Analysis And Discussion On The Clinical Features Of Small Bowel Crohn’s Disease

Objective:The aim of this study is to evaluate the clinical phenotypes of Chinese Crohn’disease(CD), according to the Montreal Classification criteria. And then, we analyse the clinical features of small bowel CD (SBCD) patients who had disease location confined to small bowel with compare to those of colonic and ileocolonic CD disease,which will offer clinical doctors more data about the disease and improve the efficiency in the process of diagnosis and treatment.Methods:This retrospective study included138CD inpatients that all had small bowel investigations in second xiangya hospital of Central South University between2009and2012.We analysed their clinical phenotypes according to the Montreal Classification.In addition, for the SBCD patients,the clinical presentations,laboratory date,endoscopic and radiologic characteristic were summarized. Besides, the medicinal therapy, surgery and recurrence condition were also assessed.Results:First, the Montreal clinical classification of138CD patientsThe CD patients in our center had a male-to-female ratio of3:1. As for age at diagnosis, there were10patients(7.2%) of A1(<16years old),93patients(67.4%) of A2(17-40years old),35patients(25.4%) of A3(>40years old). As for disease location, there were28patients(20.3%) of L1(terminal ileum),36patients(26.0%) of L2(colon),32patients(23.2%) of L3(ileocolon),42patients(30.8%) of L4(proximal gastrointestinal). For patients with the L4phenotype,18patients (13.0%) had localized lesions in the proximal digestve tract,8patients(5.8%) had definite lesions confined to the jejunum,16patients (11.6%) with the L4+L1phenotype, 3patients (2.2%) with L4+L2phenotype,5cases (3.6%) with L4+L3phenotype.As for disease behavior,85(61.6%),34(24.6%),24(17.4%), and19(13.7%) patients were classified as B1(non-stricturing non-penetrating),B2(stricturing),B3(penetrating) and P(perianal diseases).Second.The clinical features of62patients with SBCDAmong the62patients of SBCD,52patients(85.5%) were male. The mean age at diagnosis was35.3years old,42patients(67.7%) were younger than40years old at the time of diagnosis. There was significantly more stricturing in SBCD group than colonic and ileocolonic CD group (p=0.037).Statistically significant independent risk factors for stricturing behavior of CD were jejunal involvement(OR3.481,95%CI1.250-9.693) and obstructive symptoms (OR5.028,95%CI1.936-13.060). Abdominal pain, obstructive symptoms,melena or bloody stool,diarrhea were the main symptoms when first diagnosed. SBCD patients with the obstructive symptoms at first diagnosis were more than those of colonic CD.However, patients with diarrhea were significantly more often than those of colonic and ileocolonic CD. SBCD patients had a higher percentage of systemic symptoms such as anemia,hypoproteinemia,weight loss than colonic and ileocolonic CD patients,but this difference did not reach statistical significant. SBCD patients were more likely to have two or more extra-intestinal manifestations than colonic and ileocolonic CD patients. CDAI score were generally low, it did not have statistically significant correlation with serum inflammation markers such as ESR and CRP. Enteroscopy and capsule endoscopy of the small bowel have higher sensitivity for mucosal lesions. CT enterography(CTE) not only have the highest value for the diagnosis of mural and extraluminal lesions,but also indicate the disease activity. With regard to15patietns (24.2%) of pathologic diagnosed SBCD,the clinical recurrence and reoperation rate were higher in non-therapy patients than those who took the aminosalicylic acid after operation in order to prevent recurrence, but this difference did not reach statistical significant. For47patients(75.8%) of clinically diagnosed SBCD,17patients(36.2%) took aminosalicylic acid for induction of remission,19patients(40.4%) took glucocorticoids as needed,16cases(34.0%) had to take immunosuppressants,5patients(10.6%) had to take biological agents for induction of remission. The time to recurrence after clinically diagnosed CD was significantly shorter in SBCD than colonic and ileocolonic CD patients(P=0.040).However, the clinical relapse rate and surgery rate had not been observed significant differences between SBCD and colonic and ileocolonic CD patients.Conclusions:First, There are higher proportion of male patients in our center. As for the age of diagnosis,the majority CD patients are less than40years old,while the elderly are relatively rare. CD patients more often have the L4phenotype, more less have the B3phenotype.Second, SBCD takes a larger proportion in CD patients. SBCD,especially jejunum disease carry excess risk of stricturing behavior. The time from clinical diagnosis to the onset of clinical recurrence is shorter in SBCD.Future multi-center, large-sample studies are required to determine the epidemiological and clinical features of SBCD.