The Clinical Feature Of Chronic Intestinal Schistosomiasis Related Intestinal Lesions

Aim: To investigate the clinical characteristics of intestinal related lesions caused by chronic intestinal schistosomiasis japonicum.Methods: The patients with chronic intestinal schistosomiasis were collected from the endoscopy center,Wuhan Union Hospital from September 1,2014 to June 30,2019 retrospectively.The patients without intestinal schistosomiasis were also collected as control group from digestive endoscopy center in the same period as the ratio of 4:1.The characteristics of infected intestinal segments were analyzed in the patients with chronic intestinal schistosomiasis.We also compared the characteristics of demographic and intestinal related lesions including polyps,colorectal cancer(CRC),ulceration or erosion of the intestinal mucosa and hemorrhoids between the two groups.Results:248 patients with and 992 patients without chronic intestinal schistosomiasis were analyzed in this study.The ratio of male to female was 2.82 to 1 in both groups.The mean age was60.5±12.2 years of intestinal schistosomiasis patients and 57.8±11.6 years of control group.The frequencies of the involved intestinal segments were 13.3% in the ileocecum,13.3% in the ascending colon,12.5% in the transverse colon,25.8% in the descending colon,79.0% in the sigmoid colon,84.7% in the rectum.The frequency of intestinal polyps(64.5% vs 42.8%,p<0.001)especially rectal polyps(62.5% vs45.0%,p=0.002)in the intestinal schistosomiasis group was significantly higher than that in the control group.Also,it was higher in different genders and age groups of the patients with intestinal schistosomiasis than that of the control group(Male 67.2% vs45.5%,p < 0.001;Female 56.9% vs 35.4%,p=0.002;20～53y: 55.4% vs 33.6%,p <0.001;54～62y: 66.7% vs 48.0%,p=0.011;63～70y: 65.6% vs 46.7%,p=0.007;71～89y: 73.2% vs 48.7%,p=0.002).Among the patients aged 54 to 62 years,the multiple polyp frequency of intestinal schistosomiasis patients was 78.9%,which was higher than that of the control group(63.1%,p=0.070),but the difference was not statistically significant.The polyp number of patients with intestinal schistosomiasis in the above age group was higher than that in control group,with marginal statistically significance(3(2～6)vs 2(1～5),p=0.050).Morphologically,type IIa polyps were more common in the schistosomiasis enteropathy group(68.5% vs60.7%,p=0.001),however,type Is and Ip polyps were less than those in the control group(26.3% vs 32.1%,p1=0.012;1.3% vs 3.5%,p2=0.009).There was no significant difference in polyp size and pathological classification between the two groups except the proportion of traditional adenoma in patients with intestinal schistosomiasis between 71 to 89 years old was higher than that in the control group of the same age range(35.0% vs 11.4%,p<0.001).The average age of the CRC in the chronic intestinal schistosomiasis patient group was older than in the control group(69.2±13.4y vs 67.5±9.7y,p=0.016).Female patients with intestinal schistosomiasis had a higher detection rate of CRC than women in the control group(13.8% vs 5.4%,p=0.017).The proportion of scattered ulcer or erosion in transverse colon,descending colon and rectum in intestinal schistosomiasis group was prone to lower than that in control group,with a large difference,but without statistical significance(0.0% vs 9.9%,p1=0.188;4.3% vs 23.9%,p2 = 0.063;47.8% vs 63.4%,p3=0.186).There was no significant difference in the incidence of ulcerative colitis between the two groups(0.8% vs 0.6%,p=0.664).In addition,the detection rate of internal hemorrhoids was higher in schistosomiasis enteropathy patients than that in the control group(58.9% vs 51.0%,p=0.027).Conclusions: Chronic intestinal schistosomiasis mainly involved the rectum and sigmoid colon,and was more likely to induce intestinal polyps especially rectal polyps and internal hemorrhoids.The risks of scattered ulcer or erosion in colon may be reduced after intestinal schistosomiasis infection.Women with chronic schistosomiasis have a higher risk of colorectal cancer than women without schistosomiasis.Regular colonoscopy screening is beneficial to the patients with intestinal schistosomiasis,which can improve the early detection and treatment of colorectal polyp and cancer and further prolong the patients’ survival.