| Object: Conducting a retrospective analysis of patients’ clinical data with inflammatory bowel disease(IBD)combined with hepatobiliary system diseases,the author summarized their clinical features,and explored their treatment strategies,so as to provide references for accurate clinical diagnosis and reasonable treatment.Methods: Patients who were hospitalized with IBD in the Gastroenterology Department of the First Affiliated Hospital of Dalian Medical University from January 2017 to December 2020 were selected as the research objects.These IBD patients were divided into ulcerative colitis(UC)group and Crohn’s disease(CD)group.According to the presence or absence of combined hepatobiliary disease,they were divided into combined hepatobiliary disease IBD group and simple IBD group.The author collected clinical data of all patients and conducted statistical analysis of the data.Results:1.General information and clinical characteristics of IBD patients(1)Basic information: There were 345 cases of IBD patients,including 285 cases of UC and 60 cases of CD.They were 212 males and 133 females,with a male-female ratio of1.6:1;They were aged from 14 to 84 years old,with an average age of(48.1±16.3)years old.(2)Clinical manifestations: Among 285 cases of UC patients,mucus,pus,blood and stool were the most common,accounting for 79.3%(226/285),followed by abdominal pain and diarrhea,accounting for 45.3%(129/285)and 54.0%(154/ 285).Among 60 patients with CD,abdominal pain was the most common,accounting for 75.0%(45/60),followed by diarrhea,bloody stool,and perianal disease,accounting for 43.3%(26/60)and 11.7%(7/60),respectively,20.0%(12/60),some may have abdominal mass symptoms,accounting for 5.0%(3/60).(3)Disease involving position: In the UC group,the whole colon was more common,accounting for 54.0%(154/285),followed by the left colon involvement,accounting for38.6%(110/285),and rectal disease accounting for 7.4%(21/285).Among patients with CD disease,small bowel disease is the most common,accounting for 41.7%(25/60),small bowel and colon disease accounting for 33.3%(20/60),colon disease accounting for 23.3%(14/60),upper digestion the tract affected accounted for 1.7%(1/60).(4)Stages of disease: There were 185 cases in the UC group in the active stage,of which 84 were mild,74 were moderate,27 were severe,and 100 were in remission.In the CD group,there were 27 cases in active phase,19 cases in mild,8 cases in moderate,0 cases in severe,and 33 cases in remission.(5)Laboratory examination: The average blood Cholesterol and blood Low-density lipoproteinl of the UC group were 4.3±0.9mmol/L and 2.4±0.7mmol/L,respectively,which were significantly higher than those of the CD group(P<0.05).The average blood Ig A of the CD group was 3.0±1.5g/L,which was significantly higher than that of the UC group(P<0.05).Compared with the mean values of other laboratory indexes,the difference was not statistically significant(P>0.05).(6)Endoscopy and imaging examination Endoscopy: All patients in the UC group showed congestion,edema,and erosion of the colonic mucosa under colonoscopy.Scattered ulcers were more common,followed by purulent secretions and mucosal hemorrhage.Some patients showed polyp hyperplasia and coelenteropathy.In the CD group,enteroscopic manifestations were most common with mucosal congestion and edema or discontinuous lesions,followed by ulcers and intestinal stenosis,some paving stone-like changes appeared,and a few were diagnosed by pathology after surgery.In capsule endoscopy,multiple longitudinal ulcers of the small intestine are the most common,followed by small intestinal mucosal congestion and edema,erosion,segmental intestinal stenosis,and multiple colon ulcers.Imaging examination: In the CD group,small bowel CT examination was more common with mucosal congestion,edema and thickening,some of which could be manifested as small bowel obstruction,stenosis,and perforation.(7)Treatment status: patients in the UC group took oral mesalazine as the main treatment drug,accounting for 92.3%(263/285),mesalamine suppositories(anal injection)accounted for 47.4%(135/285),and oral glucocorticoids accounted for 4.9%(14/285),glucocorticoids(enema)accounted for 7.4%(21/285),oral azathioprine accounted for 1.4%(4/285),intravenous infliximab accounted for 11.9%(34/285).In the CD group,infliximab injection was the main treatment drug,accounting for61.7%(37/60),oral mesalazine accounted for 43.3%(26/60),and mesalamine suppository(anal injection)accounted for 1.7%(1 /60),oral azathioprine accounted for35.0%(21/60),oral glucocorticoid accounted for 1.7%(1/60),oral thalidomide accounted for 1.7%(1/60).The proportions of oral mesalazine patients and mesalamine suppositories(anal injection)in the UC group were 92.3% and 47.4%,respectively,which were significantly higher than those in the CD group(P<0.05).The proportions of patients with azathioprine and infliximab in the CD group were 35.0% and 61.7%,respectively,which were significantly higher than those in the UC group(P<0.05).There was no statistically significant difference in the proportions of glucocorticoids and thalidomide between the two groups(P>0.05).2.The general situation of IBD patients with hepatobiliary disease(1)Distribution of IBD combined with hepatobiliary disease Among patients with IBD combined with hepatobiliary disease,non-alcoholic fatty liver(NAFLD)and cholelithiasis were the most common,accounting for 11.3%(39/345)and11.0%(38/345)respectively,followed by drug-induced liver damage,which accounted for 0.9%(3/345),0.6%(2/345)had no obvious cause of liver enzyme changes,primary sclerosing cholangitis(PSC),small bile duct-PSC,primary biliary cholangitis(PBC),autoimmune Patients with AIH and AIH-PBC overlap syndrome accounted for 0.3%(1/345).Among patients with chronic hepatitis B,only 0.3%(1/345)had hepatitis B reactivation,and patients with chronic hepatitis C accounted for 0.6%(2/345).(2)Distribution of combined hepatobiliary diseases in UC and CD Among UC patients with hepatobiliary disease,NAFLD and cholelithiasis are the most common,accounting for 12.9%(37/285)and 10.5%(30/285)respectively,drug-induced liver damage accounts for 0.7%(2/285),PSC,PBC,AIH,and hepatitis B reactivation accounted for 0.3%(1/285),combined with chronic hepatitis B accounted for 3.1%(9/285),chronic hepatitis C accounted for 0.7%(2/285),liver without obvious cause enzyme damage accounted for 0.7%(2/285).Among patients with CD and hepatobiliary disease,cholelithiasis is the most common,accounting for 13.3%(8/60),followed by NAFLD accounting for 3.3%(2/60)and chronic hepatitis B 5.0%(3/60),small bile duct-PSC,Both PBC-AIH and drug-induced liver damage accounted for 1.7%(1/60).(3)Age distribution There were 73 patients in the UC group with hepatobiliary diseases,all ages were distributed,of which 56.2%(41/73)were ≥50 years old,compared with 53.3%(113/212)in the UC group alone,there was no statistical difference academic significance(P>0.05).There were 13 patients in the CD group with hepatobiliary disease,of which 61.5%(8/13)were ≥50 years old,which was significantly higher than 23.4%(11/47)in the CD group alone(P<0.05).3.Clinical features of IBD patients with hepatobiliary disease(1)Comparison of clinical features86 patients in the IBD group with hepatobiliary diseases,male: female = 1.8:1,average age 49.1 ± 16.4 years,average course of disease 65.7 ± 73.1 months,259 patients in the simple IBD group,male: female = 1.5:1,average age 47.7±16.3 years old,with an average course of 54.3±66.8 months.There was no statistically significant difference between the two groups(P>0.05).73 patients in the UC group with hepatobiliary diseases,male: female = 1.5:1,average age 49.5 ± 15.7 years,average course of disease 68.3 ± 73.8 months,212 patients in the simple UC group,male: female = 1.4:1,average age 50.5±15.5 years old,with an average course of 58.3±67.6 months.There was no significant difference between the two groups(P>0.05).There was no statistically significant difference in the proportion of patients with lesions involving the rectum,left colon,and total colon between the two groups(P>0.05).13 patients in CD group with hepatobiliary disease,male: female = 2.2:1,average age49.5 ± 21.0 years,average course of disease 65.8 ± 78.3 months,47 patients in CD group only,male: female = 2.9:1,average age 36.7±14.8 years old,with an average course of 51.8±65.7 months.There was no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference in disease behavior between the CD group with hepatobiliary disease and the CD group alone(P>0.05).Most of the lesions in the CD group with hepatobiliary disease involved76.9%(10/13)of the terminal ileum,which was significantly higher than that in the CD group(31.9%,15/47)(P<0.05).There was no statistically significant difference in the proportion of patients with lesions involving the colon,ileocolon,and upper gastrointestinal tract between the two groups(P>0.05).(2)Disease activity and severity of disease73 patients in the UC group with hepatobiliary diseases,of which 42.5%(31/73)were in remission,57.5%(42/73)were in active stage,35.7%(15/42)were in mild disease severity,and 35.7% were in moderate severity.45.2%(19/42),severe accounted for19.1%(8/42),compared with the simple UC group,the difference was not statistically significant(P>0.05).13 cases in CD group with hepatobiliary disease,of which 53.8%(7/13)were in remission phase,46.2%(6/13)were in active phase,83.3%(5/6)were in mild disease severity,and 5/6 were in moderate severity.16.7%(1/6),compared with the simple CD group,the difference was not statistically significant(P>0.05).(3)The order of appearance of IBD and hepatobiliary disease Hepatobiliary disease can occur at any stage of the development of IBD patients,but it is most common after intestinal symptoms.There were 73 patients in the UC group with hepatobiliary disease.Hepatobiliary disease occurred before the intestinal symptoms of UC accounted for 10.9%(8/73),and19.2%(14/73)occurred at the same time,and the intestinal symptoms occurred after69.9%(51/73).In the CD group of 13 patients with hepatobiliary disease,7.7%(1/13)of the hepatobiliary disease appeared before the intestinal symptoms of CD,38.5%(5/13)occurred at the same time,and 53.8%(7/13)appeared after the intestinal symptoms.(4)IBD combined with autoimmune liver disease Among the 345 cases of IBD patients,3 cases of UC and 2 cases of CD combined with autoimmune liver disease,3 cases of male and 2 cases of female,all received ursodeoxycholic acid treatment,including 2 cases of AIH and PBC-AIH overlap syndrome all patients developed decompensated liver cirrhosis,and gallstones were found in patients with overlap syndrome.(5)IBD complicated with viral hepatitis Among IBD patients,HBs Ag positive accounted for 3.5%(12/345),anti-HBc Ab positive accounted for 29.9%(103/345),hepatitis B reactivation accounted for 0.3%(1/345),anti-HCV positive accounted for 0.6%(2/345),no patients with viral hepatitis A and E have been seen.In the UC group,HBs Ag-positive patients accounted for 3.1%(9/285),and anti-HBc Ab-positive patients accounted for 29.1%(83/285).Hepatitis B reactivation and chronic hepatitis C were both seen in UC patients.In the CD group,HBs Ag-positive patients accounted for 5.0%(3/60),and anti-HBc Ab-positive patients accounted for 33.3%(20/60).(6)Treatment Among 39 patients with IBD and NAFLD,4 cases were given glucocorticoid(enema +oral),accounting for 10.2%,and 6 cases were infliximab,accounting for 15.4%.Among them,1 case with elevated liver enzymes,intravenous and intravenous oral hepatoprotective drug treatment.Among the 38 patients with IBD and cholelithiasis,2underwent cholecystectomy,accounting for 5.3%(2/38).The remaining patients did not undergo surgery and medication.5 patients with autoimmune liver disease were all treated with oral ursodeoxycholic acid and hepatoprotective drugs.3 patients with drug-induced liver damage,1 case was caused by azathioprine,liver function improved for a short time after stopping the drug,and 2 cases were caused by mesalazine,treated with intravenous and oral hepatoprotective drugs,after stopping the drug liver function quickly returned to normal.3 patients with chronic hepatitis B received oral entecavir,accounting for 25%(3/12);1patient with hepatitis B reactivation was not treated.Two patients with liver enzyme changes without obvious cause,without any history of liver disease,were treated with oral hepatoprotective drugs.Conclusion:1.NAFLD is the most common in IBD patients with hepatobiliary disease,followed by cholelithiasis,and NAFLD is more common in UC patients,and cholelithiasis is more common in CD patients.2.CD patients with hepatobiliary disease are mostly over 50 years old,and the lesions are more likely to occur in the terminal ileum.3.IBD patients with hepatobiliary disease are not parallel with intestinal inflammatory activity and disease severity.Hepatobiliary disease can appear at any stage of the course of IBD,but it is most common after intestinal symptoms.4.IBD patients with abnormal liver function need to find the cause in time and give active intervention treatment.5.The application of mesalazine and immunosuppressive agents in IBD patients can cause liver damage and hepatitis B reactivation.Hepatitis B virology screening,liver function and HBV-DNA monitoring are necessary. |
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