Department of Gastroenterology and Hepatology, Jinling Hospital, Southern Medical University, No. 305, Zhongshan East Road, Nanjing, 210002, Jiangsu, China.
Department of Gastroenterology and Hepatology, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, No. 305, Zhongshan East Road, Nanjing, 210002, Jiangsu, China.
Dig Dis Sci. 2019 Nov;64(11):3291-3299. doi: 10.1007/s10620-019-05651-1. Epub 2019 May 11.
The epidemiology of upper gastrointestinal (L4) Crohn's disease in China remains poorly characterized.
We aimed to identify the clinical characteristics of L4 disease and clarify the relationship between disease characteristics at diagnosis and early outcomes.
We retrospectively enrolled 246 patients diagnosed between 2013 and 2017 and followed up for > 1 year post-diagnosis. Primary outcomes included the 1-year rates of hospitalization and abdominal surgery according to disease location and behavior.
Of 80 patients with L4 disease (61, 25, and 18 with esophagogastroduodenal, jejunal, and proximal ileal involvement, respectively), none had granuloma, whereas 66.7%, 50%, 46.9%, 75%, and 70% had disease-specific endoscopic lesions in the esophagus, stomach, duodenum, jejunum, and proximal ileum, respectively. Compared to non-L4 disease, L4 disease was associated with higher rates of abdominal surgery (41.3% vs. 11.4%, P < 0.001) but similar rates of hospitalization within 1 year post-diagnosis. In L4 disease, jejunal and proximal ileal involvement was associated with stricturing behavior (P = 0.034, P < 0.001) and higher abdominal surgery rate (both: P < 0.001). Risk factors for abdominal surgery within 1 year post-diagnosis included age ≥ 40 years (OR 1.920; 95% CI 1.095-3.367), L4 phenotype (OR 6.335; 95% CI 3.862-10.390), stricturing disease (OR 3.162; 95% CI 1.103-9.866), and penetrating disease (OR 11.504; 95% CI 3.409-38.825), whereas the protective factor was female sex (OR 0.214; 95% CI 0.123-0.373).
Early outcomes are worse for L4 than for non-L4 disease. Jejunoileum involvement predicts stricturing disease and early surgery. More aggressive initial therapy is needed to improve L4-disease prognosis.
中国上消化道（L4）克罗恩病的流行病学特征仍不清楚。
本研究旨在明确 L4 疾病的临床特征，并阐明诊断时疾病特征与早期结局之间的关系。
我们回顾性纳入了 2013 年至 2017 年间诊断的 246 例患者，并在诊断后进行了超过 1 年的随访。主要结局包括根据疾病部位和行为评估的 1 年住院率和腹部手术率。
80 例 L4 疾病患者（61 例、25 例和 18 例分别为食管胃十二指肠、空肠和回肠近端受累）中无一例存在肉芽肿，分别有 66.7%、50%、46.9%、75%和 70%的患者在食管、胃、十二指肠、空肠和回肠近端有特定于疾病的内镜下病变。与非 L4 疾病相比，L4 疾病的腹部手术率更高（41.3% vs. 11.4%，P < 0.001），但 1 年内的住院率相似。在 L4 疾病中，空肠和回肠近端受累与狭窄性疾病行为相关（P = 0.034，P < 0.001），且腹部手术率更高（均为 P < 0.001）。1 年内行腹部手术的危险因素包括年龄≥40 岁（OR 1.920；95%CI 1.095-3.367）、L4 表型（OR 6.335；95%CI 3.862-10.390）、狭窄性疾病（OR 3.162；95%CI 1.103-9.866）和穿透性疾病（OR 11.504；95%CI 3.409-38.825），而保护性因素是女性（OR 0.214；95%CI 0.123-0.373）。
与非 L4 疾病相比，L4 疾病的早期结局更差。空肠和回肠受累预测狭窄性疾病和早期手术。需要更积极的初始治疗来改善 L4 疾病的预后。
