Çocukluk Çağında Görülen Kabızlığın Fizyolojisi
Özet
Kabızlık, çocukluk çağında en sık görülen gastrointestinal hastalıklardan biri olup, pediatrik gastroenteroloji ve çocuk cerrahisi pratiğinde önemli bir yer tutmaktadır. Günümüzde çocukluk çağı kabızlığı yalnızca dışkılama sıklığında azalma ile karakterize bir bozukluk olarak değil; gastrointestinal motilite, enterik sinir sistemi, anorektal fonksiyonlar, bağırsak mikrobiyotası ve bağırsak-beyin ekseni arasındaki karmaşık etkileşimlerin sonucu gelişen multifaktöriyel bir hastalık olarak kabul edilmektedir. Bu bölümde normal defekasyon fizyolojisi özetlenmiş; kolonik motilite, enterik sinir sistemi, interstisyel Cajal hücreleri, rektoanal inhibitör refleks ve pelvik taban kaslarının koordineli işlevleri ele alınmıştır. Fonksiyonel kabızlığın patofizyolojisinde ağrılı defekasyon ve dışkı tutma davranışı, rektal yeniden şekillenme, rektal hiposensitivite, kolonik motilite bozuklukları ile bağırsak-beyin ekseni ve bağırsak mikrobiyotasındaki değişikliklerin rolü değerlendirilmiştir. Ayrıca yavaş geçişli kabızlık ve dissinergik defekasyonun temel mekanizmaları ile tedaviye dirençli olgularda anorektal manometri ve diğer motilite incelemelerinin tanısal önemi vurgulanmıştır. Hirschsprung hastalığı, internal anal sfinkter akalazyası, anorektal malformasyonlar ve nörojenik bağırsak hastalıkları gibi organik nedenlerin fizyopatolojik özellikleri de özetlenmiştir.
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