İnflamatuar barsak hastalığında osteoporoz
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Date
2016
Authors
Avcı, Mustafa
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
İnflamatuar barsak hastalıkları (İBH), gastrointestinal kanalın çeşitli bölge ve katmanlarını tutabilen, remisyon ve alevlenmelerle seyreden, kronik inflamasyon sonucu gelişen bir gastrointestinal sistem (GİS) hastalığıdır. Ülseratif kolit (ÜK), Crohn hastalığı (CH) ve her ikisinden ayırt edilemeyen indetermine kolit de (İK) bu grupta yer alır. İBH etiyolojisinden genetik, çevresel koşullar ve konak immün cevabı gibi faktörler sorumludur. İnflamatuar barsak hastalıkları klinik, endoskopik ve histolojik özellikleri ile teşhis edilirler. İnflamatuar barsak hastalığı olan hastalarda düşük kemik mineral yoğunluğu (KMY) prevalansı normal olgularla karşılaştırıldığında daha yüksek bulunmuştur. İnflamatuvar barsak hastalıklarında düşük kemik yoğunluğu etyolojisinin bir ölçüde kortikosteroid (KS) kullanımı ile ilişkili olduğuna inanılmaktadır. Bununla birlikte, KS'lerin genellikle aralıklı olarak, kısa süreli yüksek dozun ardından hızla azaltılarak kullanılıyor olması nedeniyle İBH hastalarında düşük kemik yoğunluğu etyolojisi yalnızca KS kullanımına bağlı olmayıp, bu çok faktörlü sürece malabsorbsiyon nedeniyle D vitamini eksikliği, seks hormonları, hastalık aktivitesiyle ilişkili inflamatuar sitokinler ve düşük vücut kitle indeksi (VKİ) gibi faktörlerin katkıda bulunabileceğine yönelik görüşler vardır. Bu çalışmaya Uludağ Üniversitesi Tıp Fakültesi Hastanesi Gastroenteroloji polikliniğine 01.01.2014 - 20.10.2015 tarihleri arasında başvurmuş olan 52 Ülseratif kolit ve 23 Crohn hastalığı olan toplam 75 inflamatuar barsak hastası alındı. Hastalara femur ve vertebra DEXA ölçümleri 1 kez yapıldı. Değerlendirmede lomber total T ve Z, femur boyun T ve Z skorları ele alındı. Genç erişkine göre; T skor değeri 1 standart sapmaya (SD) kadar olanlar normal (+1 ile -1 arasında), T skor değeri -1 SD'den küçük ise osteopeni (-1 ile -2.5 arasında), T skor değeri -2.5 SD'den küçük ise osteoporoz göstergesi olarak kabul edildi. Hastalar arasında cinsiyet dağılımı, yaş ortalaması ve VKİ açısından anlamlı fark yoktu (p>0.05). Crohn ve Ülseratif kolit hasta gruplarında kemik mineral yoğunlukları açısından anlamlı fark saptanmadı (p>0.05). Hem ÜK hem de Crohn hastalarında erkek ve kadın cinsiyetler arasında KMY ölçümleri bakımından anlamlı fark yoktu (p>0.05). Yine ÜK ve Crohn hastalarında hastalık aktivitesi ve uzun hastalık yaşı ile KMY arasında anlamlı ilişki saptanmadı (p>0.05). Operasyon geçirmiş olmakla Crohn hastalarında anlamlı ilişki saptanmamasına rağmen (p>0.05), ÜK hastalarında operasyon durumu ile düşük KMY arasında anlamlı istatistiksel ilişki izlendi (p<0.05). Kümülatif dozda (>5g) kortikosteroid kullanımıyla Crohn ve ÜK hastalarında KMY arasında ilişki görülmedi (p>0.05). Bulgularımızda yalnızca opere olmuş ÜK hastalarında kemik mineral yoğunluğunun anlamlı şekilde azaldığı saptanmıştır. İnflamatuvar barsak hastalığı ve osteoporoz arasındaki multifaktöriyel ilişkinin netlik kazanabilmesi için hasta sayısının daha fazla olduğu ve daha fazla değişkenin dahil edildiği kapsamlı çalışmaların yapılması yararlı olacaktır.
Inflammatory bowel disease (IBD) is a chronic gastrointestinal system disorder develops a result of chronic inflammation involving various portions and layers of gastrointesinal tractus and presenting remisions and exacerbations. Ulcerative colitis (UC), Crohn disease (CD) and indeterminate colitis (IC) which can not be distinguished from both are involved in IBD. Factors in genetics, environment and host immune response are responsible for etiology of inflammatory bowel disease. IBD is diagnosed by clinical, endoscopic and histologic features. Patients with IBD have an increased prevalence of reduced bone mineral density (BMD) compared with healthy controls. Although the reduced bone mineral density in IBD patients is thought to be related to natural attitude of disease, the use of long-standing and high dose of corticosteroids may play a role in this situation. However, steroids are usually spaced a short term to be used rapidly reduced after high-dose. Low bone density etiology of IBD patients is not only due to the use corticosteroids, this multifactorial malabsorption process due to vitamin D deficiency, sex hormones, inflammatory associated with disease activity and cytokines are opinions for could contribute to factors such as low body mass index. In this study, who were admitted to Gastroenterology policlinic of Uludag University Medical Faculty Hospital between 01/01/2014 - 10/20/2015 dates, 52 ulcerative colitis and 23 Crohn disease total of 75 inflammatory bowel patients were taken. Dual energy X-ray absorbtiometry (DEXA) was used to determine bone density and measurements were taken at vertebra and femoral neck. Measurements that were 1 standard deviation below the controls (t score -1SD) were considered as osteopenia and 2.5 standard deviations below the controls ( -2.5) were considered as osteoporosis. There was no significant difference about gender distribution, age and BMI among patients (p>0.05). Crohn's disease and ulcerative colitis patients was no significant difference in bone mineral density (p>0.05). Both ulcerative colitis and crohn disease there were no significant differences in BMD measurements in men and women between the sexes (p>0.05). Also there was no significant difference in BMD between disease activity and longer disease duration (p>0.05). Although no significant relationship was found to have undergone surgery in Crohn's disease patients (p>0.05), were observed in UC patients a statistically significant relationship between operating conditions with low BMD (p<0.05). There was no relationship between BMD and cumulative doses (> 5g) corticosteroid use in Crohn and UC patients (p>0.05). Our findings are only found that the bone mineral density significantly reduced in UC patients were operated. Inflammatory bowel disease and the number of patients in order to acquire more clarity multifactorial osteoporosis and more comprehensive studies of the relationship between variables to be included would be useful to do.
Inflammatory bowel disease (IBD) is a chronic gastrointestinal system disorder develops a result of chronic inflammation involving various portions and layers of gastrointesinal tractus and presenting remisions and exacerbations. Ulcerative colitis (UC), Crohn disease (CD) and indeterminate colitis (IC) which can not be distinguished from both are involved in IBD. Factors in genetics, environment and host immune response are responsible for etiology of inflammatory bowel disease. IBD is diagnosed by clinical, endoscopic and histologic features. Patients with IBD have an increased prevalence of reduced bone mineral density (BMD) compared with healthy controls. Although the reduced bone mineral density in IBD patients is thought to be related to natural attitude of disease, the use of long-standing and high dose of corticosteroids may play a role in this situation. However, steroids are usually spaced a short term to be used rapidly reduced after high-dose. Low bone density etiology of IBD patients is not only due to the use corticosteroids, this multifactorial malabsorption process due to vitamin D deficiency, sex hormones, inflammatory associated with disease activity and cytokines are opinions for could contribute to factors such as low body mass index. In this study, who were admitted to Gastroenterology policlinic of Uludag University Medical Faculty Hospital between 01/01/2014 - 10/20/2015 dates, 52 ulcerative colitis and 23 Crohn disease total of 75 inflammatory bowel patients were taken. Dual energy X-ray absorbtiometry (DEXA) was used to determine bone density and measurements were taken at vertebra and femoral neck. Measurements that were 1 standard deviation below the controls (t score -1SD) were considered as osteopenia and 2.5 standard deviations below the controls ( -2.5) were considered as osteoporosis. There was no significant difference about gender distribution, age and BMI among patients (p>0.05). Crohn's disease and ulcerative colitis patients was no significant difference in bone mineral density (p>0.05). Both ulcerative colitis and crohn disease there were no significant differences in BMD measurements in men and women between the sexes (p>0.05). Also there was no significant difference in BMD between disease activity and longer disease duration (p>0.05). Although no significant relationship was found to have undergone surgery in Crohn's disease patients (p>0.05), were observed in UC patients a statistically significant relationship between operating conditions with low BMD (p<0.05). There was no relationship between BMD and cumulative doses (> 5g) corticosteroid use in Crohn and UC patients (p>0.05). Our findings are only found that the bone mineral density significantly reduced in UC patients were operated. Inflammatory bowel disease and the number of patients in order to acquire more clarity multifactorial osteoporosis and more comprehensive studies of the relationship between variables to be included would be useful to do.
Description
Keywords
Crohn hastalığı, Ülseratif kolit, DEXA, Osteopeni, Osteoporoz, Crohn disease, Ulcerative colitis, DEXA, Osteopenia, Osteoporosis
Citation
Avcı, M. (2016). İnflamatuar barsak hastalığında osteoporoz. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.