Gomes Tarcia Nogueira Ferreira, de Azevedo Fabio Silva, Argollo Marjorie, Miszputen Sender Jankiel, Ambrogini Orlando
Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Clin Exp Gastroenterol. 2021 Mar 17;14:91-102. doi: 10.2147/CEG.S288688. eCollection 2021.
Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract with an increasing incidence in developing countries.
To report clinical and demographic data of CD and UC at a referral center for inflammatory bowel disease (IBD) in São Paulo.
We conducted a retrospective cross-sectional study on adult patients with established IBD. Demographic and clinical data were obtained by medical records analysis from the IBD Outpatient Clinic of EPM-UNIFESP, from October 1997 to October 2017.
Of 658 patients included, 355 had UC (54%) and 303 had CD (46%). UC was more prevalent in women than CD (219 [61.7%] vs 152 [50.2%], p=0.003). The median time between the onset of symptoms and diagnosis was 13 (5-38) months, with a longer duration for CD patients. CD mostly affected the ileocolonic location (47.9%). CD patients with stricture, fistula and/or perianal disease (213/303, 70.3%) were younger at diagnosis, had a longer disease duration, higher rates of corticosteroid, immunomodulatory, and biological therapy, hospitalization, and referral to surgery, compared to patients without complication. Extensive colitis was the most common extension of UC (50.6%), which was more frequently associated with younger age at diagnosis, hepatobiliary disease, increased need for hospitalization, higher use of immunomodulatory, and biologic therapy, compared to patients with less extensive disease. In the last 5 years, CD patients were more frequently on biologic and/or immunomodulatory (70.9%) therapy, and UC patients often received salicylates (78.1%) and immunomodulatory (28.1%) treatments. There was a consistent reduction in salicylate usage for CD in the last 5 years compared to the total period of follow-up.
Despite the increasing incidence, we highlight the diagnostic delay and a more complicated CD and extensive UC in this cohort, reflecting a high need for immunomodulatory and biological treatment, hospitalization, and surgery.
克罗恩病（CD）和溃疡性结肠炎（UC）是胃肠道的慢性炎症性疾病，在发展中国家发病率呈上升趋势。
报告圣保罗一家炎症性肠病（IBD）转诊中心的CD和UC患者的临床及人口统计学数据。
我们对确诊为IBD的成年患者进行了一项回顾性横断面研究。通过对1997年10月至2017年10月间EPM-UNIFESP的IBD门诊病历分析获取人口统计学和临床数据。
纳入的658例患者中，355例患有UC（54%），303例患有CD（46%）。UC在女性中的患病率高于CD（219例[61.7%]对152例[50.2%]，p=0.003）。症状出现至诊断的中位时间为13（5-38）个月，CD患者的病程更长。CD最常累及回结肠部位（47.9%）。与无并发症的患者相比，有狭窄、瘘管和/或肛周疾病的CD患者（213/303，70.3%）诊断时年龄更小，病程更长，使用皮质类固醇、免疫调节剂和生物治疗的比例更高，住院率和接受手术转诊的比例也更高。广泛性结肠炎是UC最常见的病变范围（50.6%），与病变范围较小的患者相比，其在诊断时年龄更小、合并肝胆疾病、住院需求增加、免疫调节剂和生物治疗的使用频率更高。在过去5年中，CD患者接受生物和/或免疫调节治疗的频率更高（70.9%），UC患者常接受水杨酸盐治疗（78.1%）和免疫调节治疗（28.1%）。与整个随访期相比，过去5年中CD患者水杨酸盐的使用量持续减少。
尽管发病率在上升，但我们强调该队列中存在诊断延迟以及CD和广泛性UC更为复杂的情况，这反映出对免疫调节和生物治疗、住院治疗及手术的高度需求。
