Konstipasyon baskın irritabl barsak sendromu (İBS) semptomları ile menstruel siklus hormonları arasındaki ilişki
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Date
2013
Authors
Gültepe, Ahmet
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
İrritabl barsak sendromu (İBS), fizyopatolojisi tam bilinmeyen, biyopsikososyal bir bozukluktur. Yaşam kalitesini bozan ve iş verimliliğini düşüren yaygın bir hastalıktır. Roma III tanı kriterlerine göre İBS, baskın dışkı şekline göre alt tiplere ayrılmaktadır. Kabızlık baskın İBS (İBS-K), kadınlarda erkeklere oranla iki kat fazla bildirilmiştir. Bu çalışmada, menstruel siklus hormonlarının İBS-K semptomlarına etkisi araştırılmıştır. Çalışmanın başında 40 hastanın Roma III modülünde İBS semptomları sorgulandı. Foliküler fazda (5-7.günler) kan veren 32 hasta, geç luteal fazda (23-25.günler) kan veren 27 hastanın serumunda progesteron, östradiol düzeyi radyoimmunoassey yöntemiyle ölçüldü. Premens, mens ve postmenstruel dönemde sorgulanan İBS-K semptomları (karın ağrısı ve şişkinlik skorları, haftalık dışkılama sayısı ve ıkınma oranları) ile östradiol, progesteron düzeyleri arasındaki ilişki analiz edildi. Premenstruel karın ağrısı, karın şişkinliği ve dışkı şekli skorları, mens ve postmenstruel skordan daha yüksek iken, dışkılama sayısının daha düşük olduğu görüldü (p<0.001). Geç luteal fazdaki östradiol ve progesteron ani azalmasıyla korele bir şekilde, premens dönemde dışkı sertleşmekte ve dışkılama sayısı azalmaktadır. Premens-postmens ıkınma oranı farkı artışı, geç luteal fazdaki östradiol ve progesteron azalmasıyla korele idi (p<0.01). Geç luteal fazdaki ani progesteron ve östradiol düşüklüğüne, premenstruel dışkı sertleşmesi ve dışkılama sayısı azalmasının eşlik etmesi; progesteronun serotonin yolaklarını (progesteron reseptör4 üzerinden) etkileyerek İBS-K semptomlarını arttırdığı gözlemini desteklemektedir. Menstrual siklus hormonları, motilite değişiklikleriyle birlikte visseral algılamayı da etkileyerek İBS fizyopatolojisinde rol oynamaktadır. İBS-K semptomlarının arttığı menstruel siklusda, geç luteal ve midluteal fazdaki östradiol ve progesteron düzeyi ölçülebilirse bu ilişki daha iyi gösterilebilir.
Pathophysiology of irritable bowel syndrome (IBS) is not known exactly, but is generally accepted as a biopsychosocial disorder. It is a common disease that affects quality of life and working performance. Rome III criteria for IBS, are divided into subtypes based on the predominant form of feces. Constipation predominant IBS-C twice more common in women than men. In this study, effects of changes in menstrual cycle hormones on IBS-C symptoms were investigated. At the begining of the study; symptoms of 40 patients were interrogated by Rome III criteria. Serum progesteron and estradiol levels were measured 32 patients in folicular phase (5-7 days) and 27 patients in late luteal phase (23-25 days), by radioimmunoassay. Relationship between estradiol and progesteron levels and IBS-C symptoms (abdominal pain, bloaing, straining rates and number of bowel movements per week ) were analysed in premens, mens and post menstrual periods. Abdominal pain, abdominal distension and stool form scores were higher in the premens period than mens and postmens periods. Number of defecation was observed lower in premens period (p<0,001). Abrupt decrease of the progesterone and estradiol levels in the late luteal phase is correlated with the stiffening of the stool and the decrease in the number of defecation. Decrease of estradiol and progesterone in the late luteal phase was correlated with increase of the premens - postmens straining rates (p <0.01). Observation of hardening of the stool and decrease in the number of defecation associated with the decrease in estradiol and progesterone levels in the late luteal phase, supports the IBS-C symptoms were increased due to progesterone influence on serotonin pathways ( via progesterone receptor 4). The effect of menstruel cycle hormones on visceral perception and motility changes may play a role in IBS-C physiopathology. If östradiol and progesterone can be measured in mid and late luteal phase, the relation between IBS-C symptoms and menstruel cycle changes can be revealed better.
Pathophysiology of irritable bowel syndrome (IBS) is not known exactly, but is generally accepted as a biopsychosocial disorder. It is a common disease that affects quality of life and working performance. Rome III criteria for IBS, are divided into subtypes based on the predominant form of feces. Constipation predominant IBS-C twice more common in women than men. In this study, effects of changes in menstrual cycle hormones on IBS-C symptoms were investigated. At the begining of the study; symptoms of 40 patients were interrogated by Rome III criteria. Serum progesteron and estradiol levels were measured 32 patients in folicular phase (5-7 days) and 27 patients in late luteal phase (23-25 days), by radioimmunoassay. Relationship between estradiol and progesteron levels and IBS-C symptoms (abdominal pain, bloaing, straining rates and number of bowel movements per week ) were analysed in premens, mens and post menstrual periods. Abdominal pain, abdominal distension and stool form scores were higher in the premens period than mens and postmens periods. Number of defecation was observed lower in premens period (p<0,001). Abrupt decrease of the progesterone and estradiol levels in the late luteal phase is correlated with the stiffening of the stool and the decrease in the number of defecation. Decrease of estradiol and progesterone in the late luteal phase was correlated with increase of the premens - postmens straining rates (p <0.01). Observation of hardening of the stool and decrease in the number of defecation associated with the decrease in estradiol and progesterone levels in the late luteal phase, supports the IBS-C symptoms were increased due to progesterone influence on serotonin pathways ( via progesterone receptor 4). The effect of menstruel cycle hormones on visceral perception and motility changes may play a role in IBS-C physiopathology. If östradiol and progesterone can be measured in mid and late luteal phase, the relation between IBS-C symptoms and menstruel cycle changes can be revealed better.
Description
Keywords
İrritabl barsak sendromu, Konstipasyon, Menstruel siklus hormonları, Irritable bowel syndrome, Constipation, Menstruel cycle hormones
Citation
Gültepe, A. (2013). Konstipasyon baskın irritabl barsak sendromu (İBS) semptomları ile menstruel siklus hormonları arasındaki ilişki. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.