胶囊内镜与小肠CT成像在小肠克罗恩病诊断中的应用价值

背景:小肠克罗恩病(CD)是影像学检查的难点。近年来,胶囊内镜被广泛应用于诊断小肠CD。目的:探讨胶囊内镜与小肠CT成像(CTE)在小肠CD临床诊断中的应用价值。方法:回顾性研究2014年10月—2018年4月同济大学附属第十人民医院收治的28例小肠CD患者,比较胶囊内镜与CTE的病变检出率和诊断准确性。结果:胶囊内镜与CTE总体病变检出率无明显差异(96. 4%对85. 7%,P 0. 05),但胶囊内镜对小肠CD的诊断准确性优于CTE(89. 3%对42. 9%,P 0. 05),尤其是对空肠病变的诊断(96. 4%对21. 4%);两者对回肠病变的检出率无明显差异(96. 4%对78. 6%,P0. 05)。CTE在病变定位以及发现肠外病变、结肠病变方面优于胶囊内镜。两者联合应用,对小肠CD的诊断准确性可达100%。结论:胶囊内镜对小肠CD的病变检出率与CTE相当,诊断准确性则明显优于CTE,尤其是对于空肠病变。两者联合应用在小肠CD的临床诊断中具有重要应用价值,值得进一步推广。     

108例克罗恩病临床特点及胶囊内镜下表现

克罗恩病（CD）临床表现多样，诊断有一定难度，误诊率较高。本研究总结分析我院1997至2005年108例CD患者的临床资料及胶囊内镜表现，评价胶囊内镜在CD诊断中的临床价值。     

磁控胶囊内镜对小肠克罗恩病早期诊断的临床研究

目的探讨磁控胶囊内镜对小肠克罗恩病(CD)早期诊断的临床应用价值。 方法选择2015年8月至2017年2月临床怀疑小肠CD经上海交通大学医学院附属瑞金医院卢湾分院消化内科行磁控胶囊内镜检查的203例小肠CD高危患者进行磁控胶囊内镜检查,根据检查结果参照De Bona等^{[ 6 ]}的标准进行分组,随访各组治疗情况、病情进展及转归。 结果A组17例符合确诊标准;B组87例符合可疑标准,随访1～2年后,7例确诊为CD;C组67例符合非特异性肠炎。B组和C组治疗前后各项炎症指标比较有统计学意义,提示治疗有效。 结论磁控胶囊内镜对小肠CD早期诊断具有一定的临床应用价值,能够早期用于指导治疗,改善疾病的预后。     

双气囊小肠镜在小肠克罗恩病中的诊断价值研究

目的 探讨双气囊小肠镜在小肠克罗恩病(CD)诊断中的价值.方法 回顾性总结141例临床怀疑小肠CD行双气囊小肠镜检查患者的临床资料,以病理诊断结合内镜表现和临床随访结果为最终诊断结果,对比分析小肠CD双气囊小肠镜、CT小肠成像以及胶囊内镜的检出率和确诊率.结果 双气囊小肠镜检出小肠CD 128例,检出率为90.8％( 128/141),最终经病理及临床随访确诊126例,确诊率为98.4％ (126/128);CT小肠成像检出小肠CD 19例,检出率为76.0％( 19/25),最终经病理及临床随访确诊17例,确诊率为89.5％ (17/19);胶囊内镜镜检出小肠CD 15例,检出率为60.0％( 15/25),最终经病理及临床随访确诊14例,确诊率为93.3％ (14/15).双气囊小肠镜组小肠CD检出率和确诊率均高于胶囊内镜和CT小肠成像.结论 双气囊小肠镜在小肠CD诊断中具有较好的应用价值,对存在内镜检查禁忌证者CT小肠成像可作为首选辅助检查手段.     

胶囊内镜对小肠克罗恩病检出率的作用

克罗恩病(Crohn's disease,CD)是一种胃肠道慢性炎性反应性疾病,临床表现多样,多发生于小肠.本研究对临床疑诊小肠CD者行胶囊内镜、结肠镜、胃镜、消化道造影检查,旨在评价胶囊内镜在小肠CD诊断中的价值及优越性.     

胶囊内镜在克罗恩病小肠评估中的应用

胶囊内镜(CE)自问世以来,迅速被应用于诊断及评估各种小肠疾病中,并在消化道出血的诊断及预后监测中确立了地位。CE在疑似或确诊的克罗恩病(CD)患者中的具体应用效果仍未明确,有较高的假阳性率,并可能会造成CD的过度诊断,甚至影响治疗方案。该文对各种关于CE在CD中的应用数据进行综合分析,为其在CD患者中的临床合理应用提供依据。     

中国胶囊内镜临床应用指南

中华医学会消化内镜学分会胶囊内镜与小肠镜学组于2008年制订了《中华消化内镜学会胶囊内镜临床应用规范》,对我国规范使用胶囊内镜提供了有力参考。胶囊内镜检查经历10余年的发展,已经成为重要的消化道疾病检查手段,尤其是对小肠疾病的诊断。随着科学技术的不断进步,除了小肠胶囊内镜出现了部分改进之外,食管专用胶囊内镜、结肠专用胶囊内镜和专用磁控胶囊胃镜亦已进入临床应用阶段。所以,胶囊内镜与小肠镜学组决定与时俱进,更新和完善相关规范,在经过专家广泛讨论及多次修改后,现更新我国胶囊内镜临床应用指南如下。     

CESI、简化CDAI和CRP在评估小肠克罗恩病病变范围和活动程度中的应用价值

背景：小肠克罗恩病（CD）是一种慢性、反复发作性疾病。目前胶囊内镜评分指数（CESI）、简化CDAI和CRP在评估小肠CD病变范围和活动程度中的应用价值的研究甚少。目的：探讨CESI、简化CDAI和CRP在评估小肠CD病变范围和活动程度中的应用价值。方法：纳入行胶囊内镜检查并最终确诊为小肠CD的患者58例。分析简化CDAI和CRP与小肠病变范围的关系：评估小肠CD患者临床特征与CESI的相关性：计算简化CDAI和CRP判断胶囊内镜下炎症活动期的敏感性、特异性、阳性预测值、阴性预测值和准确性。对治疗后11例小肠CD患者行胶囊内镜复查．分析CESI改变与简化CDAI和CRP改变的相关性。结果：不同小肠病变范围的简化CDAI和CRP相比差异无统计学意义（P〉0．05）;小肠CD患者临床特征与CESI无关;简化CDAI和CRP判断胶囊内镜下炎症活动期的敏感性、特异性、阳性预测值、阴性预测值和准确性均较低。治疗后,CESI改变与简化CDAI和CRP改变无相关性（P〉0．05）。结论：简化CDAI和CRP并不能反映胶囊内镜下小肠CD患者病变范围和活动程度：小肠CD的胶囊内镜下黏膜修复情况与临床症状和生化指标的改善不一致．胶囊内镜下病变好转迟滞于简化CDAI和CRP的改善。     

1000例OMOM胶囊内镜检查患者的回顾性分析研究

小肠疾病采用传统检查技术诊断困难,至2001年胶囊内镜检查系统问世,其诊断才有了突破性的进展。胶囊内镜诊断具有无创、高效等优点,已成为疑似小肠疾病患者的主要诊断方法。现回顾近年间我院1000例接受OMOM胶囊内镜检查者的临床资料,分析在不同小肠疾病中的检查成功率、病变检出情况等,评价该胶囊内镜的临床应用价值。     

胶囊内镜临床应用新进展

自2001年通过美国食品药物管理署的认证以来,胶囊内镜的临床应用日益广泛,其已在成年人肠道疾病的诊断中奠定了重要地位,广泛用于不明原因消化系出血、小肠克罗恩病、乳糜泻、家族性息肉综合征等小肠疾病的诊断和监测.尽管胶囊内镜在未成年人中的使用相对滞后,但他同样可以为其小肠疾病提供一个准确、有效的诊断方法.胶囊内镜开创了胃肠病学界的新纪元,给小肠疾病的诊断带来了一种非侵入性的新检查工具.本文就胶囊内镜临床应用的新进展作一综述.     

Carcinoid tumour of the terminal ileum simulating Crohn disease

Carcinoid tumours are often difficult to diagnose because of obscure or non-specific symptoms. Two cases of ileal carcinoid are reported in whom the diagnosis was delayed as the symptoms and small-bowel series were thought to be consistent with Crohn disease. This report emphasizes the difficulties of diagnosing carcinoid by conventional radiological methods. Ileal carcinoid should be considered in the differential diagnosis of Crohn disease, particularly in elderly patients presenting with chronic recurrent symptoms.     

Perianal Crohn’s: Review of endoscopic and cross-sectional imaging

Crohn’s disease has many manifestations and can affect any aspect of the gastrointestinal lumen. In this article, we would review perianal manifestations of Crohn’s disease, which includes the formation of fistula tracts, strictures, and abscesses. Perirectal fistulas can be particularly challenging to manage because of the complexity in diagnosis. Additionally, clinical symptoms of perirectal disease do not always reflect disease activity. Perianal fistulas are important to diagnose early and accurately because of associated complication of abscess formation.We would review diagnostic tools to evaluate perirectal disease. These would include examination under anesthesia, fistulography, and computerized tomography imaging. Endoscopic ultrasound and magnetic resonance imaging are particularly useful in the classification of perirectal disease and are used to monitor disease activity as well as response to medication or surgical therapy or both. The uses and the limitations of these studies would be reviewed in this article. We would also review the technique of endoscopic ultrasound, its uses, along with its limitations. The classification of fistulas as simple and complex with endoscopic ultrasound helps determine treatment course from antibiotics to biologic agents to surgical therapy for more complex disease.     

Polymorphism of heat-shock protein gene HSP70-2 in Crohn disease: possible genetic marker for two forms of Crohn disease.

BACKGROUND: Previous reports have shown that heat-shock protein 70 (HSP70) may be associated with Crohn disease. However, genetic analysis of the HSP70 gene in Crohn disease has not been done. The aim of this study is to investigate whether HSP70-2 gene polymorphism is involved in susceptibility to Crohn disease in the Japanese population and whether it correlates with clinical manifestation of the disease. METHODS: A total of 108 genetically unrelated patients with Crohn disease and 108 healthy controls were typed for HSP70-2 PstI polymorphism by restriction fragment length polymorphism analysis (alleles A and B). Patients with Crohn disease were classified into two types: either perforating or non-perforating. RESULTS: Genotype and allele frequency did not differ between patients and controls. In patients with Crohn disease, allele A frequency was significantly higher in the non-perforating than in the perforating type (P = 0.02). When patients with Crohn disease of more than 6.7 years' duration were assessed, the differences in genotype and allele frequency between the two groups became more significant (P < 0.001 and P < 0.001, respectively). CONCLUSIONS: These data suggest that HSP70-2 gene polymorphic allele A is a possible genetic marker of less severe clinical phenotype in Japanese patients with Crohn disease.     

Crohn disease arthropathy: antigens in synovial fluid share epitopes with strains of two species of viridans streptococci

BACKGROUND: There is evidence to suggest that Crohn disease is caused by an immunologic response to an unknown intestinal luminal antigen, probably of bacterial origin. The reported demonstration of yersinia antigen in the synovial fluid of patients with yersinosis therefore prompted a search for bacterial antigens in the synovial fluid of patients with Crohn arthropathy. METHODS: Antisera were raised in rabbits to synovial fluids obtained from seven patients with Crohn arthropathy and from seven 'control' subjects with other forms of arthropathy. These antisera were used to probe sonicates of the bacteria cultured from the gastric juice of patients with gastric Crohn disease. RESULTS: The antisera made from the Crohn synovial fluids, but none of those made from the controls, reacted uniquely with antigens in sonicates of strains of two species of viridans streptococci (Streptococcus parasanguis and an atypical S. oralis) isolated from four of the five patients with gastric Crohn disease. CONCLUSIONS: These findings suggest that the arthropathy of Crohn disease and, possibly, the intestinal disease itself may involve an immunologically mediated inflammatory response to these antigens.     

小肠克罗恩病的特征分析

目的通过对小肠克罗恩病患者的临床特点分析,加深对小肠克罗恩病的认识,提高早期诊断水平,减少误诊率。方法对1992年1月～2006年12月期间在我院住院病历中符合克罗恩病的116例患者的临床特点进行回顾性分析。结果小肠克罗恩病24例（20．69％）,青壮年好发,首次确诊时间比其他类型克罗恩病患者更长。其临床主要表现为腹痛20例（83．33％）,便秘8例（33．3％）,腹泻6例（25％）,便血6例（25％）,消瘦14例（58．3％）,贫血8例（33．3％）,发热7例（29．2％）,手术18例（75％）。结论小肠克罗恩病临床表现多样化,诊断困难。小肠钡灌检查可作为小肠克罗恩病的有效筛查手段。     

Crohn Disease Arthropathy: Antigens in Synovial Fluid Share Epitopes with Strains of Two Species of Viridans Streptococci

Background: There is evidence to suggest that Crohn disease is caused by an immunologic response to an unknown intestinal luminal antigen, probably of bacterial origin. The reported demonstration of yersinia antigen in the synovial fluid of patients with yersinosis therefore prompted a search for bacterial antigens in the synovial fluid of patients with Crohn arthropathy. Methods: Antisera were raised in rabbits to synovial fluids obtained from seven patients with Crohn arthropathy and from seven 'control' subjects with other forms of arthropathy. These antisera were used to probe sonicates of the bacteria cultured from the gastric juice of patients with gastric Crohn disease. Results: The antisera made from the Crohn synovial fluids, but none of those made from the controls, reacted uniquely with antigens in sonicates of strains of two species of viridans streptococci (Streprococcus parasanguis and an atypical S. oralis) isolated from four of the five patients with gastric Crohn disease. Conclusions: These findings suggest that the arthropathy of Crohn disease and, possibly, the intestinal disease itself may involve an immunologically mediated inflammatory response to these antigens.     

Polymorphism of Heat-Shock Protein Gene HSP70-2 in Crohn Disease: Possible Genetic Marker for Two Forms of Crohn Disease

Background: Previous reports have shown that heat-shock protein 70 (HSP70) may be associated with Crohn disease. However, genetic analysis of the HSP70 gene in Crohn disease has not been done. The aim of this study is to investigate whether HSP70-2 gene polymorphism is involved in susceptibility to Crohn disease in the Japanese population and whether it correlates with clinical manifestation of the disease. Methods: A total of 108 genetically unrelated patients with Crohn disease and 108 healthy controls were typed for HSP70-2 PstI polymorphism by restriction fragment length polymorphism analysis (alleles A and B). Patients with Crohn disease were classified into two types: either perforating or non-perforating. Results: Genotype and allele frequency did not differ between patients and controls. In patients with Crohn disease, allele A frequency was significantly higher in the non-perforating than in the perforating type (P = 0.02). When patients with Crohn disease of more than 6.7 years' duration were assessed, the differences in genotype and allele frequency between the two groups became more significant (P &lt; 0.001 and P &lt; 0.001, respectively). Conclusions: These data suggest that HSP70-2 gene polymorphic allele A is a possible genetic marker of less severe clinical phenotype in Japanese patients with Crohn disease.     

Assessment of disease activity in inflammatory bowel diseases: Non-invasive biomarkers and endoscopic scores

Inflammatory bowel diseases (IBD) comprise two major forms: Crohn’s disease and ulcerative colitis. The diagnosis of IBD is based on clinical symptoms combined with results found in endoscopic and radiological examinations. In addition, the discovery of biomarkers has significantly improved the diagnosis and management of IBD. Several potential genetic, serological, fecal, microbial, histological and immunological biomarkers have been proposed for IBD, and they have been evaluated for clinical routine and clinical trials. Ileocolonoscopy, especially with biopsy collection, has been considered the standard method to diagnose IBD and to assess clinical activity of the disease, but it is limited to the colon and terminal ileum and is considered invasive. For this reason, non-invasive biomarkers are necessary for this type of chronic inflammatory disease, which affects mostly young individuals, as they are expected to have a long follow-up.     

炎症性肠病血浆Prickle1水平的鉴别意义

目的 研究炎症性肠病患者血浆Prickle1水平对于鉴别诊断的价值.方法 应用酶联免疫吸附试验(Enzyme-Linked ImmunoSorbent Assay,ELISA)分析克罗恩病患者、溃疡性结肠炎患者和正常对照者血浆中Prickle1蛋白的表达.受试者工作特征曲线(receiver-operating cha...     

Crohn disease in patients with familial Mediterranean fever

Crohn disease and familial Mediterranean fever (FMF) are inflammatory diseases characterized by abdominal pain and fever. The concurrence of the 2 diseases (FMF-CD) may pose a challenge to diagnosis and treatment. We undertook the present study to determine the prevalence of Crohn disease in FMF and to characterize FMF-CD patients clinically and genetically. Using a computerized search, the patients of our FMF clinic were screened for a concomitant diagnosis of Crohn disease. Patients and their medical records were thoroughly examined, and their DNA was genotyped for mutations in the MEFV gene. Control groups of ethnically and sex-matched patients suffering from each of the diseases alone, either Crohn disease or FMF, were used for comparison. We identified 7 patients with concomitant Crohn disease and FMF, which is more than the expected prevalence in the general population (p = 0.03). Crohn disease presented at a significantly later age in the FMF-CD group (40.6 +/- 10.0 yr versus 26.2 +/- 11.4 yr; p < 0.004). Disease severity and other characteristics of Crohn disease were comparable to the Crohn disease control group. Contrary to the FMF control group patients, FMF in FMF-CD patients was characterized by a higher attack frequency (p < 0.05) and increased prevalence of amyloidosis (p < 0.02). The overall severity score was similar in both groups. In conclusion, Crohn disease appears to be more prevalent in FMF and presents later than in patients without FMF. FMF in this group of patients shows a higher attack frequency and is more often complicated by amyloidosis.