溃疡性结肠炎相关性胃十二指肠病变患者临床特征分析

Clinical characteristics analysis of patients with gastroduodenitis associated with ulcerative colitis

目的探讨溃疡性结肠炎相关性胃十二指肠病变(GDUC)患者的临床特征。方法采用描述性病例系列研究方法。回顾性收集2016年1月至2020年12月北京协和医院诊治的6例GDUC患者的临床资料并分析临床特征。结果男性3例,女性3例;溃疡性结肠炎(UC)的发病年龄32.1(20.0~51.0)岁,GDUC的发病年龄36.5(25.0~51.0)岁;UC发病至累及上消化道的时间为4.4(0~12.0)年。UC发病时病变范围E2型(左半结肠)2例,E3型(广泛结肠)4例,改良Mayo评分9.2(8.0~12.0)分。出现GDUC时,改良Mayo评分9.8(8.0~12.0)分,病变累及胃3例,十二指肠受累6例,未见食管受累。2例患者在肠道手术后出现上消化道受累表现。5例患者存在至少1种肠外表现。超敏C-反应蛋白43.2(15.9~77.0)mg/L,红细胞沉降率41.7(12.0~74.0)mm/1 h,血红蛋白108.2(80.0~117.0)g/L。胃镜下表现为胃弥漫性充血、水肿;十二指肠弥漫性充血、点状糜烂等。结肠镜显示,病变范围E2型1例,E3型4例,Mayo内镜评分3分。1例在结直肠切除+回肠储袋肛管吻合+回肠造口术后经结肠镜提示储袋炎。6例患者均应用糖皮质激素诱导缓解,其中2例病情反复后应用英夫利西单克隆抗体诱导缓解并维持治疗,4例缓解期接受免疫抑制剂维持治疗。6例患者随访2.5(0.5~3.5)年,上消化道病变完全缓解4例,部分缓解2例;改良Mayo评分2.8(0~7.0)分。上消化道病变与结肠炎活动度均下降,两者活动度平行。结论GDUC患者具有起病年龄轻、病情重度活动、广泛结肠炎、伴随肠外表现的临床特点,升级治疗后上消化道炎症程度与结肠炎活动度均下降。

Objective To investigate the clinical characteristics of patients with gastroduodenitis associated with ulcerative colitis(GDUC).Methods A descriptive case series study was performed.The clinical data of 6 patients with GDUC in Peking Union Medical College Hospital from January 2016 to December 2020 were collected retrospectively and the clinical characteristics were analyzed.Results There were 3 males and 3 females.The age of UC onset was 32.1(20.0-51.0)years old,the age of GDUC onset was 36.5(25.0-51.0)years old,and the time from UC onset to GDUC onset was 4.4(0-12.0)years.At the onset of UC,there were 2 patients of E2 type(left colon)and 4 of E3 type(extensive colon),and the modified Mayo score was 9.2(8.0-12.0)points.At the onset of GDUC,the modified Mayo score was 9.8(8.0-12.0)points,the lesions involved the stomach in 3 patients,duodenum in 6 and no esophagus was involved.Two patients had upper gastrointestinal involvement after bowel surgery.Five patients had at least one extraintestinal manifestation.The high-sensitivity C-reactive protein was 43.2(15.9-77.0)mg/L,the erythrocyte sedimentation rate was 41.7(12.0-74.0)mm/1 h,and the hemoglobin was 108.2(80.0-117.0)g/L.The diffuse gastric congestion and edema,duodenal diffuse congestion and punctate erosions were observed under gastroscope.The UC extent was E2 type in 1 patient and E3 type in 4 by colonoscope examination.The average Mayo endoscopic score was 3 points.The colonoscope result indicated that pouchitis was observed in 1 patient after colorectal resection+ileal pouch-anal anastomosis(IPAA)+ileostomy.All of the patients with GDUC were treated with glucocorticoids to induce remission,2 of them were treated with infliximab to induce remission and maintain remission after relapse,and 4 of them received immunosuppressive maintenance therapy during remission.Six patients were followed up for 2.5(0.5-3.5)years,4 patients had complete remission of upper gastrointestinal lesions and 2 had partial remission,the modified Mayo score was 2.8(0-7.0)points.The activities of GDUC and colitis decreased parallelly.Conclusions Patients with GDUC have the clinical characteristics of early age of onset,severe activity,extensive colitis,and extraintestinal manifestations.After upgrading the treatment,the inflammatory degree of upper gastrointestinal tract and activity of colitis decrease at the same time.