Yang Ye, Li Chun-Qiang, Chen Wu-Jie, Ma Zhen-Hua, Liu Gang
Department of Gastroenterology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, Zhejiang Province, China.
Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
World J Clin Cases. 2020 Sep 6;8(17):3847-3852. doi: 10.12998/wjcc.v8.i17.3847.
Ulcerative colitis (UC) is defined as a chronic inflammatory bowel disease that can occur in any part of the large bowel. In addition, UC affects only the large bowel except for backwash ileitis and pouchitis, whereas Crohn's disease (CD) affects the entire digestive tract. Inflammatory bowel disease (IBD) patients tend to be diagnosed with CD or indeterminate colitis when combined with gastric lesion. However, in recent years, some UC patients are reported to have various degrees of lesions in gastroduodenum. Here, we report a case of gastroduodenitis associated with UC (GDUC).
A 25-year-old man with a history of Klippel-Trenaunay syndrome presented to the hospital with mucopurulent bloody stool and epigastric persistent colic pain for 2 wk. Continuous superficial ulcers and spontaneous bleeding were observed under colonoscopy. Subsequent gastroscopy revealed mucosa with diffuse edema, ulcers, errhysis, and granular and friable changes in the stomach and duodenal bulb, which were similar to the appearance of the rectum. After ruling out other possibilities according to a series of examinations, a diagnosis of GDUC was considered. The patient hesitated about intravenous corticosteroids, so he received a standardized treatment with pentasa of 3.2 g/d. After 0.5 mo of treatment, the patient's symptoms achieved complete remission. Follow-up endoscopy and imaging findings showed no evidence of recurrence for 26 mo.
The occurrence of gastrointestinal involvement in UC is rare, which may open a new window for studying the etiology and pathogenesis of UC. Physicians should consider broad differential diagnosis by endoscopic biopsy and laboratory examinations.
溃疡性结肠炎(UC)是一种慢性炎症性肠病,可发生于大肠的任何部位。此外,除反流性回肠炎和袋炎外,UC仅累及大肠,而克罗恩病(CD)累及整个消化道。炎症性肠病(IBD)患者合并胃部病变时往往被诊断为CD或不确定性结肠炎。然而,近年来,有报道称部分UC患者胃十二指肠存在不同程度的病变。在此,我们报告1例与UC相关的胃十二指肠炎(GDUC)病例。
一名25岁男性,有克-特综合征病史,因黏液脓性血便和上腹部持续性绞痛2周入院。结肠镜检查可见连续性浅表溃疡及自发性出血。随后的胃镜检查显示胃和十二指肠球部黏膜弥漫性水肿、溃疡、渗血,以及颗粒状和脆性改变,与直肠外观相似。经一系列检查排除其他可能性后,考虑诊断为GDUC。患者对静脉用糖皮质激素治疗犹豫不决,因此接受了3.2 g/d美沙拉嗪的标准化治疗。治疗0.5个月后,患者症状完全缓解。随访内镜检查和影像学检查结果显示,26个月内无复发迹象。
UC合并胃肠道受累的情况罕见,这可能为研究UC的病因和发病机制打开一扇新窗口。医生应通过内镜活检和实验室检查进行广泛的鉴别诊断。