大肠镜检阴性慢性腹泻与回肠末端病变的关系

Relationship between chronic diarrhea with normal colonoscopic findings and terminal ileal lesions

目的:探讨大肠镜检阴性慢性腹泻与回肠末端病变关系.方法:病例组为徐州医学院附属淮安医院2009-01/2010-06内镜大肠镜检阴性慢性腹泻患者40例,排除甲状腺功能亢进症、糖尿病等.正常对照组为徐州医学院附属淮安医院同期体检无腹泻患者40例.两组患者均进镜至回肠末端20cm或以上,腹泻伴回肠末端有病变者予灭滴灵及微生态制剂治疗10-14d.结果:内镜大肠镜检阴性慢性腹泻患者40例,29例内镜下表现为回肠末端充血、水肿、糜烂、溃疡,10例内镜下表现为回肠末端淋巴滤泡明显增生,淋巴滤泡较大,最大7-8mm,1例回肠末端正常.治疗后症状消失35例,内镜复查30例回肠末端病变消失.对照组有5例散在淋巴滤泡增生,淋巴滤泡较小,最大3mm,无充血、水肿糜烂、溃疡.慢性腹泻组治疗前镜下表现与对照组比较有显著性差异(χ2=58.38,P<0.05).结论:大肠镜检正常的慢性腹泻患者,回肠末端往往有病变,内镜下表现为糜烂、溃疡、淋巴滤泡增生等,予灭滴灵及微生态制剂治疗效果较好.

AIM：To explore the relationship between chronic diarrhea with normal colonoscopic findings and terminal ileal lesions. METHODS：Forty patients with chronic diarrhea and normal colonoscopic findings and 40 healthy controls without diarrhea were included in this study.Colonoscopy was inserted 20 cm or up into the terminal ileum for examination in both groups.Diarrhea patients were administered metronidazole and probiotics for 10-14 d after being diagnosed with ideal lesions. RESULTS：Of 40 patients with chronic diarrhea and normal colonoscopic findings,29 showed hyperemia,edema,erosion,ulcer of the terminal ileum,10 showed hyperplasia and enlargement of lymphoid follicles（maximum diameter up to 7-8 mm） ,and 1 was normal.After treatment,clinical symptoms disappeared in 35 patients,and endoscopic ileal lesions disappeared in 30 patients.In healthy controls,the terminal ileum showed scattered hyperplasia of lymphoid follicles in 5 patients,but the size of lymphoid follicles was small（maximum diameter,3 mm） . No congestion,edema,erosion and ulcer of the terminal ileum were found in controls.Colonoscopic manifestations were significantly different between the two groups of subjects（χ2= 58.38,P〈0.05） . CONCLUSION：Patients with chronic diarrhea and normal colonoscopic findings often have lesions in the terminal ileum,such as erosion and ulcer of the terminal ileum,and hyperplasia of lymphoid follicles.Metronidazole and probiotics show good therapeutic effects in these patients.