmayanlar arasında öfke ve paranoid düşünce açısından farklılık yoktu. Ancak İrritabl Barsak Sendrom'lu hastalarda depresyon, somatizasyon ve ek maddeler (uyku bozukluğu, iştah bozukluğu, suçluluk) alt parametrelerinde tarama puanları yüksek bulunmuştur. Diğer parametrelerde ise tarama için sınır değerin üzerinde olmamasına rağmen İrritabl Barsak Sendromu olanların puanları olmayanlardan daha yüksek bulunmuştur (p<0,05). Çalışmamızda diyalize giren, Kronik Böbrek Hastalığı olan hastalarda İrritabl Barsak Sendromu yaygın olarak bulunmuştur. Diyaliz hastalarında İrritabl Barsak Sendromu yönetimi planlanırken İrritabl Barsak Sendromu ile depresyon başta olmak üzere psikopatolojik birlikteliklerin de olabileceği göz önünde bulundurulmalıdır. Bu sayede tedavi başarısı arttırılabilir. Diyaliz hastalarında İrritabl Barsak Sendromu hakkında yeterli veri yoktur. Hatta İrritabl Barsak Sendrom'lu diyaliz hastalarında psikopatolojik durumlarla olan ilişki daha az bilinmektedir. Bu hasta grubunda İrritabl Barsak Sendromu risk faktörlerini ortaya koymak, komorbid durumları belirlemek için daha fazla çalışmaya ihtiyaç vardır. Anahtar Kelimeler: İrritabl Barsak Sendromu, Diyaliz Hastaları, Psikolojik Belirti Tarama Anketi(SCL 90-R)
Irritable Bowel Syndrome (IBS) is a frequently encountered functional bowel illness that does not threat lives but disrupts the quality of life and causes serious economical losses. It is a gastrointestinal disorder identified with chronic and repetitive abdominal pain, diarrhea, constipation and/or dyspesia. IBS prevelance is approximately 10-15% all around the world. Gastrointestinal system(GIS) symptoms in dialysis patients and general symptoms are high in rate. Among these GIS symptoms, IBS symptoms are more frequent than the general population and they ocur in 11-44% of hemodialysis patients. Dialysis patients are under psychological stress during the natural process of dialysis. It has been known that major depression and anxiety are common among the patients with chronic kidney ilness. Psychiatric disorder frequency in patients with IBS has increased. In this study, investigations of IBS prevelance in dialysis patients, factors related to IBS and psychopathologies in patients were targetted. 80 (53,3%) males and 70 (46,7%) females of total 150 patients in hemodialysis or periton dialysis program were included in the study. A total of 142 (%94,6) patients was on hemodialysis and 8 (%5,4) patients was on periton dialysis program. Mean age of patients was 59,07±16,76'years in this study. Mean age of men was 58,50±17,08 and mean age of women was 59,72±16.48 years. Individuals who had presence of fecal occult blood accompanied by weight loss or colon cancer history in the family, colon cancer, crohn disease, ulcerative colitis, common gastrointestinal illnesses such as gluten enteropathy and who used antibiotic in the last 1 month weren't included in the study. In addition, individuals who had amputation history due to ischemic foot ulcer or extreme ischemy and who received coronary revascularization procedure in the last 6 months, individuals with an angına pectoris or who had myocard infarct, or who had any of the findings or alarm symptoms of the Irritable Bowel Syndrome distinctive diagnosis were also excluded. The sociodemographic and clinical charasteristics of the patients together with their laboratory results were recorded. In the IBS diagnosis, Roma III diagnose criteria were conducted. SCL 90-R Psychologic Symptom Scan questionnarie was filled in by the patients. Scores were calculated. Statistical analysis were done after the data was installed in SPSS 22 program. IBS has been detected in 59 (%39,3) patients out of 150 dialysis patients included in the study. 56 (%39,4) hemodialysis patients have IBS, 86 (%60,6) hemodialysis patients do not have IBS according to the study. 3 (%37,5) of the patients have IBS, 5 (%62,5) of the patients do not have IBS in the periton dialysis program. There were not any significant differences between hemodialysis and periton dialysis patients in terms of IBS prevelance. IBS prevelance was found significantly higher in females (p<0,05). No other parameter causing a considerable difference was found when the patients were evaluated according to their sociodemographic charasteristics. When they were evaluated according to their clinical features, existence of KAH or erythropoietin usage was significantly high in IBS patients (p<0,05). The relation between IBS prevelance and laboratory parameters in patients were investigated and there was not any considerable parameter detected. Patients with and without IBS were compared in relation with their SCL 90-R scores. Patients with IBS and without IBS did not reveal any difference in accordance with Anger and Paranoid Thought. Yet, the scan scores in the subparameters of Depression, Somatization and supplementary elements (sleep disorder, appetite disorder, feeling guilty) of the patients with IBS were high. In the other parameters, for the scan although the limit was not above the value, the scores of the patients with IBS were higher than the ones without IBS (p<0,05). In our study, IBS is common among dialysis patients with CKD. While planning IBS management in dialysis patients, it should be considered that psychopathological alignments, chiefly IBS and depression, may ocur, as well. In this way, the success of the treatment could be improved. There is not enough data about IBS in dialysis patients. Moreover, the association with the psychopathologic cases in dialysis patients with IBS is known less. In this patient group, more study should be done to put forward IBS risk factors and to identify comorbid situations. Key words: Irritable Bowel Syndrome, Dialysis Patients, Psychological Symptom Scanning Questionarrie (SCL 90-R)
Irritable Bowel Syndrome (IBS) is a frequently encountered functional bowel illness that does not threat lives but disrupts the quality of life and causes serious economical losses. It is a gastrointestinal disorder identified with chronic and repetitive abdominal pain, diarrhea, constipation and/or dyspesia. IBS prevelance is approximately 10-15% all around the world. Gastrointestinal system(GIS) symptoms in dialysis patients and general symptoms are high in rate. Among these GIS symptoms, IBS symptoms are more frequent than the general population and they ocur in 11-44% of hemodialysis patients. Dialysis patients are under psychological stress during the natural process of dialysis. It has been known that major depression and anxiety are common among the patients with chronic kidney ilness. Psychiatric disorder frequency in patients with IBS has increased. In this study, investigations of IBS prevelance in dialysis patients, factors related to IBS and psychopathologies in patients were targetted. 80 (53,3%) males and 70 (46,7%) females of total 150 patients in hemodialysis or periton dialysis program were included in the study. A total of 142 (%94,6) patients was on hemodialysis and 8 (%5,4) patients was on periton dialysis program. Mean age of patients was 59,07±16,76'years in this study. Mean age of men was 58,50±17,08 and mean age of women was 59,72±16.48 years. Individuals who had presence of fecal occult blood accompanied by weight loss or colon cancer history in the family, colon cancer, crohn disease, ulcerative colitis, common gastrointestinal illnesses such as gluten enteropathy and who used antibiotic in the last 1 month weren't included in the study. In addition, individuals who had amputation history due to ischemic foot ulcer or extreme ischemy and who received coronary revascularization procedure in the last 6 months, individuals with an angına pectoris or who had myocard infarct, or who had any of the findings or alarm symptoms of the Irritable Bowel Syndrome distinctive diagnosis were also excluded. The sociodemographic and clinical charasteristics of the patients together with their laboratory results were recorded. In the IBS diagnosis, Roma III diagnose criteria were conducted. SCL 90-R Psychologic Symptom Scan questionnarie was filled in by the patients. Scores were calculated. Statistical analysis were done after the data was installed in SPSS 22 program. IBS has been detected in 59 (%39,3) patients out of 150 dialysis patients included in the study. 56 (%39,4) hemodialysis patients have IBS, 86 (%60,6) hemodialysis patients do not have IBS according to the study. 3 (%37,5) of the patients have IBS, 5 (%62,5) of the patients do not have IBS in the periton dialysis program. There were not any significant differences between hemodialysis and periton dialysis patients in terms of IBS prevelance. IBS prevelance was found significantly higher in females (p<0,05). No other parameter causing a considerable difference was found when the patients were evaluated according to their sociodemographic charasteristics. When they were evaluated according to their clinical features, existence of KAH or erythropoietin usage was significantly high in IBS patients (p<0,05). The relation between IBS prevelance and laboratory parameters in patients were investigated and there was not any considerable parameter detected. Patients with and without IBS were compared in relation with their SCL 90-R scores. Patients with IBS and without IBS did not reveal any difference in accordance with Anger and Paranoid Thought. Yet, the scan scores in the subparameters of Depression, Somatization and supplementary elements (sleep disorder, appetite disorder, feeling guilty) of the patients with IBS were high. In the other parameters, for the scan although the limit was not above the value, the scores of the patients with IBS were higher than the ones without IBS (p<0,05). In our study, IBS is common among dialysis patients with CKD. While planning IBS management in dialysis patients, it should be considered that psychopathological alignments, chiefly IBS and depression, may ocur, as well. In this way, the success of the treatment could be improved. There is not enough data about IBS in dialysis patients. Moreover, the association with the psychopathologic cases in dialysis patients with IBS is known less. In this patient group, more study should be done to put forward IBS risk factors and to identify comorbid situations. Key words: Irritable Bowel Syndrome, Dialysis Patients, Psychological Symptom Scanning Questionarrie (SCL 90-R)
Açıklama
Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Gastroenteroloji, Gastroenterology
