克罗恩病上消化道病变的临床、内镜及病理特征分析

Analysis of clinical, endoscopic, and pathological features of upper gastrointestinal tract lesions in Crohn's disease

目的 分析成人克罗恩病(CD)上消化道病变的发生情况及其与上消化道症状的关系,以评估胃镜检查对CD诊断的价值.方法 连续纳入2017年7月至2018年4月在中山大学附属第六医院就诊的幽门螺旋杆菌(Hp)阴性成年CD确诊患者.所有病例由指定的内镜专家和病理学家进行胃镜检查并活检和病理组织学检查.内镜检查时常规从患者上消化道的6个部位(食管、胃体、胃窦、胃角、十二指肠球部和降段)采集10块标本送检.同时收集患者人口学和临床资科.结果 纳入136例Hp阴性成年CD患者中,58例(42.6％)和83例(61.0％)分别检出可能与CD相关的内镜和病理组织学病变.病理组织学发现非干酪性肉芽肿7例(5.1％),局灶增强性胃炎14例(10.3％),局灶活动性炎31例(22.8％).根据内镜和组织学特征可确定CD病变26例(19.1％),其中无上消化道症状组和有上消化道症状组分别为24例(24/111,21.6％)和2例(2/25,8.0％).结论 无论有或无上消化道症状的成人CD患者中,上消化道病变常见,可确定CD特异的上消化道病变也不少见,推荐对疑诊或确诊的CD患者进行常规胃镜检查和活检.

Objective To analyze the prevalence of upper gastrointestinal tract (UGIT) involvement and its relationship to UGIT symptoms in adult patients with Crohn's disease (CD) in order to evaluate the diagnostic value of gastroscopy.Methods Adult CD patients with negative Helicobacter pylori (Hp)diagnosed at The Sixth Affiliated Hospital of Sun Yat-sen University from July 2017 to April 2018 were consecutively included.All the cases received gastroscopy,biopsy and histopathological examination performed by designated endoscopy specialist and pathologist.During the endoscopy,10 specimens were collected from 6 parts of the UGIT (esophagus,gastric body,antrum,angulus,duodenal bulb and descending section).At the same time,patient demographics and clinical data were collected.Results Among the 136 adult CD and Hp-negative patients,endoscopic and histologic lesions probably related to CD were found in 58 (42.6％)and 83 (61.0％)patients,respectively.Seven (5.1％) patients had non-caseating granulomas,14 (10.3％) patients had focally enhanced gastritis,and 31 (22.8％) patients had focal active inflammation.According to endoscopic and histological features,26 cases (19.1％) of CD lesions were identified,among whom 24 cases (21.6％) were found in the asymptomatic group and 2 cases (8.0％) in the symptomatic group.Conclusions There is a high frequency of UGIT involvement in adult patients with CD,irrespective of the presence or absence of UGIT symptoms.Confirmable specific UGIT lesions of CD are also common,and routine gastroscopy and biopsy are worth recommending for patients suspected of having CD or diagnosed with CD.