成人炎症性肠病初诊患者上消化道病变情况研究

来源：医学界消化频道

翻译及述评：东南大学医学院附属江阴医院消化内科  沈卫东

Carmen S. Horjus Talabur Horje, MD, Jos Meijer, PhD, Lian Rovers, PhD, Ellen G. van Lochem, PhD, Marcel J. M. Groenen, MD, PhD,and Peter J. Wahab, MD, PhD

背景：目前关于成人炎症性肠病累及上消化道的患病情况，主要在患病时间较长的患者中进行的。本研究主要目的是通过对新诊断并进行初次治疗的炎症性肠病患者（不管有无上消化道相关症状），进行连续性观察，从而前瞻性评估成人炎症性肠病上消化道病变情况。

方法：对疑似炎症性肠病患者联合进行回结肠镜和胃镜检查，并进行活检。入组病例是诊断为溃疡性结肠炎或克罗恩病患者，但需排除使用非甾体消炎药和Hp感染患者（有无Hp感染主要依据病理组织检查）。研究过程中，记录患者内镜下胃和十二指肠病变情况，而对于炎症性肠病累及上消化道的诊断需结合内镜及病理结果。

结果：总共152例患者（108例CD和44例UC）纳入分析研究。胃镜下改变仅见于CD患者（60/108, 55%），而病理改变在CD和UC患者中均可见，主要表现为局灶性胃炎（其中CD患者为 58例，占54%；UC患者10例，占23%）、肉芽肿改变（仅44例CD患者可见，占41%，UC 患者未有此病变）。44例CD患者（44/108, 41%）诊断为炎症性肠病累及上消化道（无UC患者），其中14例患者（14/44, 32%）有上消化道系统症状。

结论：在新诊断为CD患者中，上消化道系统累及比较多见，且多数患者并无消化系统症状。在CD患者和UC患者中，局灶性胃炎均可发生，而肉芽肿性炎症仅见于CD患者。

Prevalence of Upper Gastrointestinal Lesions at Primary Diagnosis in Adults with Inflammatory Bowel Disease Inflamm Bowel Dis 2016;0:1–6

Background: The prevalence of upper gastrointestinal (GI) involvement in adult inflammatory bowel disease has mostly been studied in patients with long-standing disease. The aim of this study was to prospectively evaluate the prevalence of upper GI involvement in a consecutive series of newly diagnosed, treatment-naive adult patients with inflammatory bowel disease, irrespective of upper GI tract symptoms.

Methods: Consecutive patients with suspected inflammatory bowel disease underwent combined ileocolonoscopy and upper endoscopy with biopsies. Patients diagnosed with either Crohn’s disease (CD) or ulcerative colitis (UC), denying use of nonsteroidal anti-inflammatory drug, were included in the study. Helicobacter pylori infection was diagnosed histologically and positive patients were excluded from the analysis. Endoscopic and histologic lesions in the stomach and duodenum were recorded. Upper GI location (+L4) was defined as a combination of endoscopic and histological lesions.

Results: A total of 152 patients (108 CD and 44 UC) were analyzed. Endoscopic lesions were only seen in patients with CD (60 of 108, 55%).Histological lesions were present in both patients with CD and patients with UC: focally enhanced gastritis in 58 CD (54%) and 10 UC (23%), granulomas in 30 CD (28%). Upper GI disease location was diagnosed in 44 patients with CD (41%) and no patients with UC. Upper GI tract symptoms were reported in 14 of 44 patients (32%) with upper GI location.

Conclusions: A high prevalence of upper GI involvement was observed in newly diagnosed patients with CD, with a majority of the patients being asymptomatic. Focally enhanced gastritis was common in both patients with CD and patients with UC, whereas granulomatous inflammation was restricted to patients with CD.

述评：结肠镜及小肠镜并结合病理，是诊断CD最重要的依据。但对于新诊断为CD的患者是否均需要行上消化道内镜并判断疾病的严重程度，尚无定论。而最近欧洲及美国指南都建议这样的患者需进一步行上消化道内镜检查。本研究结果发现，初次诊断为CD的患者合并上消化道病变并不少见，但往往这些患者并无消化道相关症状，且目前尚无前瞻性研究表明上消化道内镜下发现与CD病程的复杂性有确定相关性。因此，该研究认为，上消化道内镜检查在CD合并有消化系统症状患者，或在确定是UC还是CD诊断时（特别是病理发现有肉芽肿性改变时）才建议推荐。但此项研究来自荷兰，针对我国胃镜检查相对普及的情况，译者认为对于IBD患者常规行胃镜检查，以明确有无上消化道累及及排除其他上消化道疾病，还是有一定必要的。

译者简介：

沈卫东，副主任医师，东南大学医学院附属江阴医院消化内科副主任，江苏省医学会消化分会青年委员会委员，江苏省医学会消化分会IBD学组成员。

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