Çocukluk çağında mikroskopik kolite yaklaşım
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Date
2018
Authors
Urgancı, Nafiye
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Mikroskopik Kolit; kronik sulu ishal, normal endoskopik ve histopatolojik bulgular ile karakterize inflamatuvar değişiklikler gösteren nadir bir barsak hastalığıdır. Kronik diarenin sık görülen bir nedenidir. Kollajenöz kolit ve lenfositik kolit (LK) olmak üzere iki subtipi mevcuttur. Klinik ve histopatoloik özellikleri benzer olan bu tiplerinin biribirinden ayrı hastalık mı,yoksa aynı hastalığın farklı fenotipleri mi olduğu halen bilinmemektedir. Etyolojisi bilinmemekle birlikte; genetik, otoimmunite, luminal bir antijene karşı (gıda, mikroorgaanizma vs) immunolojik veya inflamatuvar reaksiyon, ilaçlar, bakteriyal infeksiyon ve toksinleri, safra asitleri ve safra asit malabsorbsiyon, bozulmuş sıvı ve elektrolit emilimi ve salınımı, kollajen sentez-degredasyon (parçalanma) dengesi ve nitrik oksit öne sürülen başlıca mekanizmalardır. Erişkin yaş grubunda sıklıkla altıncı ve yedinci dekatlarda daha fazla olmakla birlikte çocuk yaş grubu dahil her yaş grubunda giderek arttığı bildirilmektedir. Çocukluk çağında MK’in sıklığı bilinmemektedir. Klinik bulguları nonspesifik olup ikisinde de kronik veya tekrarlayan sulu, kansız, dehidratasyona neden olmayan şiddetli, gecede olabilen ishal, karın ağrısı, kramplar, kilo kaybı ve fekal inkontinans görülür. Rutin laboratuvar incelemeler genellikle yardımcı değildir Tanı çoğu zaman klinik belirtiler varlığında, alınan biyopsilerle histolojik olarak konulabilmektedir. Bu amaçla çıkan ve sigmoid kolondan biyopsi alınmalıdır. Ayırıcı tanıda, ilaca bağlı mikrosopik kolit ve çölyak hastalığı mutlaka ekarte edilmelidir. Tedavisinde fazla kontrollü çalışma yoktur. En fazla çalışılan ilaç budesoniddir. Hafif vakalarda anti-diareikler genellikle yeterli olmaktadır. Genel olarak MKin uzun süreli izlem sonucunda prognoz oldukça iyidir.
Microscopic colitis (MC), is a rare disorder characterised by chronic watery diarrhea, normal endoscopic and histopathological findings and inflammatory changes. MC is one of the most frequent causes of chronic diarrhea. MC is divided into two subgroups; collagenous colitis and lymphocytic colitis. It is still unclear, if these subgroups are the same disease with similar clinical and histopathological characteristics or they are different phenotypes of the same disease. Although etiology is unknown, proposed mechanisms of MC are genetics, autoimmunity, immunological or inflammatory reactions to a luminal antigen (food, microorganisms vs), drugs, bacterial infections and toxins, malabsorption of bile acids and bile, defective absorption of fluid and electrolytes, equilibrium of collagen synthesis and degradation and nitric oxide. The prevalence is higher among adults, especially 6th and 7th decades of life, but increasing in every age group including childhood. MC has nonspecific signs such as chronic, recurrent, watery, nonbloody diarrhea which does not cause dehydratation, abdominal pain, weight loss, fecal incontinence. The laboratory examinations are usually not helpful. The diagnosis is made on the basis of clinical signs and histopathological examinations of biopsy specimens taken from ascendent colon and sigmoid colon. Microscopic colitis caused by drugs and celiac disease should be excluded in the differential diagnosis of the disease. There are not enough well-controlled studies about the treatment of MC. Budesonid is the most studied drug. Anti-diarrheals are usually efficient in mild forms of MC. The long-term prognosis is fairly well.
Microscopic colitis (MC), is a rare disorder characterised by chronic watery diarrhea, normal endoscopic and histopathological findings and inflammatory changes. MC is one of the most frequent causes of chronic diarrhea. MC is divided into two subgroups; collagenous colitis and lymphocytic colitis. It is still unclear, if these subgroups are the same disease with similar clinical and histopathological characteristics or they are different phenotypes of the same disease. Although etiology is unknown, proposed mechanisms of MC are genetics, autoimmunity, immunological or inflammatory reactions to a luminal antigen (food, microorganisms vs), drugs, bacterial infections and toxins, malabsorption of bile acids and bile, defective absorption of fluid and electrolytes, equilibrium of collagen synthesis and degradation and nitric oxide. The prevalence is higher among adults, especially 6th and 7th decades of life, but increasing in every age group including childhood. MC has nonspecific signs such as chronic, recurrent, watery, nonbloody diarrhea which does not cause dehydratation, abdominal pain, weight loss, fecal incontinence. The laboratory examinations are usually not helpful. The diagnosis is made on the basis of clinical signs and histopathological examinations of biopsy specimens taken from ascendent colon and sigmoid colon. Microscopic colitis caused by drugs and celiac disease should be excluded in the differential diagnosis of the disease. There are not enough well-controlled studies about the treatment of MC. Budesonid is the most studied drug. Anti-diarrheals are usually efficient in mild forms of MC. The long-term prognosis is fairly well.
Description
Keywords
Mikroskopik kolit, Kollajenöz kolit, Lenfositik kolit, Çocukluk çağı, Microscopic colitis, Collagenous colitis, Lymphocytic colitis, Childhood
Citation
Urgancı, N. (2018). "Çocukluk çağında mikroskopik kolite yaklaşım". Güncel Pediatri, 16(2), 219-229.