Ahn Soo Min, Kim Yong-Gil, Bae Seung-Hyeon, Lim Doo-Ho, Hong Seokchan, Park Sang Hyoung, Lee Chang-Keun, Yoo Bin
Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Intern Med. 2017 Sep;32(5):916-922. doi: 10.3904/kjim.2015.313. Epub 2017 Aug 11.
BACKGROUND/AIMS: In some Western countries, up to 50% of patients with ankylosing spondylitis (AS) have subclinical gut inflammation. This study was conducted to evaluate the prevalence and severity of gut inflammation and to determine clinical factors associated with colonic inflammation in Korean AS patients who performed ileocolonoscopy without evidence of established inf lammatory bowel diseases before.
One hundred and eight AS patients who underwent ileocolonoscopy were included in this study. Patients were divided into two groups based on gross ileocolonoscopic findings; patients with inflammatory lesions, and patients without inflammatory lesions.
Inf lammatory lesions in ileocolonoscopic findings were found in 40 patients. The Ankylosing Spondylitis Disease Activity Score C-reactive protein was higher in the group with inflammatory lesions and gut lesions were found often in the terminal ileum. The risk of inflammatory lesions was higher for AS patients whose symptoms required ileocolonoscopy than for AS patients who underwent routine ileocolonoscopy screening (odds ratio, 3.96). However, abnormal lesions were detected also in 17.6% of the patients who underwent ileocolonoscopy for routine screening and most of them were erosion and ulcer. Among patients with inflammatory lesions (n = 40), 23 showed subclinical gut inflammation associated with AS and 17 were diagnosed finally as Crohn's disease (n = 12), intestinal tuberculosis (n = 4), and ulcerative colitis (n = 1).
Our findings suggest that ileocolonoscopy might be recommended regularly in AS patients even without gastrointestinal symptoms, especially in the patients with high AS activity.
背景/目的：在一些西方国家，高达50%的强直性脊柱炎（AS）患者存在亚临床肠道炎症。本研究旨在评估韩国AS患者肠道炎症的患病率和严重程度，并确定与结肠炎症相关的临床因素，这些患者之前进行过回结肠镜检查且无确诊的炎症性肠病证据。
本研究纳入了108例接受回结肠镜检查的AS患者。根据回结肠镜大体检查结果将患者分为两组；有炎症性病变的患者和无炎症性病变的患者。
40例患者在回结肠镜检查中发现有炎症性病变。有炎症性病变组的强直性脊柱炎疾病活动评分C反应蛋白较高，且肠道病变常发生在回肠末端。症状需要进行回结肠镜检查的AS患者发生炎症性病变的风险高于接受常规回结肠镜筛查的AS患者（比值比，3.96）。然而，在接受常规筛查的回结肠镜检查的患者中，也有17.6%检测到异常病变，其中大多数为糜烂和溃疡。在有炎症性病变的患者（n = 40）中，23例表现为与AS相关的亚临床肠道炎症，17例最终被诊断为克罗恩病（n = 12）、肠结核（n = 4）和溃疡性结肠炎（n = 1）。
我们的研究结果表明，即使没有胃肠道症状，也可能建议AS患者定期进行回结肠镜检查，尤其是AS活动度高的患者。
