Attauabi Mohamed, Zhao Mirabella, Bendtsen Flemming, Burisch Johan
Gastrounit, Medical Section, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, Denmark.
Gastrounit, Medical Section, Copenhagen University Hospital, Hvidovre, Denmark.
Therap Adv Gastroenterol. 2021 Jun 22;14:17562848211004839. doi: 10.1177/17562848211004839. eCollection 2021.
Patients with Crohn's disease (CD) are at increased risk of co-occurring immune-mediated inflammatory diseases (IMIDs). As discrepancy exists regarding the phenotypic presentation of CD among patients with such co-occurring IMIDs, we aimed to conduct a systematic review with meta-analysis characterizing the phenotype of CD among this subgroup of patients.
, , and were searched from their earliest records to October 2019 for studies reporting the behavior and localization of CD according to the Vienna or Montreal Classifications and CD-related surgery in patients with co-occurring IMIDs. These studies were the subject of a random effect meta-analysis.
After reviewing 24,413 studies, we identified a total of 23 studies comprising 1572 and 35,043 CD patients with and without co-occurring IMIDs, respectively, that fulfilled our inclusion criteria. Overall, patients with co-occurring IMIDs were more likely to have upper gastrointestinal inflammation than were patients without co-occurring IMIDs [relative risk (RR) = 1.49 (95% confidence interval (CI) 1.09-2.04), = 0.01, = 7%]. In addition, presence of primary sclerosing cholangitis (PSC) was associated with a lower occurrence of ileal affection [RR = 0.44 (95% CI 0.24-0.81), < 0.01, = 32%], increased occurrence of colonic affection [RR = 1.78 (95% CI 1.33-2.38), < 0.01, = 32%] and an increased likelihood of non-stricturing and non-penetrating behavior [RR = 1.43 (95% CI 0.97-2.11), = 0.07, = 86%]. The latter reached significance when cumulating different IMIDs [RR = 1.30 (95% CI 1.09-1.55), < 0.01, = 88%]. CD patients with PSC also underwent fewer CD-related surgeries [RR = 0.55 (95% CI 0.34-0.88), = 0.01, = 0%], irrespective of CD location or behavior.
This study emphasizes that CD patients with co-existing PSC are likely to have a unique inflammatory distribution primarily confined to the colon, while patients with IMIDs in general have higher likelihood of affection of upper gastrointestinal tract and a non-stricturing and non-penetrating behavior. As such a phenotype of CD is typically associated with a milder disease course; future studies are needed to confirm these results.
克罗恩病（CD）患者并发免疫介导性炎症性疾病（IMIDs）的风险增加。由于在患有此类并发IMIDs的患者中，CD的表型呈现存在差异，我们旨在进行一项系统评价和荟萃分析，以描述该亚组患者中CD的表型特征。
检索了 、 和 ，从其最早记录至 2019 年 10 月，以查找报告根据维也纳或蒙特利尔分类法确定的 CD 行为和定位以及并发 IMIDs 患者的 CD 相关手术的研究。这些研究是随机效应荟萃分析的对象。
在审查了 24413 项研究后，我们共确定了 23 项研究，分别包括 1572 例并发 IMIDs 的 CD 患者和 35043 例未并发 IMIDs 的 CD 患者，这些研究符合我们的纳入标准。总体而言，并发 IMIDs 的患者比未并发 IMIDs 的患者更有可能出现上消化道炎症[相对风险（RR）=1.49（95%置信区间（CI）1.09 - 2.04），P = 0.01，I² = 7%]。此外，原发性硬化性胆管炎（PSC）的存在与回肠受累发生率较低相关[RR = 0.44（95%CI 0.24 - 0.81），P < 0.01，I² = 32%]，结肠受累发生率增加[RR = 1.78（95%CI 1.33 - 2.38），P < 0.01，I² = 32%]以及非狭窄和非穿透性行为的可能性增加[RR = 1.43（95%CI 0.97 - 2.11），P = 0.07，I² = 86%]。当累积不同的 IMIDs 时，后者具有统计学意义[RR = 1.30（95%CI 1.09 - 1.55），P < 0.01，I² = 88%]。患有 PSC 的 CD 患者也较少接受 CD 相关手术[RR = 0.55（95%CI 0.34 - 0.88），P = 0.01，I² = 0%]，无论 CD 的位置或行为如何。
本研究强调，合并 PSC 的 CD 患者可能具有主要局限于结肠的独特炎症分布，而一般患有 IMIDs 的患者上消化道受累以及非狭窄和非穿透性行为的可能性更高。由于这种 CD 表型通常与较轻的病程相关；未来需要进一步研究来证实这些结果。
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