双气囊内镜与多层螺旋CT小肠造影在小肠克罗恩病诊断中的作用

目的 研究双气囊内镜(DBE)和多层螺旋CT小肠造影(MSCTE)在小肠克罗恩病(CD)诊断中的价值.方法 对71例临床疑似小肠CD患者分别进行DBE和MSCTE检查并作出诊断.结合病理及临床随访结果,比较两种方法在小肠CD诊断、判断病变范围、活动性和并发症等方面的能力.结果 DBE与MSCTE对小肠CD确诊率相似,两者间差异无统计学意义(χ2=2.29,P>0.05).前者阳性似然比为22.5,阴性似然比为0.022;后者阳性似然比为1.6,阴性似然比为0.240.两种检查方法对于无-轻度管腔狭窄者判断的一致性明显高于中-重度管腔狭窄者(χ2=11.298,P=0.001).DBE与MSCTE对疾病活动性判断的一致性为95.8%.结论 DBE可能是确诊小肠CD的首选方法,与MSCTE联合应用有利于诊断和评价小肠CD患者的病情.     

多层螺旋CT小肠造影对回盲部良性溃疡疾病的临床价值

目的探讨多层螺旋CT小肠造影(MSCTE)在诊治回盲部良性溃疡性疾病中的价值。方法回顾性分析51例行MSCTE的回盲部良性溃疡患者的病历资料,总结回盲部良性溃疡病病因学构成及其MSCTE的影像学特点,并分析MSCTE能否提高回盲部良性溃疡病变的诊断率。结果本组病例有回盲部良性溃疡表现的主要为克罗恩病(Crohn’s disease,CD)及肠结核,但也有部分病例难以明确;该类疾病MSCTE的影像学特点有肠道管壁增厚(45例,88.2%),节段性病变(20例,39.2%),肠腔狭窄(7例,13.7%),梳齿征(7例,13.7%),腹腔脓肿、瘘管形成(1例,2.0%),肠系膜及腹膜后淋巴结肿大(13例,25.5%),相对于内镜检查,结合MSCTE回盲部良性溃疡病因的诊断率提高21.6%,其中CD、肠结核及非特异性炎的诊断率分别提高33.3%、16.7%、50.0%。结论 MSCTE检查对回盲部良性溃疡病病因的诊断价值较大,其中以CD明显,同时可对疾病并发症、肠壁增厚及肠外病变等进行评估,为临床诊治该类疾病提供重要参考。     

多排螺旋计算机断层成像技术小肠造影对小肠疾病的诊断价值

目的评价多排螺旋计算机断层成像技术小肠造影（MSCTE）对诊断小肠疾病的诊断价值。方法98例疑为小肠病变的患者行MSCTE检查，观察受试者对MSCTE的耐受性以及有无并发症，观察分析不同病变的MSCTE表现，并以手术病理结果或小肠捕管造影、内镜和（或）活检病理的综合诊断结果为金标准来判断MSCTE对小肠病变的诊断价值。结果所有受试者均顺利完成MSCTE，未发现并发症。其中2例为小肠捕管造影失败而改行MSCTE。MSCTE诊断小肠病变总的灵敏度为96．5％（83／86），MSCTE结果与最后临床诊断符合率为90．8％（89／98）。结论MSCTE是一种简便易行、能多方位、全景式显示小肠的方法，对多种小肠疾病有较高的诊断价值。     

多层螺旋CT小肠造影与双气囊小肠内镜判断小肠克罗恩病活动度的价值

目的研究多层螺旋CT小肠造影(MSCTE)和双气囊小肠内镜(DBE)在小肠克罗恩病(CD)的诊断和判断其活动度的价值。方法选取经临床确诊的32例小肠CD患者,分别进行MSCTE检查和DBE检查并作出诊断和分析,比较两种方法在诊断小肠CD,判断病变位置、范围、活动度和并发症方面的能力。结果 MSCTE与DBE对小肠CD确诊率相似,两者比较,差异无统计学意义(P0.05)。对于显示并发症的能力,MSCTE明显优于DBE。结论 MSCTE是诊断小肠CD的首选辅助检查,能判断炎症是否处于活动期及发现肠腔外并发症,而且能指导DBE的进镜方式,与DBE联合应用有利于诊断和评价小肠CD患者的炎症活动度,指导临床治疗。     

胶囊内镜配合多层螺旋CT小肠造影在小肠血管畸形诊断中的应用价值

目的研究胶囊内镜（CE）和多层螺旋CT小肠造影（MSCTE）在小肠血管畸形（vascular malformation,VM）诊断中的价值。方法对36例临床疑似小肠VM患者分别进行CE和MSCTE检查并做出诊断,结合术后病理及临床随访结果,比较两种方法在小肠VM诊断,判断病变范围及并发症等方面的情况。结果 CE与MSCTE对小肠VM确认率相似,两者间差异无统计学意义（χ2=2.29,P〉0.05）。两种检查方法对Ⅲ型和Ⅳ型血管VM判断的一致性明显高于对Ⅰ型和Ⅱ型的VM（χ2=11.298,P=0.001）。CE和MSCTE对疾病范围判断的一致性为95.2%。结论 CE可能是确诊小肠VM的首选方法,与MSCTE联合应用有利于诊断和评价小肠VM患者的病情。     

胶囊内镜、CT小肠成像、小肠造影及回结肠镜对克罗恩病诊断价值的比较

目的 比较4种影像技术方法在小肠克罗恩病(CD)诊断中的应用价值.方法 57例经临床病理诊断为小肠CD的患者伴有不同程度腹痛、消瘦、腹泻或发热、大便潜血阳性等症状体征,进行回结肠镜、CT小肠成像(CTE)、胶囊内镜(CE)、小肠造影(SBFT)检查,发现异常患者则具体记录病变部位、性质,并对单项检杳及两项检查联合的阳性检出率进行比较.结果 57例CD患者中50例完成了回结肠镜检查,33例发现回肠末端溃疡(66.00%),17例回肠末端正常;CTE 34例,发现小肠病变29例(85.29%);CE 27例,其中1例发生CE在胃内潴留未达小肠,发现小肠病变26例(96.30%);SBFT 39例,发现小肠病变26例(66.67%).CE诊断CD的阳性率最高(96.30%),而回结肠镜最低(66.0%),4种检查方法的阳性率差异有统计学意义(P=0.006).两种检查方法联合的诊断CD的阳性检出率:CE+CTE为92.86%(13/14),SBFT+CTE为90.91%(20/22),CE+回结肠镜为95.65%(22/23),CE+SBFT为100%(17/17),回结肠镜+CTE为89.66%(26/29),回结肠镜+SBFT为77.78%(28/36),两种检查联合的组间比较,差异无统计学意义(P=0.140).结论 CE、CTE诊断轻度、中度CD的阳性率比SBFT高,CE发现早期黏膜病变较好,CTE发现肠壁及肠外病变较好,最重要的是CE及CTE可应用于非梗阻性小肠CD患者,传统技术如SBFT或回结肠镜阴性或不能明确诊断时,CE还可用于解释临床症状、随访及指导治疗.     

CT小肠造影在克罗恩病临床诊断中的价值

目的:总结与评估多排CT小肠造影(CT enteroclysis,CTE)在克罗恩病(Crohn’s disease,CD)临床诊断与病情评估中的应用价值.方法:回顾性分析31例CD患者的病史资料,分析与总结CD患者CTE的影像学特点,并与炎症活动生物指标[血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)]、结肠镜、单气囊小肠镜等结果进行比较分析.结果:CTE诊断阳性率在活动期CD为75%,缓解期为66.7%.CD活动期CTE常见的表现为节段性肠壁增厚(26例,92.9%)、双层或多层强化(20例,71.4%)、肠周围淋巴结肿大(20例,71.4%)、肠系膜血管增多/梳状征(17例,60.7%)、肠腔狭窄(13例,46.4%),随着疾病活动程度加重,此5种CTE表现的阳性率有逐渐升高趋势,且均与CRP呈正相关,而多层强化、梳状征与ESR水平具有正相关.25例CD患者行结肠镜检查,11例(44.0%)结肠镜与CTE发现病变部位一致,10例(40.0%)结肠镜下未见末端回肠病变而CTE下可见小肠病变,结肠镜与CTE二者联合诊断23例(92.0%).31例中有12例行单气囊小肠镜检查,结果显示所有12例(100%)CD患者CTE发现的病变部位均与单气囊小肠镜一致.结论:常规结肠镜检查联合CTE可有效而全面的评估CD患者的病情,尤其对于小肠病变的发现以及疾病的活动性评估等方面,CTE有重要价值.     

炎症性肠病858例临床分析

目的总结分析炎症性肠病（IBD）的临床特点,探讨诊治策略。方法对1998年1月至2009年7月354例炎症性肠病住院患者和2003年1月至2009年7月504例炎症性肠病门诊患者资料进行回顾性分析。结果本组资料显示我院近12年来IBD发病呈逐年上升趋势,溃疡性结肠炎（UC）明显多于克罗恩病（CD）。本组IBD患者中男女之比为1.28∶1。IBD平均发病年龄（41.07±16.07）岁。UC发病高峰年龄为30～49岁,CD发病高峰年龄为20～39岁。本组住院患者中UC和CD两组民族构成比较无统计学差异。肠镜检查中UC以直肠和乙状结肠病变为主,CD以回盲部及回肠末端病变为主。本组患者IBD病理组织学检出率为41.5%,UC误诊率为17.0%,CD误诊率为25.0%。治疗以氨基水杨酸类及类固醇激素为主。结论炎症性肠发病数呈逐年上升趋势;IBD诊断主要依靠内镜及病理。IBD呈慢性复发性发作过程,应长期维持治疗。     

小肠肠壁增厚的MSCTE征象在不同类型小肠疾病诊断中的价值

目的研究不同类型小肠疾病采用多层螺旋CT小肠造影(MSCTE)表现出的小肠肠壁增厚征象,并对其诊断价值作出分析。方法调取经MSCTE检查后发现小肠肠壁增厚的小肠疾病患者60例为研究对象,所有患者经手术及病理检查证实诊断,由2名经验丰富的放射科医生对60例患者的影像学结果进行阅片,分析增厚肠壁的受累肠段、受累长度、强化方式、对称情况和肠周异常情况。结果恶性肿瘤多表现为不均匀强化和不对称性的局限性肠壁增厚,炎性或感染性疾多表现为均匀强化和对称性的节段性肠壁增厚,克罗恩病则多见于良性病变。增厚肠壁分层状强化在炎性或感染性疾病中较为常见,均匀强化和不均匀强化在肿瘤中较为常见,强化减弱在肠缺血中较为常见,增厚肠壁邻近淋巴结增大在小肠恶性肿瘤、克罗恩病与结核中较为常见,邻近肠系膜血管异常在炎性性或感染性疾病中较为常见。结论不同类型小肠疾病肠壁增厚的受累长度、程度、对称性与否、强化方式情况和肠周异常情况的MSCTE征象不同,可将MSCTE检查作为鉴别克罗恩病、炎性性或感染性疾病、恶性肿瘤诊断的有效方式。     

炎症性肠病患者血清纤维化指标的变化

背景：炎症性肠病（IBD）具有慢性和反复发作的特点，肠壁组织反复损伤和修复可致局部纤维化和瘢痕形成。目的：观察IBD患者常用血清纤维化指标层黏蛋白（LN）、Ⅳ型胶原（C-Ⅳ）、透明质酸（HA）和Ⅲ型前胶原氨基端肽（PmNP）的变化，评价其与疾病活动度的关系。方法：收集经结肠镜和活检病理检查确诊的48例溃疡性结肠炎（UC）患者、50例克罗恩病（CD）患者和50例对照者，以放射免疫测定检测血清LN、C-1V、HA和PmNP水平，以酶联免疫吸附测定（ELISA）检测血清高敏C反应蛋白（hs-CRP）水平。结果：与对照组相比，UC和CD患者血清LN水平显著增高，C-Ⅳ和PⅢNP水平显著降低（P〈0．05），UC和CD两组间则无明显差异；三组间血清HA水平均无明显差异。血清hs-CRP水平可反映IBD疾病活动度，活动期患者hs-CRP水平均高于200mg／L。IBD患者的LN水平与hs-CRP呈正相关（UC：r=0．33，CD：r=0．53，P〈0．05），C-Ⅳ和PmNP水平与hs-CRP无明显关联。LN水平与CD病变部位无明显关联。结论：IBD患者血清LN水平增高，C-Ⅳ和PmNP水平降低．可能成为肠壁组织炎症和修复的间接标志物：血清LN水平可间接反映IBD疾病活动度。     

Epidemiology of inflammatory bowel disease in adults who refer to gastroenterology care in Romania: a multicentre study

AIM: The Romanian Society of Gastrointestinal Endoscopy developed a multicentre, prospective study to evaluate the frequency and epidemiological features of inflammatory bowel disease (IBD) in an adult population that refers to gastroenterology centres in Romania. MATERIAL AND METHODS: Eighteen centres with adequate diagnostic and therapeutic facilities uniformly distributed across Romania reported through a proforma the new and old IBD cases between 1 June 2002 and 1 June 2003. The rates of incidence and prevalence of ulcerative colitis (UC) and Crohn's disease (CD) have been reported per 100 000 inhabitants. Epidemiological features and disease characteristics were analysed. RESULTS: During the study, 407 cases of UC (163 incident cases) and 254 cases of CD (85 incident cases) were identified. The incidence in the referral population was 0.97/100 000 and 0.50/100 000 for UC and CD, respectively, whereas the prevalences was 2.42/100 000 and 1.51/100 000 for UC and CD, respectively. A slight male predominance, wider age distribution and predominant urban residence were the main demographic features of incident cases; smoking and appendectomy/appendicitis were infrequent in UC, while a higher proportion of CD patients were smokers. Lower rates of severe, extensive or complicated IBD were noted as compared with the literature. CONCLUSION: Incidence and prevalence rates of IBD in Romania are low. Predominant male involvement and a wider distribution of incident cases were the main demographic features in our population. IBD in our patients had a more 'benign' course as compared with the literature, with lower rates of severe, extensive or complicated disease and a small proportion of patients who need surgery.     

Joint manifestations in gastrointestinal diseases. 1. Pathophysiological aspects, ulcerative colitis and Crohn's disease.

The many unique structural and functional features of the intestine may offer explanations to the well-established association between arthritis and inflammatory bowel diseases (IBD). In ulcerative colitis (UC) and Crohn's disease (CD) some 6-8% of cases develop peripheral joint disease which frequently correlates with the activity and extent of the underlying bowel disorder. Ankylosing spondylitis is also found rather frequently in UC and CD, but is apparently not related to the severity of colitis. The occurrence of rheumatic manifestations in these two IBD is reviewed in detail.     

Familial and Sporadic Inflammatory Bowel Disease: Comparison of Clinical Features and Serological Markers in a Genetically Homogeneous Population

Background: The familial occurrence of inflammatory bowel disease (IBD) and the clinical features of familial and sporadic IBD in the genetically homogeneous Finnish population are evaluated. Methods: 257 patients with Crohn disease (CD) and 436 with ulcerative colitis (UC) participated in the study. They were asked whether IBD was present (familial IBD) or absent (sporadic IBD) in their first-degree relatives. Data on the clinical course of the disease were collected from the patient records. Antibodies to Saccharomyces cerevisiae (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) were determined from serum samples. Results: Affected first-degree relatives were found in 15.6% of patients with CD and in 13.8% of patients with UC. In familial cases, CD was more often located in the ileum (38% versus 21%) and less often in the ileocolon (35% versus 50%) ( P < 0.05) than in sporadic cases. A greater percentage of CD patients than UC patients were smokers (47% versus 13%; P < 0.01). An elevated level of IgA and/or IgG antibodies for ASCA was found more often in CD patients than in UC patients (59% versus 14%; P < 0.01), while pANCA were found more often in UC than in CD patients (48% versus 12%; P < 0.01). The combination of pANCA-ASCA + yielded a sensitivity, specificity and positive predictive value of 48%, 92% and 90%, respectively, for CD, and the combination of pANCA + ASCAof 55%, 94% and 90%, respectively, for UC. Conclusions: The percentage of familial IBD cases in Finland is comparable to that reported elsewhere in Europe. No important clinical differences between patients with familial and sporadic forms of the disease were found. ASCA is associated with both familial and sporadic CD and pANCA with UC, but low sensitivity diminishes their value as a serological marker of IBD or as a differential diagnostic test between CD and UC.     

2 The differential diagnosis of Crohn's disease and ulcerative colitis

Most cases of inflammatory bowel disease (IBD) can be correctly labelled as Crohn's disease (CD) or ulcerative colitis (UC) with careful initial gross and microscopic examination of biopsy and resection specimens together with close clinical and radiological correlation. Until we understand more of the aetiology and immunology of IBD we should admit that there are limitations imposed by current diagnostic criteria, consider the use of reporting proforma to improve diagnostic accuracy, and accept that in a small number of patients clinicopathological features will overlap, and CD may masquerade as UC.     

Secondary amyloidosis in inflammatory bowel disease: a study of 18 patients admitted to Rikshospitalet University Hospital, Oslo, from 1962 to 1998.

BACKGROUND: Amyloidosis (A) is a well-known but rare complication to inflammatory bowel disease (IBD). We describe 18 patients with IBD and A, with special emphasis on clinicopathologic features and site relationships, comparing our results with previously reported cases in the world literature. METHODS: Patient records were collected from the files of the medical department at Rikshospitalet. Clinical data were compiled from records. RESULTS: Fifteen of the 18 patients had Crohn's disease (CD), 1 had ulcerative colitis (UC), one had UC preceding CD, and 1 had indeterminate colitis. There was a male preponderance of 13:5 = 2.6. Five of the patients had A at the time of diagnosis of IBD. Median time from diagnosis of IBD to A was 4 years, and A was diagnosed within 5 years after onset of IBD in 11 patients. Thirteen of the patients had suppurative complications; 12 had extraintestinal manifestations. Sixteen of the patients had been treated by bowel resection, 14 due to refractory IBD. Ten patients had been treated by renal transplantation. After 15 years of follow-up, the survival rate was 60%. CONCLUSIONS: Our findings strengthen the previous impression of an approximately 3-fold increased preponderance in males, with at least 10-fold increased frequency in CD compared with UC, and with a possible relationship to suppurative complications and extraintestinal manifestations, as well as an increased risk of having a bowel resection. The increased survival seems to be due to the introduction of renal transplantation.     

Familial and sporadic inflammatory bowel disease: comparison of clinical features and serological markers in a genetically homogeneous population

BACKGROUND: The familial occurrence of inflammatory bowel disease (IBD) and the clinical features of familial and sporadic IBD in the genetically homogeneous Finnish population are evaluated. METHODS: 257 patients with Crohn disease (CD) and 436 with ulcerative colitis (UC) participated in the study. They were asked whether IBD was present (familial IBD) or absent (sporadic IBD) in their first-degree relatives. Data on the clinical course of the disease were collected from the patient records. Antibodies to Saccharomyces cerevisiae (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) were determined from serum samples. RESULTS: Affected first-degree relatives were found in 15.6% of patients with CD and in 13.8% of patients with UC. In familial cases CD was more often located in the ileum (38% versus 21%) and less often in the ileocolon (35% versus 50%) (P< 0.05) than in sporadic cases. A greater percentage of CD patients than UC patients were smokers (47% versus 13%; P < 0.01). An elevated level of IgA and/or IgG antibodies for ASCA was found more often in CD patients than in UC patients (59% versus 14%; P < 0.01), while pANCA were found more often in UC than in CD patients (48% versus 12%; P < 0.01). The combination of pANCA-ASCA+ yielded a sensitivity, specificity and positive predictive value of 48%, 92% and 90%, respectively, for CD, and the combination of pANCA + ASCA- of 55%, 94% and 90%, respectively, for UC. CONCLUSIONS: The percentage of familial IBD cases in Finland is comparable to that reported elsewhere in Europe. No important clinical differences between patients with familial and sporadic forms of the disease were found. ASCA is associated with both familial and sporadic CD and pANCA with UC, but low sensitivity diminishes their value as a serological marker of IBD or as a differential diagnostic test between CD and UC.     

Primary sclerosing cholangitis associated colitis: Characterization of clinical,histologic features,and their associations with liver transplantation

BACKGROUND Primary sclerosing cholangitis(PSC) associated inflammatory bowel disease(IBD) is a unique form of IBD(PSC-IBD) with distinct clinical and histologic features from ulcerative colitis(UC) and Crohn disease(CD). In patients with PSC and IBD, the severity of the two disease processes may depend on each other.AIM To study the histologic and clinical features of PSC patients with and without IBD.METHODS We assessed specimens from patients with UC(n = 28), CD(n = 10), PSC and UC(PSC-UC; n = 26); PSC and CD(PSC-CD; n = 6); and PSC and no IBD(PSC-no IBD; n = 4) between years 1999-2013. PSC-IBD patients were matched to IBD patients without PSC by age and colitis duration. Clinical data including age, gender, age at IBD and PSC diagnoses, IBD duration, treatment, follow-up, orthotopic liver transplantation(OLT) were noted.RESULTSPSC-UC patients had more isolated right-sided disease(P = 0.03), and less active inflammation in left colon, rectum(P = 0.03 and P = 0.0006), and overall(P = 0.0005) compared to UC. They required less steroids(P = 0.01) and fewer colectomies(P = 0.03) than UC patients. The PSC-CD patients had more ileitis and less rectal involvement compared to PSC-UC and CD. No PSC-CD patients required OLT compared to 38% of PSC-UC(P = 0.1). PSC-IBD(PSC-UC and PSCCD) patients with OLT had severe disease in the left colon and rectum(P = 0.04).CONCLUSION PSC-UC represents a distinct form of IBD. The different disease phenotype in PSC-IBD patients with OLT may support liver-gut axis interaction, however warrants clinical attention and further research.     

Inflammatory bowel disease in the Hubei Province of China

AIM: To analyze clinical features and response to treatment in inflammatory bowel disease (IBD) patients from the Hubei Province of China.METHODS: Clinical data was collected retrospectively from 74 patients with IBD [66 with ulcerative colitis (UC) and 8 with Crohn’s disease (CD)] admitted to The Second Hospital, Hubei Medical University from 1986 to 1995.RESULTS: The most common symptoms in IBD patients were abdominal pain, diarrhea, blood and mucus in stool, and constipation. Extraintestinal manifestations of IBD were not common. In these patients, inflammation was predominantly located in the sigmoid and left colon in UC cases, and in the ileum and colon in CD cases. Treatment with sulphasalazine and corticosteroids was effective in 95% of UC cases; However, about 42% of UC patients showed disease recurrence during the follow-up period of 1.11 years. Five out of eight CD patients had part of their intestine removed, whereas three were treated with anti-tuberculosis drugs or the antibiotic metronidazole. Out of four patients we followed up for 1-8 years, one died of severe complications after surgery, two experienced recurrence while in treatment with drugs, and one remained in remission under sulphasalazine treatment after surgery.CONCLUSION: Five percent of the patients reported a family history of IBD. About 34% of the patients were smokers and 32% of the patients were alcoholic. Epidemiological studies are urgently needed in the Hubei Province of China to assess the role that genetics and environmental factors play in the pathogenesis of inflammatory bowel diseases.