Kaufman S S, Vanderhoof J A, Young R, Perry D, Raynor S C, Mack D R
Department of Surgery, Creighton University, Childrens Hospital, Omaha, Nebraska, USA.
Am J Gastroenterol. 1997 Jul;92(7):1209-12.
This is a retrospective review of five pediatric cases of inflammatory bowel disease with gastroduodenal as well as pancolonic inflammation. The presumptive diagnosis was Crohn's disease in all. Three of five also had microscopic ileitis. Chronic active gastritis was present at diagnosis in all five and duodenitis in four of five. None ever had noncaseating granulomas in any location. Prolonged (mean, 22 months) and ineffective trials of multiple medical therapies were carried out before subtotal proctocolectomy, which allowed the diagnosis of ulcerative colitis to be made in all children. Surgery remained curative after follow-up of over 1 yr (mean, 16 months). This experience confirms that gastroduodenal inflammation occurs in children with ulcerative colitis. Presence of gastroduodenal inflammation does not ensure the diagnosis of Crohn's unless other characteristic features of Crohn's are present. Accurate discrimination between Crohn's and ulcerative colitis remains important in management of pediatric inflammatory bowel disease to facilitate timely surgical referral. Upper gastrointestinal tract inflammation in ulcerative colitis warrants further study.
这是一项对五例患有胃十二指肠及全结肠炎症的儿童炎症性肠病病例的回顾性研究。所有病例的初步诊断均为克罗恩病。五例中有三例同时患有显微镜下可见的回肠炎。所有五例在诊断时均存在慢性活动性胃炎，五例中有四例存在十二指肠炎。所有病例在任何部位均未出现非干酪样肉芽肿。在进行次全直肠结肠切除术之前，进行了多种药物治疗的长期（平均22个月）且无效的试验，最终所有儿童均被诊断为溃疡性结肠炎。在随访超过1年（平均16个月）后，手术仍具有治愈效果。该经验证实，溃疡性结肠炎患儿会出现胃十二指肠炎症。胃十二指肠炎症的存在并不能确诊为克罗恩病，除非同时具备克罗恩病的其他特征性表现。在儿童炎症性肠病的管理中，准确区分克罗恩病和溃疡性结肠炎对于促进及时进行手术转诊仍然很重要。溃疡性结肠炎中的上消化道炎症值得进一步研究。
