Niriella M A, Liyanage I K, Kodisinghe S K, De Silva A P, Jayatissa A V G A M, Navarathne N M M, Peiris R K, Kalubovila U P, Kumarasena S R, Jayasekara R W, de Silva H J
Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
BMC Gastroenterol. 2021 Feb 16;21(1):71. doi: 10.1186/s12876-021-01644-5.
Inflammatory bowel disease (IBD) is increasing in the Asia-Pacific region, with changes in disease phenotype and course. We aimed to assess the changing phenotypes of IBD over ten years, describe the early clinical course (ECC) and identify the clinical predictors (CP) of poor outcomes among a large, multi-centre, cohort of Sri Lankan IBD patients.
We included patients [diagnosed between June/2003-December/2009-Group-1(G1), January/2010-June/2016-Group-2(G2)] with ulcerative colitis (UC) and Crohn disease (CD) from five national-referral centres. Changing phenotype from G1 to G2, ECC (disease duration < 3-years) and CP of poor outcomes (disease duration ≥ 1-year) was assessed. Poor outcomes were complicated-disease (CompD-stricturing/penetrating-CD, extensive-UC/pancolitis, perforation/bleeding/colectomy/malignancy) and treatment-refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory and biologic use).
375 (UC-227, CD-148) patients were recruited. Both G1/G2 had more UC than CD (77% vs 23%, 54.5 vs 45.5 respectively, p < 0.01). Increase of CD from G1-to-G2 was significant (23-45.4%, p < 0.001). In both groups, left-sided colitis (E2) and ileo-colonic (L3)/non-stricturing, non-penetrating disease behaviour (B1) CD predominated. Extensive-colitis (E3) (36.4% vs 22.7, p < 0.05) and stricturing-CD (B2) (26.1% vs 4.0%, p < 0.01) was commoner in G1. ECC was assessed in 173-patients (UC-94, CD-79). Aggressive disease behaviour and TRD were low among both UC and CD. Immunomodulator use was significantly higher among CD than UC (61.5% vs 29.0% respectively, p < 0.01). Anti-TNF use was low among both groups (UC-3.2%, CD-7.7%). Disease complications among UC [bleeding (2.1%), malignancy-(1.1%), surgery-(2.1%)] and CD [stricture-(3.9%), perforation-(1.3%), malignancy-(1.3%), surgery-(8.9%)] were generally low. CPs were assessed in 271-patients (UC-163, CD-108). Having a family history of IBD (for UC), extraintestinal manifestation (EIM), severe disease at presentation, being in younger age categories and severe disease at presentation, (for both UC and CD) predicted poor outcomes.
There was an increase in CD over time without change in disease phenotype for both UC and CD. A relatively benign ECC was observed. Family history (UC), EIMs (UC/CD), severe disease at presentation (UC/CD), younger age (CD/UC) CPs of poor outcomes.
炎症性肠病（IBD）在亚太地区呈上升趋势，疾病表型和病程发生了变化。我们旨在评估IBD在十年间的表型变化，描述早期临床病程（ECC），并确定一大群斯里兰卡IBD患者中不良结局的临床预测因素（CP）。
我们纳入了来自五个国家转诊中心的溃疡性结肠炎（UC）和克罗恩病（CD）患者[诊断时间为2003年6月至2009年12月 - 第1组（G1），2010年1月至2016年6月 - 第2组（G2）]。评估了从G1到G2的表型变化、ECC（病程<3年）以及不良结局的CP（病程≥1年）。不良结局包括疾病并发症（CompD - 狭窄/穿透性 - CD、广泛性 - UC/全结肠炎、穿孔/出血/结肠切除术/恶性肿瘤）和治疗难治性疾病（TRD - 频繁复发、类固醇依赖/难治以及使用生物制剂）。
共招募了375例患者（UC - 227例，CD - 148例）。G1组和G2组中UC患者均多于CD患者（分别为77%对23%，54.5对45.5，p < 0.01）。从G1到G2，CD的比例显著增加（23%至45.4%，p < 0.001）。两组中，左侧结肠炎（E2）和回结肠型（L3）/非狭窄、非穿透性疾病行为（B1）的CD占主导。广泛性结肠炎（E3）（36.4%对22.7%，p < 0.05）和狭窄性CD（B2）（26.1%对4.0%，p < 0.01）在G1组中更常见。对173例患者（UC - 94例，CD - 79例）评估了ECC。UC和CD患者中侵袭性疾病行为和TRD的发生率均较低。CD患者中免疫调节剂的使用显著高于UC患者（分别为61.5%对29.0%，p < 0.01）。两组中抗TNF的使用均较低（UC - 3.2%，CD - 7.7%）。UC[出血（2.1%）、恶性肿瘤 -（1.1%）、手术 -（2.1%）]和CD[狭窄 -（3.9%）、穿孔 -（1.3%）、恶性肿瘤 -（1.3%）、手术 -（8.9%）]的疾病并发症总体较低。对271例患者（UC - 163例，CD - 108例）评估了CP。IBD家族史（针对UC）、肠外表现（EIM）、初诊时病情严重、年龄较小以及初诊时病情严重（针对UC和CD）均预测不良结局。
随着时间推移，CD有所增加，而UC和CD的疾病表型未发生变化。观察到相对良性的ECC。家族史（UC）、EIM（UC/CD）、初诊时病情严重（UC/CD）、年龄较小（CD/UC）是不良结局的CP。
