Gastrointestinal Sistem Ağrılarında Mikrobiyal Etkenler; Patogenezden Kliniğe
Özet
Gastrointestinal sistem ağrısı, klinik uygulamada en sık karşılaşılan semptomlardan biri olup enfeksiyöz ve enfeksiyöz olmayan çok sayıda hastalığın ortak bulgusudur. Mikrobiyal etkenler, akut ve kronik gastrointestinal ağrının önemli nedenleri arasında yer almakta; bakteriler, virüsler, parazitler ve mantarlar farklı patojenik mekanizmalar aracılığıyla ağrı gelişimine katkıda bulunmaktadır. Bu bölümde gastrointestinal sistem ağrısına neden olan başlıca mikrobiyal etkenler güncel literatür doğrultusunda değerlendirilmiş; ağrının oluşumunda rol oynayan mukozal invazyon, toksin üretimi, inflamasyon, visseral hipersensitivite, nöroimmün etkileşimler ve mikrobiyota–bağırsak–beyin ekseni ayrıntılı olarak ele alınmıştır. Ayrıca Helicobacter pylori, Salmonella spp., Shigella spp., Campylobacter spp., patojenik Escherichia coli grupları, viral gastroenterit etkenleri, intestinal parazitler ve fırsatçı fungal enfeksiyonların gastrointestinal ağrıdaki klinik önemi özetlenmiştir. Son yıllarda moleküler tanı yöntemleri, mikrobiyota analizleri ve nörogastroenteroloji alanındaki gelişmeler, gastrointestinal ağrının patogenezinin daha iyi anlaşılmasını sağlamış ve hedefe yönelik yeni tedavi yaklaşımlarına ışık tutmuştur. Mikrobiyal etkenlerin doğru tanımlanması ve patofizyolojik mekanizmaların anlaşılması, gastrointestinal ağrının etkili tanı ve tedavisinde temel öneme sahiptir.
Gastrointestinal pain is one of the most common symptoms encountered in clinical practice and represents a shared manifestation of numerous infectious and non-infectious diseases. Microbial pathogens constitute major causes of both acute and chronic gastrointestinal pain, with bacteria, viruses, parasites, and fungi contributing through diverse pathogenic mechanisms. This chapter comprehensively reviews the principal microbial agents associated with gastrointestinal pain and discusses the underlying mechanisms, including mucosal invasion, toxin production, inflammation, visceral hypersensitivity, neuroimmune interactions, and the microbiota–gut–brain axis. The clinical significance of Helicobacter pylori, Salmonella spp., Shigella spp., Campylobacter spp., pathogenic Escherichia coli strains, viral gastroenteritis agents, intestinal parasites, and opportunistic fungal infections is also summarized. Recent advances in molecular diagnostics, microbiome research, and neurogastroenterology have significantly improved our understanding of the pathogenesis of gastrointestinal pain and have opened new perspectives for targeted therapeutic strategies. Accurate identification of microbial pathogens together with a comprehensive understanding of the underlying pathophysiological mechanisms is essential for improving the diagnosis, management, and prevention of gastrointestinal pain associated with infectious diseases.
Referanslar
Drewes AM, Olesen AE, Farmer AD, et al. Gastrointestinal pain. Nature Reviews Disease Primers. 2020;6(1):1. doi:10.1038/s41572-019-0135-7.
Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. American Family Physician. 2008;77(7):971-978.
Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014.
Troeger C, Blacker BF, Khalil IA, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases. The Lancet Infectious Diseases. 2018;18(11):1211-1228.
Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis: The incidence and prognosis of post-infectious irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2007;26(4):535-544. doi:10.1111/j.1365-2036.2007.03399.x.
Drossman DA. Functional gastrointestinal disorders: History, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016. doi:10.1053/j.gastro.2016.02.032.
Butt MF, Reghefaoui MH, Benedict AS, et al. Irritable bowel syndrome in inflammatory bowel disease: An evidence-based practical review. Journal of Clinical Medicine. 2026;15(1):116. doi:10.3390/jcm15010116.
Grundy L, Erickson A, Brierley SM. Visceral pain. Annual Review of Physiology. 2019;81:261-284. doi:10.1146/annurev-physiol-020518-114525.
Blackshaw LA, Brookes SJ, Grundy D, Schemann M. Sensory transmission in the gastrointestinal tract. Neurogastroenterology & Motility. 2007;19(Suppl 1):1-19. doi:10.1111/j.1365-2982.2006.00871.x.
Wang S, Wang Y, Miao J, et al. Enteric nervous system and inflammatory bowel disease. Gastroenterology Report. 2026;14:goag005. doi:10.1093/gastro/goag005.
Cryan JF, O'Riordan KJ, Cowan CSM, et al. The microbiota-gut-brain axis. Physiological Reviews. 2019;99(4):1877-2013. doi:10.1152/physrev.00018.2018.
Morais LH, Schreiber HL IV, Mazmanian SK. The gut microbiota-brain axis in behaviour and brain disorders. Nature Reviews Microbiology. 2021;19(4):241-255. doi:10.1038/s41579-020-00460-0.
Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology. 2015;28(2):203-209.
Peterson LW, Artis D. Intestinal epithelial cells: Regulators of barrier function and immune homeostasis. Nature Reviews Immunology. 2014;14(3):141-153. doi:10.1038/nri3608.
Graves NS. Acute gastroenteritis. Primary Care. 2013;40(3):727-741. doi:10.1016/j.pop.2013.05.006.
Bhattarai Y, Muniz Pedrogo DA, Kashyap PC. Irritable bowel syndrome: A gut microbiota-related disorder? American Journal of Physiology-Gastrointestinal and Liver Physiology. 2017;312(1):G52-G62. doi:10.1152/ajpgi.00338.2016.
Czepiel J, Dróżdż M, Pituch H, et al. Clostridium difficile infection: Review. European Journal of Clinical Microbiology & Infectious Diseases. 2019;38(7):1211-1221. doi:10.1007/s10096-019-03539-6.
Wallrapp A, Chiu IM. Neuroimmune interactions in the intestine. Annual Review of Immunology. 2024;42(1):489-519. doi:10.1146/annurev-immunol-101921-042929.
Prystupa A, Mróz T, Wojciechowska K, et al. Clinical approach to visceral pain in irritable bowel syndrome: Pathophysiology, symptoms, and treatment. Annals of Agricultural and Environmental Medicine. 2013;20(1):8-13.
Deising A, Gutierrez RL, Porter CK, Riddle MS. Postinfectious functional gastrointestinal disorders: A focus on epidemiology and research agendas. Gastroenterology & Hepatology. 2013;9(3):145-157.
Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: The Maastricht VI/Florence consensus report. Gut. 2022. doi:10.1136/gutjnl-2022-327745.
Lamichhane B, Mawad AMM, Saleh M, et al. Salmonellosis: An overview of epidemiology, pathogenesis, and innovative approaches to mitigate the antimicrobial resistant infections. Antibiotics. 2024;13(1):76. doi:10.3390/antibiotics13010076.
Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi AKM. Shigellosis. The Lancet. 2018;391(10122):801-812. doi:10.1016/S0140-6736(17)33296-8.
Mattock E, Blocker AJ. How do the virulence factors of Shigella work together to cause disease? Frontiers in Cellular and Infection Microbiology. 2017;7:64. doi:10.3389/fcimb.2017.00064.
Kaakoush NO, Castaño-Rodríguez N, Mitchell HM, Man SM. Global epidemiology of Campylobacter infection. Clinical Microbiology Reviews. 2015;28(3):687-720. doi:10.1128/CMR.00006-15.
Talukdar PK, Dines MC, Shelden EA, et al. Campylobacter jejuni regulates cell cycle progression to potentiate host cell invasion. Cell Communication and Signaling. 2025;23(1):343. doi:10.1186/s12964-025-02348-z.
Pakbin B, Brück WM, Rossen JWA. Virulence factors of enteric pathogenic Escherichia coli: A review. International Journal of Molecular Sciences. 2021;22(18):9922. doi:10.3390/ijms22189922.
Cobo-Simón M, Hart R, Ochman H. Escherichia coli: What is and which are? Molecular Biology and Evolution. 2023;40(1):msac273. doi:10.1093/molbev/msac273.
Markantonis JE, Fallon JT, Madan R, Alam MZ. Clostridioides difficile infection: Diagnosis and treatment challenges. Pathogens. 2024;13(2):118. doi:10.3390/pathogens13020118.
Seabaugh JA, Anderson DM. Pathogenicity and virulence of Yersinia. Virulence. 2024;15(1):2316439. doi:10.1080/21505594.2024.2316439.
Almagro-Moreno S, Martinez-Urtaza J, Pukatzki S. Vibrio infections and the twenty-first century. Advances in Experimental Medicine and Biology. 2023;1404:1-16. doi:10.1007/978-3-031-22997-8_1.
Maulahela H, Simadibrata M, Nelwan EJ, et al. Recent advances in the diagnosis of intestinal tuberculosis. BMC Gastroenterology. 2022;22(1):89. doi:10.1186/s12876-022-02171-7.
Karst SM, Tibbetts SA. Recent advances in understanding norovirus pathogenesis. Journal of Medical Virology. 2016;88(11):1837-1843. doi:10.1002/jmv.24559.
Winder N, Gohar S, Muthana M. Norovirus: An overview of virology and preventative measures. Viruses. 2022;14(12):2811. doi:10.3390/v14122811.
Pawłuszkiewicz K, Ryglowski PJ, Idzik N, et al. Rotavirus infections: Pathophysiology, symptoms, and vaccination. Pathogens. 2025;14(5):480. doi:10.3390/pathogens14050480.
Chio CC, Chien JC, Chan HW, Huang HI. Overview of the trending enteric viruses and their pathogenesis in intestinal epithelial cell infection. Biomedicines. 2024;12(12):2773. doi:10.3390/biomedicines12122773.
Cortez V, Meliopoulos VA, Karlsson EA, et al. Astrovirus biology and pathogenesis. Annual Review of Virology. 2017;4(1):327-348. doi:10.1146/annurev-virology-101416-041742.
Fernández S, Castro P, Azoulay E. What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients. Intensive Care Medicine. 2025;51(1):39-61. doi:10.1007/s00134-024-07737-5.
Yeh PJ, Wu RC, Chen CL, et al. Cytomegalovirus diseases of the gastrointestinal tract in immunocompetent patients: A narrative review. Viruses. 2024;16(3):346. doi:10.3390/v16030346.
Guillén N. Pathogenicity and virulence of Entamoeba histolytica, the agent of amoebiasis. Virulence. 2023;14(1):2158656. doi:10.1080/21505594.2022.2158656.
Adam RD. Giardia duodenalis: Biology and pathogenesis. Clinical Microbiology Reviews. 2021;34(4):e00024-19. doi:10.1128/CMR.00024-19.
Oladele DB, Swain M, Robinson G, et al. A review of recent Cryptosporidium hominis and Cryptosporidium parvum gp60 subtypes. Current Research in Parasitology & Vector-Borne Diseases. 2025;8:100292. doi:10.1016/j.crpvbd.2025.100292.
Lee Y, Lu M, Lillehoj HS. Coccidiosis: Recent progress in host immunity and alternatives to antibiotic strategies. Vaccines. 2022;10(2):215. doi:10.3390/vaccines10020215.
Schindler-Piontek M, Chaubal N, Dehmani S, et al. Ascariasis, a review. Medical Ultrasonography. 2022;24(3):329-338. doi:10.11152/mu-3343.
Siviero I, de Almeida UVB, Penna CRR, et al. Abdominal complications of ascariasis in childhood. Jornal de Pediatria. 2024;100(5):460-467. doi:10.1016/j.jped.2024.02.001.
Özen FZ, Celep G. Clinicopathological assessment in patients with Enterobius vermicularis infection. Turkiye Parazitoloji Dergisi. 2023;47(2):93-99. doi:10.4274/tpd.galenos.2023.02418.
Jourdan PM, Lamberton PHL, Fenwick A, Addiss DG. Soil-transmitted helminth infections. The Lancet. 2018;391(10117):252-265. doi:10.1016/S0140-6736(17)31930-X.
Behniafar H, Sepidarkish M, Tadi MJ, et al. The global prevalence of Trichuris trichiura infection in humans (2010–2023): A systematic review and meta-analysis. Journal of Infection and Public Health. 2024;17(5):800-809. doi:10.1016/j.jiph.2024.03.005.
Napieralska A, Garbarczyk W, Kapla A, et al. Taeniasis: Symptoms, diagnosis and treatment – A systematic review. Journal of Education, Health and Sport. 2025;79:58206. doi:10.12775/JEHS.2025.79.58206.
Luvira V, Siripoon T, Phiboonbanakit D, et al. Strongyloides stercoralis: A neglected but fatal parasite. Tropical Medicine and Infectious Disease. 2022;7(10):310. doi:10.3390/tropicalmed7100310.
Pappas PG, Lionakis MS, Arendrup MC, et al. Invasive candidiasis. Nature Reviews Disease Primers. 2018;4:18026. doi:10.1038/nrdp.2018.26.
Kullberg BJ, Arendrup MC. Invasive candidiasis. New England Journal of Medicine. 2015;373(15):1445-1456. doi:10.1056/NEJMra1315399.
Skiada A, Lass-Floerl C, Klimko N, et al. Challenges in the diagnosis and treatment of mucormycosis. Medical Mycology. 2018;56(Suppl 1):93-101. doi:10.1093/mmy/myx101.
Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: An initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. The Lancet Infectious Diseases. 2019;19(12):e405-e421. doi:10.1016/S1473-3099(19)30312-3.
