Objectives: At present, there are many studies on Crohn's disease of terminal ileum and colon, but few studies on Crohn's disease of small intestine alone. This study aims to analyze the clinical features and therapeutic effect of small bowel in adult patients with Crohn's disease so as to strengthen the diagnosis and treatment for this disease.
Methods: From July 1, 2015 to October 31, 2018, patients with small bowel Crohn's disease at Department of Gastroenterology, Third Xiangya Hospital of Central South University, were enrolled. At the same time, patients' demographics and clinical data were collected.
Results: A total of 44 patients were small bowel Crohn's disease. Among them, 40 patients were male. The age at diagnosis was (35.8±10.3) years old and disease duration was (35.2±59.5) months. The subtypes included 29(65.9%) of ileum, 7(15.9%) of jejunum, 8(18.2%) of ileum with jejunum. There were 27(61.4%) of stricture behavior, 4(9.1%) of penetrating behavior, and 13(29.5%) of non-stricture and non-penetrating behavior. Endoscopic visible stricture (29/85, 34.1%) was common, followed by longitudinal ulcers (27/85, 31.8%). Non-caseate granulomatous were found in 2 cases (4.5%). The score of Crohn's disease activity index was correlated to hemoglobin, hematocrit, and erythrocyte sedimentation rate (all P<0.05). Among the most common symptom of abdominal pain (34/44, 77.3%), 11 patients (25.0%) developed complications (eg. intestinal obstruction) during the follow-up, and 66.7% of patients treated with mesalazine had complications.
Conclusions: Patients with ileum account for a large proportion in patients with small bowel Crohn's disease. Stricture is more common in small bowel Crohn's disease. Stricture and longitudinal ulcer are more common under enteroscopy. Crohn's disease activity index is correlated to hemoglobin, red blood cell specific volume, and erythrocyte sedimentation rate. The most common complication is intestinal obstruction. Mesalazine is less effective on small bowel Crohn's disease.
目的: 目前国内外对回肠末端、结肠型克罗恩病的研究较多，但单独对于小肠克罗恩病的研究很少。本研究分析小肠克罗恩病的临床特征及治疗效果，以加强对小肠克罗恩病的诊治。方法: 连续纳入2015年7月1日至2018年10月31日在中南大学湘雅三医院消化内科住院的小肠克罗恩病患者，收集患者人口学和临床资料进行分析。结果: 纳入小肠克罗恩病患者44例，其中男40例；年龄(35.8±10.3)岁；病程(35.2±59.5)个月。病变部位：回肠29例(65.9%)，空肠7例(15.9%)，回肠+空肠8例(18.2%)。疾病行为：狭窄型27例(61.4%)，穿透型4例(9.1%)，非狭窄非穿透型13例(29.5%)。小肠镜下以狭窄多见(29/85，34.1%)，其次为纵行溃疡(27/85，31.8%)。病理检查结果示非干酪样肉芽肿2例(4.5%)。血红蛋白、红细胞压积、红细胞沉降率在缓解期及活动期差异有统计学意义(P<0.05)。起病以腹痛最常见(34/44，77.3%)，随访过程中出现并发症(如肠梗阻)者11例(25.0%)，在服用美沙拉嗪治疗的患者中66.7%出现并发症。结论: 小肠克罗恩病多累及回肠，以狭窄型多见；小肠镜下以狭窄及纵行溃疡多见；血红蛋白、红细胞压积、红细胞沉降率对患者疾病活动度的判断具有参考价值；治疗后并发症以肠梗阻多见；美沙拉嗪治疗小肠克罗恩病效果欠佳。.
Keywords: Crohn’s disease; clinical features; small bowel.