Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan,
Digestion. 2019;100(3):210-219. doi: 10.1159/000494922. Epub 2018 Dec 12.
BACKGROUND/AIMS: Behçet's disease (BD) with intestinal lesions and Crohn's disease (CD) share clinical features. However, no report has compared the 2 diseases with regard to lesions of the upper gastrointestinal tract (UGT). We aimed to evaluate endoscopic and histologic findings of UGT in CD and BD.
We retrospectively assessed the endoscopic records and biopsy samples of 84 Helicobacter pylori-negative patients (50 CD, 34 BD). In duodenal samples, MUC5AC immunohistochemical analysis was performed to identify gastric foveolar metaplasia.
In endoscopic findings, bamboo joint-like appearance (17/50 CD, 0/34 BD) and erosions (14/50 CD, 2/34 BD) were significantly more frequent in CD gastric lesions (p < 0.001, and p = 0.012). In histologic findings of stomach, focal neutrophil infiltration in lamina propria (15/48 CD, 1/34 BD) was significantly more frequent in CD (p < 0.001). In that of duodenum, wide gastric foveolar metaplasia (19/49 CD, 1/34 BD) was significantly more frequent in CD duodenal lesions (p = 0.013). The mean maximum width of the gastric foveolar metaplasia was 114.0 ± 10.6 and 29.5 ± 4.5 μm for CD and BD respectively (p = 0.003).
In H. pylori-negative patients, gastric focal neutrophil infiltration and wide duodenal gastric foveolar metaplasia were important for distinguishing CD from BD.
背景/目的：肠病性贝赫切特病（BD）和克罗恩病（CD）有共同的临床特征，且都伴有肠部病变。然而，目前尚无研究比较这两种疾病的上消化道（UGT）病变。本研究旨在评估 CD 和 BD 的 UGT 内镜和组织学表现。
我们回顾性评估了 84 例 H. pylori 阴性患者（50 例 CD，34 例 BD）的内镜记录和活检样本。在十二指肠样本中，我们进行了 MUC5AC 免疫组织化学分析，以鉴定胃小凹上皮化生。
在内镜表现方面，CD 胃病变中竹节样外观（17/50 CD，0/34 BD）和糜烂（14/50 CD，2/34 BD）更为常见（p < 0.001 和 p = 0.012）。胃组织学表现中，固有层局灶性中性粒细胞浸润（15/48 CD，1/34 BD）在 CD 中更为常见（p < 0.001）。在十二指肠组织学表现中，广泛的胃小凹上皮化生（19/49 CD，1/34 BD）在 CD 十二指肠病变中更为常见（p = 0.013）。CD 组胃小凹上皮化生的最大宽度平均值为 114.0 ± 10.6μm，BD 组为 29.5 ± 4.5μm（p = 0.003）。
在 H. pylori 阴性患者中，胃局灶性中性粒细胞浸润和广泛的十二指肠胃小凹上皮化生对于区分 CD 和 BD 具有重要意义。
