Retrospective study of 404 cases of patients with ulcerative colitis in Zhongnan Hospital of Wuhan university

目的 调查近20年来我院溃疡性结肠炎(UC)住院患者的患病情况和临床病理变化,探讨溃疡性结肠炎的发病情况和临床特征.方法 收集近20年我院确诊为溃疡性结肠炎患者的临床资料,统计患病情况、临床特征、内镜及病理特点、治疗情况、病程与预后.结果 近20年我院溃疡性结肠炎患者明显增多,并呈逐渐上升趋势.404例患者中,男女比例1.23∶1,年龄6～84岁,平均年龄(42.7±14.8)岁,平均病程3.4年.溃疡性结肠炎主要临床表现为血便(80.2％)、腹泻(74.O％).肠外表现17例(4.2％),并发症19例(4.7％).病变以慢性复发型(62.1％)为主,轻、中度病变多见(85.9％),部位以左半结肠为主(68.3％).93.8％的溃疡性结肠炎患者经氨基水杨酸类药物和糖皮质激素治疗有效,手术患者14例(3.5％),死亡1例.结论 近20年来我院溃疡性结肠炎患者患病呈上升趋势,患者年龄偏大,病情较轻,病程较短,肠外表现和并发症少,手术病例少,死亡率低,内科治疗预后较好.     

内镜下导管注药治疗重度溃疡性结肠炎

目的观察经内镜下注药对重度溃疡性结肠炎的治疗效果.方法随机对106例重度溃疡性结肠炎患者,应用内镜Bc-9L导管将中、西药物混合液直接注入病变部位进行治疗.选用药物锡类散、肿痛安、维生素、替硝唑、免疫抑制剂等.局部给药后,采取特殊体位,保留药液3h以上,1次/d,每4wk～6wk为一疗程.本组患者男72例,女34例,年龄20岁～73岁,其中30岁～59岁85例(80.2%),病程6mo～15a以上,临床表现多以腹痛、腹泻、粘液便或粘液血便为主.病变部位在直乙状结肠64例(60.37%),右半结肠24例(22.64%),全结肠18例(16.98%).结果经4wk～6wk治疗症状体征消失,镜检溃疡愈合86例(81.14%),症状体征基本消失,镜检溃疡范围缩小超过60%者10例(9.43%),症状体征有改善,镜检溃疡范围缩小未达50%者10例,视为无效,本组治疗有效率达90.6%.结论经内镜直接局部注药对重复溃疡性结肠炎有明显治疗作用.     

中西药结合治疗溃疡性结肠炎17例

目的观察中西药结合治疗溃疡性结肠炎效果．方法17例患者，临床诊断均符合1993年太原全国慢性非感染性肠病学术会订的溃疡性结肠炎的诊断标准．其中男10例，女7例，年龄32岁～62岁，病程最长6a．患者多以急性发作入院．临床表现为腹痛、腹泻和粘液脓血便．大便常规：红、白细胞满视野．粪培养阳性．均做下消化道造影：示溃疡性结肠炎．其中病变累及全结肠1例，直肠5例，乙状结肠及直肠9例，2例未见异常者做肠镜示：粘膜充血，水肿伴糜烂．急性期给中西药结合（由锡类散、雷尼替丁、丁胺卡那、地塞米松组成）保留灌肠治疗．4wk为一疗程，一疗程后对患者的临床症状、下消化道造影和肠镜检查结果进行比较分析．结果经中西药结合治疗一疗程后，临床症状全部好转，下消化道造影及肠镜检查．溃疡愈合11例，占64％；溃疡面缩小6例，占36％，随访复发2例，再次用以上方法治疗后好转．结论中西药结合治疗溃疡性结肠炎有良好效果．     

中国溃疡性结肠炎的研究现状与对策

1概况 溃疡性结肠炎(UC)1859年由Wilks首先描述,1920年被医学界公认,我国于1956年首次报道.过去认为该病欧美多见,亚非少见,但近几十年研究表明,UC在我国也是一种较常见的消化道疾病,并且正在逐渐成为消化病学研究的一个新热点,尽管我国目前还缺乏UC的流行病学资料,但据<世界华人消化杂志>2000年3月[1]对1978年以来几次重要的全国性消化会议的资料统计,该病发病率和患病率在我国有明显增加趋势:1978年杭州第一次全国消化系统疾病学术会议报告的病例为337例,1999年西安第六次全国消化系统疾病学术会议报告病例为例达1627例;1986年成都全国慢性腹泻研讨会报告的病例为581例,1996年江西全国肠病研讨会报告的病例为1412例;特别是1993年太原全国慢性非感染性肠道疾病学术研讨会上报告的病例达3065例,远远超过UC高发区全欧洲同期(1991/1993)新诊断的患者数1397例.     

溃疡性结肠炎的临床特点和治疗转归

目的分析溃疡性结肠炎患者的临床特点,探讨评价诊断方法、临床疗效及转归。方法回顾性分析自1989年10月至2005年6月在北京大学第三医院消化科住院的所有溃疡性结肠炎病例。填写调查表,统计病人的症状、诊断、分期、分型及治疗效果。结果共155例病人入选,男女比例为1·54∶1。平均年龄是41·8岁;发病高峰年龄20~30岁(44例,28·4%)。肠外表现较少见(12·9%)。轻度占32·3%,中度占41·3%,重度26·5%。病变范围以全结肠炎型最多(52·9%),分型以慢性复发型最多(39·4%),大部分病人都可以通过临床、内镜及病理(72·9%)得到确诊,病人经过内科保守治疗大多数都能缓解,少数需要手术治疗(4·5%),没有死亡病例。结论本组病人以轻中型为主,内科疗效较好,部分中重型病人需要使用激素和免疫抑制剂治疗,并发症(20例,12·9%)发生率和手术率(7例,4·5%)较低。     

溃疡性结肠炎临床特征分析及其处理对策评价

目的通过分析溃疡性结肠炎（UC）住院患者的临床特征并随访其预后,以评价目前溃疡性结肠炎的处理对策。方法收集2002年～2007年我院住院的溃疡性结肠炎患者,并对其病情、随访治疗和预后进行评估。结果共纳人溃疡性结肠炎患者64例,男女比例为1．56：1,年龄14～71岁,平均年龄（40±17）岁。消化系统表现以腹泻最多（95．3％）,其次为便血（84．4％）和腹痛（76．6％）,全身表现以发热（92．2％）多见。病变累及全结肠者占50．8％,重度活动期患者占82．8％。治疗药物主要为单纯氨基水杨酸制剂（67．2％）和氨基水杨酸制剂联合糖皮质激素（28．1％）。经内科治疗后完全缓解者占26．6％,有效者占71．9％。50％患者治疗后复发。结论本组溃疡性结肠炎以全结肠病变和重度活动期患者居多,肠外表现少,并发症少,癌变率较低,绝大多数患者经氨基水杨酸制剂和糖皮质激素治疗后可取得较好疗效,但复发率较高。     

16例老年溃疡性结肠炎患者的临床特点

目的 探讨60岁及以上老年溃疡性结肠炎患者的临床特点。方法 选取武汉大学中南医院和人民医院1985～2000年间诊断为溃疡性结肠炎的住院患者及部分门诊患者共186例,对其临床特点进行分析,比较老年溃疡性结肠炎患者(≥60岁)与非老年溃疡性结肠炎患者(20～59岁)间是否存在差异。结果 186例溃疡性结肠炎患者中,≥60岁者16例(8.6％)。在老年溃疡性结肠炎患者中,腹痛、腹泻及发热较非老年溃疡性结肠炎患者多见,便血少见,但差异均无显著性(P>0.05);消瘦及贫血则明显多见(P<0.01)。两组患者的肠外表现及并发症的发生率(分别为12.5％和12.5％、12.7％和3％),差异无显著性(P>0.05)。2例老年溃疡性结肠炎患者并发结直肠癌,非老年溃疡性结肠炎患者中亦有2例结肠癌。其癌变率分别为12％和1％,差异有显著性(P<0.05)。老年组中病情轻度占19％,中重度占81％;而非老年组分别为54％和47％,两者差异有显著性(P<0.01)。结论 老年溃疡性结肠炎患者的病情较非老年患者重,癌变率高于非老年患者,可能与溃疡性结肠炎病程长有关。     

溃疡性结肠炎的临床特点和治疗转归

目的分析溃疡性结肠炎患者的临床特点，探讨评价诊断方法、临床疗效及转归。方法回顾性分析自1989年10月至2005年6月在北京大学第三医院消化科住院的所有溃疡性结肠炎病例。填写调查表，统计病人的症状、诊断、分期、分型及治疗效果。结果共155例病人入选，男女比例为1．54：1。平均年龄是41．8岁；发病高峰年龄20—30岁（44例，28．4％）。肠外表现较少见（12．9％）。轻度占32．3％，中度占41．3％，重度26．5％。病变范围以全结肠炎型最多（5209％），分型以慢性复发型最多（3904％），大部分病人都可以通过临床、内镜及病理（7209％）得到确诊，病人经过内科保守治疗大多数都能缓解，少数需要手术治疗（4．5％），没有死亡病例。结论本组病人以轻中型为主，内科疗效较好，部分中重型病人需要使用激素和免疫押制剂治疗，并发症（加例，12．9％）发生率和手术率（7例，4．5％）较低。     

炎症性肠病患者的肠外表现(附201例临床分析)

目的了解炎症性肠病(IBD)患者肠外表现的发生情况。方法对1978-01~2003-12期间北京大学第一医院收治的201例IBD患者的临床资料进行回顾性分析。结果25年间共收治IBD患者201例,其中溃疡性结肠炎(UC)患者182例,克罗恩病(CD)患者19例。IBD伴肠外表现发生率为20·9%(42/201),UC患者为21·43%(39/182),CD患者为15·79%(3/19)。女性显著多于男性(P<0·05)。UC患者年龄小于20岁者肠外表现发生率高(P<0·01),年龄大于50岁者肠外表现发生率低(P<0·01)。发生于UC活动期者占89·74%(35/39),而发生在缓解期者仅占10·26%(4/39);CD患者肠外表现均发生在活动期。肠外表现中关节、肌肉损害最为多见,其次为皮肤损害。侵犯泌尿系统、甲状腺及肝胆系统者罕见。伴有结节性红斑、坏疽性脓皮病及外周关节炎的患者多易合并其他种肠外表现。结论IBD患者伴有肠外表现者并非少见,女性年轻患者肠外表现发生率高,关节、肌肉及皮肤损害是IBD患者最多见的肠外表现,肠外表现的发生随IBD疾病活动性、疾病严重程度、病变范围的增加有增多的趋势。     

中国大陆地区溃疡性结肠炎少见的肠外表现汇总分析

[目的]总结我国大陆地区溃疡性结肠炎少见的肠外表现,通过认识到本病临床表现的多样性,以揭示其可能的发病机制。[方法]对我国大陆近20年来报道的溃疡性结肠炎的文献进行追溯检索,对符合标准的少见的肠外表现的数据进行摘录、登记、统计分析。[结果]2001-01—2012-12期间符合标准的文献20篇,少见的溃疡性结肠炎肠外表现共28例,涉及皮肤、呼吸系统、神经系统、肌肉关节系统及血液系统等。[结论]溃疡性结肠炎的肠外表现多样,常同时累及多个系统,易导致漏诊;认识溃疡性结肠炎少见的肠外表现,有助于了解其发病机制,并帮助诊治。     

An analysis of 10218 ulcerative colitis cases in China

AIM: To analyze the characteristics of ulcerative colitis(UC) in China. METHODS: From 1981 to 2000, a total of 10218 patients of UC reported in Chinese medical literature and including our cases diagnosed were analyzed according to the diagnostic criteria of Lennard-Jones. RESULTS: The number of cases increased by 3.08 times over the past 10 years (2506 patients were diagnosed from 1981 to 1990 while 7512 patients were diagnosed from 1991 to 2000).Lesion range were described in 7966 patients, 5592 (70.20%) were proctosigmoiditis or proctitis, 1792(22.50%) left-sided colitis, 582(7.30%) pancolitis. Among the 8122 patients, 2826 (34.8%) had first episode, 4272 (52.6%) had chronic relapse, 869 (10.7%) were of chronic persist type, 154 (1.9%) were of acute fulminant type. The course of the illness were described in 5867 patients, 4427(75.5%) were less than 5 years, 910 (15.5%) between 5 and 10 years,530 (9.1%) more than 10 years. Six hundred and sixteen patients 618 patients(6.1%) had extraintestinal manifestations.The mean age at the diagnosis was 40.7 years( range 6-80 years, and the peak ages 30-49 years). The male to female ratio was 1.09. Among 270 patients diagnosed in our hospital,36 had histories of smoking, there was no negative association between the severity of UC and smoking(P>0.05), 21 smokers were followed up for one year, 15 of them had given up smoking when the disease were diagnosed, and one year later, 7 patients relapsed, another 6 patients continued smoking, and one year later,2 patients relapsed. Among 270 UC patients diagnosed in our hospital, 4 patients(1.48%) from 2 families had familial history of UC. Treatment was mentioned in 6859 patients, only 5-ASA and/or corticosteroid only in 1276 patients(18.6%), only Chinese herbs in 1377 patients(20.1%), combined Chinese and western medicine in 4056 patients(59.1%), surgery was performed in 87 patients(1.3%),other treatments in 63 patients(0.9%). CONCLUSIONS: In China, number of UC patients increased significantly in the past 10 years. Lesions are commonly located to left side colon. The course is short with rare extraintestinal manifestations. The age of onset is relatively high.Males and females are nearly equally affected. No negative relation was found between smoking and severity of the disease. Familial relatives are rarely involved Traditional Chinese medicine(TCM) is widely used in the treatment of UC.     

Inflammatory bowel disease in Iran: a review of 457 cases

BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) was believed to be infrequent in Iran; however, unofficial reports have confessed the continuing rise in IBD in our country. METHODS: Demographic and clinical features, extraintestinal manifestations, extension of disease and complications of 401 patients with ulcerative colitis (UC), 47 with Crohn's disease (CD), and nine with indeterminatn colitis (IC) were assessed retrospectively. The exact course of physicians' visits of 250 IBD patient was asked through face-to-face interview. RESULTS: Mean age at diagnosis was 31.9 years in UC and 30.5 years in CD patients. The male to female ratio was 0.8 for UC and 1.3 for CD. The percentage of CD and UC patients who were non-smokers was 82.9 and 84.5%, respectively. Patients with UC presented with rectal bleeding (41.9%), whereas those with CD complained of abdominal pain (46.9%). Among UC patients, proctosigmoid was affected in 51.9%. Colorectal cancer was diagnosed in two patients. The mean lag time between the onset of symptoms and definite diagnosis was 13.9 and 17.7 months for UC and CD patients, respectively. A total of 32.4% of patients with IBD had at least one of the five major extra-intestinal diseases. Conclusion: The demographic and clinical picture of IBD is more or less the same as that of other developing countries; however, the rarity of CD in Iran is noted. Although the true epidemiologic profile of IBD in Iran is still unknown, it is not as rare as previously thought, and it seems as if gradual adoption of a Western lifestyle may be associated with the continuing rise in IBD.     

Epidemiology and clinical characteristics of ulcerative colitis in Chinese population: experience from a single center in Hong Kong

Background and Aim: Rising incidence and prevalence of ulcerative colitis (UC) had been observed in Asian countries. We conducted a study in an Asian center, aiming to describe the epidemiology and clinical characteristics of UC in local Chinese population. Methods: This is a retrospective analysis of patients with diagnosis of UC in our hospital from June 1990 to December 2006. The diagnosis of UC has to satisfy the internationally accepted criteria. All patients were Chinese residents in a well‐defined catchment area. Clinical and epidemiological data were obtained from medical records and patient interviews. Results: Seventy‐three Chinese UC patients had been managed in our hospital. The hospital‐based prevalence had risen by three times over a 10‐year period, but no definite rising incidence can be demonstrated. The mean age at diagnosis was 40.6 years and the median duration of disease is 72 months. In our patient cohort, 38.4% had ulcerative proctitis and 26% had left‐sided UC, whereas 35.6% had extensive UC at presentation. The majority presented with mild (39.7%) or moderate (30.2%) disease activity, but 27.4% presented with severe disease. Two patients (2.7%) present with fulminant disease with one of them developed toxic megacolon. Extra‐gastrointestinal manifestations occurred in 13.7%. During the follow‐up period, most patients (86.3%) were in disease remission. Four patients (5.5%) underwent colectomy, four patients (5.5%) died, and two patients (2.7%) were lost to follow up. Conclusion: The prevalence but not the incidence of UC is rising in Chinese population. It usually affects young patients and a substantial proportion of patients presented with severe and fulminant disease. The disease activity of most Chinese patients can be controlled with medical treatment, though a small proportion of patients need surgery or have fatal outcome.     

Clinical epidemiology of ulcerative colitis in Arabs based on the Montréal classification

AIM: To determine the clinical, epidemiological and phenotypic characteristics of ulcerative colitis (UC) in Saudi Arabia by studying the largest cohort of Arab UC patients.METHODS: Data from UC patients attending gastroenterology clinics in four tertiary care centers in three cities between September 2009 and September 2013 were entered into a validated web-based registry, inflammatory bowel disease information system (IBDIS). The IBDIS database covers numerous aspects of inflammatory bowel disease. Patient characteristics, disease phenotype and behavior, age at diagnosis, course of the disease, and extraintestinal manifestations were recorded.RESULTS: Among 394 UC patients, males comprised 51.0% and females 49.0%. According to the Montréal classification of age, the major chunk of our patients belonged to the A2 category for age of diagnosis at 17-40 years (68.4%), while 24.2% belonged to the A3 category for age of diagnosis at > 40 years. According to the same classification, a majority of patients had extensive UC (42.7%), 35.3% had left-sided colitis and 29.2% had only proctitis. Moreover, 51.3% were in remission, 16.6% had mild UC, 23.4% had moderate UC and 8.6% had severe UC. Frequent relapse occurred in 17.4% patients, infrequent relapse in 77% and 4.8% had chronic disease. A majority (85.2%) of patients was steroid responsive. With regard to extraintestinal manifestations, arthritis was present in 16.4%, osteopenia in 31.4%, osteoporosis in 17.1% and cutaneous involvement in 7.0%.CONCLUSION: The majority of UC cases were young people (17-40 years), with a male preponderance. While the disease course was found to be similar to that reported in Western countries, more similarities were found with Asian countries with regards to the extent of the disease and response to steroid therapy.     

Demography and clinical course of ulcerative colitis in a multiracial Asian population: A nationwide study from Malaysia

OBJECTIVE: To establish the clinical course of ulcerative colitis (UC) in the Malaysian population, comparing the three major ethnic groups: Malay, Chinese and Indian. METHODS: Patients who were diagnosed with UC from seven major medical referral centers in Malaysia were recruited. Their baseline characteristics, and the extent of the disease, its clinical course and complications were recorded. RESULTS: A total of 118 patients was included. The extent of disease was as follows: proctitis alone in 22 (18.6%), sigmoid colon in 23 (19.5%), descending colon in 16 (13.6%), transverse colon in 11 (9.3%), ascending colon and pancolitis 46 (39%). Most patients had chronic intermittent disease. Extra‐intestinal complications were seen in 27 (22.9%) patients and fulminant colitis was seen in four (3.4%). None developed colorectal cancer. The overall cumulative colectomy rates at 1, 5 and 10 years were 3.4% (CI: 0.9–8.5), 5.9% (CI: 1.9–13.2) and 15.6% (CI: 6.5–29.4), respectively. There was a higher prevalence of extra‐intestinal manifestations and a trend towards more extensive disease among Indian patients. However, no significant differences were seen in the age of onset, the severity of disease (fulminant colitis, refractory disease) and the colectomy rate. CONCLUSION: As in developed countries, most of our patients have a remitting and relapsing pattern of disease but the clinical course appears to be milder, with lower rates of colectomies. There are differences in clinical presentation among the three major ethnic groups, with Indians having a higher prevalence of extra‐intestinal manifestations and a trend towards more extensive disease.     

3100例溃疡性结肠炎住院病例回顾分析

目的 回顾性调查住院溃疡性结肠炎（UC）患者,探讨近年住院病例UC的特点.方法全国选取11个地区23家医院,调查1990-2003年期间住院符合UC诊断的3100例患者的诊断、治疗、逐年住院情况和同期内镜检出率,并粗略估计患病率.结果 近14年UC住院例数和内镜检出例数均有逐年增加的趋势.UC粗略患病率为11.62/105.住院UC患者以轻度（35.4%）和中度（42.9%）为主.临床类型以慢性复发型（46%）和初发型（34.6%）为主,暴发型仅占2.4%.主要症状有腹泻（75.8%）、腹痛（67.3%）、血便（63.3%）等.肠外表现（14.0%）和并发症（9.6%）少见.辅助确诊手段主要为结肠镜（95.0%）及病理（62.3%）.UC治疗上以氨基水杨酸类（66.8%）和类固醇激素（42.8%）为主.仅2.1%患者应用免疫抑制剂.单纯内科治疗总有效率达93.6%,手术率3%,死亡19例（0.6%）.结论 UC近年有逐渐增加的趋势,以轻中度为主,疾病类型以慢性复发型和初发型为主,暴发型少见.肠外表现及并发症较少.国内轻中度患者治疗以柳氮磺胺吡啶及类固醇激素为主,手术率、死亡率及癌变率均较国外低.     

溃疡性结肠炎的内镜特点和临床分析

目的 总结溃疡性结肠炎(UC)的临床特点及内镜下表现。方法 收集1975年至2001年经结肠镜检查及病理确诊的UC患者的相关资料，其中1975—1994年组有486例，1995—2001年组490例，观察其临床特点及内镜表现。确诊靠病理活检。结果 在1975—1994年和1995—2001年两组中，经结肠镜检查确诊的UC患者占同期结肠镜的总数从3．51％上升至4．44％，男女之比分别为1．67和1．25，平均发病年龄从42．4岁上升至51．5岁，高峰年龄段分别是30—49岁和40—49，≥60岁。临床主要表现为黏液脓血便、腹泻、腹痛等，病变范围：直肠及乙状结肠炎占55．4％和64．5％，左半结肠炎占17.3％和13．9％，全结肠炎占11．9％和14．3％。分别有89．9％和90．4％的患者病程小于10年。结论 UC的发病例数有所增加，病变主要以左半结肠为主，病程短，发病年龄相对较大，癌症发生率及并发症低。结肠镜及活检是诊断UC的主要方法。     

Low colectomy rate five years after diagnosis of ulcerative colitis. Results from a prospective population-based cohort in Sweden (ICURE) diagnosed during 2005–2009*

Objective: The medical treatment of ulcerative colitis (UC) has seen a change towards a more active attitude during recent years, including both the use of more traditional drugs as well as new biological substances. In this epidemiological study we have evaluated the results of modern treatment of UC in a population-based cohort of patients including all age groups, with regard to relapse rate, colectomy and IBD-associated mortality.

Material and methods: Patients diagnosed with UC in the Uppsala health care region in the middle of Sweden during 2005–2009 were included in the study. Out of 524 patients, 491 (93%) could be followed for five full years or until death.

Results: Nineteen patients (3.9%) had died and two of these deaths could be attributed to UC (one postoperative death and one colonic carcinoma). The following drugs were used by the patients during the study period: 5-ASA (91%), systemic steroids (66%), immunomodulators (IMM), mainly thiopurines (26%) and anti-TNF (11%). During the observation period, 74% experienced at least one relapse and 5.3% were subjected to colectomy. Among patients?<17 years at diagnosis, colectomy was performed in two (4.8%).

Conclusions: Five years after diagnosis of ulcerative colitis, 5.3% had been subjected to colectomy and two patients (0.38%) had died because of the disease.