Clinical Features And Differential Diagnosis Of 509 Cases Of Ileocecal Ulcerative Lesions

BackgroundIleocecal lesions are caused by a variety of etiological diseases involving the anatomical site.The disease mostly originates from the special location and composition.The common manifestations are ulcerative lesions,which are often difficult to identify clinically and easy to misdiagnose.With the rapid development of endoscopy technology and the improvement of people’s understanding of the disease,the detection rate of ileocecal ulcer disease is increasing.The etiology of ulcerative lesions in the ileocecal area is diverse,such as Inflammatory bowel disease(IBD),ischemic bowel disease,rheumatism-related diseases and malignant tumors.The etiology spectrum of this site is complex and diverse,and endoscopic and pathological biopsy findings are often similar,especially for non-neoplastic lesions,the rate of clinical misdiagnosis,mistreatment and missed diagnosis is still relatively high.In addition,clinical treatment programs for ileocecal ulcers of different etiology and diseases are different,and their effects on the quality of life and prognosis are different.There are still few literatures on the differential diagnosis of ileocecal ulcer lesions reported at home and abroad.In order to improve the understanding of the various etiologies and diseases of ileocecal ulcer lesions,this study retrospectively analyzed the patients admitted to the First Affiliated Hospital of Zhengzhou University In the case of patients with ileocecal ulcer disease,understand and analyze the clinical characteristics,colonoscopy and pathological biopsy results of each etiology and disease,and provide theoretical basis for the diagnosis,identification and treatment of each etiology and disease,and have a profound understanding of the prognosis of each etiology and ulcerative disease of the ileocecal part.ObjectiveThis article retrospectively analyzes the clinical characteristics,laboratory examination,imaging examinations,colonoscopy and pathological biopsy prognosis and other data of patients with ileocecal ulcer disease,and analyzes the clinical characteristics and identification of ileocecal ulcer disease of each etiology.Differences in diagnosis,treatment and prognosis,summarize the characteristics of each etiology,in order to improve the understanding of ileocecal ulcer disease,seek reliable differential diagnosis methods,achieve early diagnosis and identification,avoid misdiagnosis and treatment,and improve the survival and prognosis of patients with blind ulcer disease,actively seek more specific and sensitive diagnosis plans.MethodsThe clinical data of 509 patients with ileocecal ulcerative lesions who received colonoscopy and were admitted to the First Affiliated Hospital of Zhengzhou University on January 1,2016 and on December 31,2019 were collected,who finally confirmed according to the clinical guidelines,by pathology and various laboratory examinations,of which,201 patients were finally diagnosed with ulcerative colitis(UC),33 patients were diagnosed with Crohn’s disease(CD),22 patients were diagnosed with intestinal tuberculosis(ITB),and 40 patients were diagnosed with intestinal Behcet’s disease(BD),8 patients were diagnosed with appendicitis,98 patients were diagnosed with ileocecal non-specific inflammation,2 patients were diagnosed with Henoch-Schonlein purpura(HSP),82 patients were diagnosed with colon cancer,18 patients were diagnosed with ileocecal lymphoma,and 5 patients were diagnosed with adenoma.The clinical data of 509 patients with ulcerative lesions in the ileocecal region were retrospectively analyzed.Statistical software(SPSS 25.0)was used to analyze the differences in gender age,laboratory examination,imaging examination,pathological biopsy,treatment and prognosis.The clinical characteristics of various etiological diseases were analyzed by t test and chi-square test.Results1.General clinical featuresThe male to female ratio of 509 patients with ileocecal ulcer lesions was 1.96:1,the average age was(48.47±15.73)years,and the most common clinical symptom was abdominal pain.According to whether it is a tumor,it can be divided into neoplastic lesions and non-neoplastic lesions.The common neoplastic lesions are colon cancer,82 cases,accounting for 78.1%of neoplastic lesions;Ileocecal lymphoma accounted for 17.1%of neoplastic lesions,Adenomas are the least.The most common non-neoplastic disease is UC,with 201 cases,accounting for 49.8%of non-neoplastic diseases;followed by non-specific enteritis of the ileocecal area,accounting for 24.2%of non-neoplastic lesions,and CD accounting for 8.2%.Intestinal BD accounted for 9.9%,ITB accounted for 5.4%,HSP accounted for 0.5%,and appendicitis accounted for 2.0%.2.Colonoscopy and pathological biopsyThe first colonoscopy and pathological biopsy of ileocecal ulcer patients were confirmed in 397 cases,and the diagnosis rate was about 78%(397/509).Repeated pathological biopsy and or re-examination of colonoscopy and pathological biopsy during follow-up,42 cases were additionally diagnosed.During period of the study,the coincidence rate of colonoscopy and pathological diagnosis with clinical diagnosis was 86.2%(439/509).UC,ileocecal nonspecific inflammation,and appendicitis have high colonoscopy diagnosis rates,respectively 94.0%,93.9%,87.5%.The pathological diagnosis rate of ileocecal colon cancer,ileocecal lymphoma and adenoma was 100%.The pathological diagnosis rate of ITB,CD and BD is low,77.7%,42.4%,and 37.5%respectively.Relatively speaking,the pathological diagnosis rate of ITB is higher.The pathological diagnosis rate of HSP is 0%.Comparative analysis of endoscopic and pathological biopsy in patients with UC,CD,ITB and BD,map ulcer,rat bite,deep chisel ulcer,non-caseating granuloma,crypt abscess and deformation,caseous necrosis,anc vasculitis have statistically significant differences in these four diseases.3.Laboratory examinationGeneral laboratory indicators,there was no statistically significant difference in Hemoglobin(Hb)reduction,White blood cell(WBC)increase,Erythrocyte sedimentation rate(ESR)increase and C-reactive protein(CRP)increase for UC,intestinal CD,ITB and BD(P<0.05),but ESR increased and the increase of CRP reflects the active stage of the disease to a certain extent.The incidence of Albumin(Alb)reduction is lower in intestinal BD.Some special laboratory examinations,T-cell spot test for tuberculosis infection(T-SPOT),acid-fast staining,antineutrophilic cytoplasmic antibody(ANCA)indicators,etc.have guiding significance for disease diagnosis.4.Imaging examinationComputed tomography(CT)enterography is suggestive for the diagnosis of CD.The examination of CT enterography of 93.9%(31/33)patients suggested that intestinal lesions combined with CD.In addition,for patients with ITB,CD and colon cancer,abdominal CT and or combined examination of CT enterography and colonoscopy pathology were more sensitive to the disease,which were 90.9%,90.9%,and 98.8%,respectively.For patients with CD,compared with abdominal CT and CT enterography alone,abdominal CT and or CT enterography and colonoscopy pathology combined diagnosis are more sensitive to the disease’s diagnosis,and the difference is statistically significant P<0.05).For ITB,the combined diagnosis of abdominal CT and or CT enterography and colonoscopy pathology was not statistically significant compared with pathology alone,abdominal CT and or CT enterography(P>0.05).5.Treatment,follow-up and prognosisAmong the 404 patients with non-neoplastic lesions,98.0%received non-surgical treatment,and 2.0%received surgical treatment.There were no deaths during follow-up in 100%of patients.Patients with IBD generally respond well to drugs.Only a small number of patients undergo surgical treatment due to severe disease and long-term recurrent or complications.The time from initial onset to diagnosis of CD,ITB and BD were 17.0 months,13.2 months and 26.4 months,respectively.21.2%(7/33)of patients with CD were unclear at first diagnosis and received experimental antituberculous therapy first.Of the 105 neoplastic lesions,44.8%were treated with non-surgical treatment and 55.2%were treated with surgical operation.About 81.0%of patients were followed up.Colon cancer deaths accounted for 9.8%,and ileocecal lymphoma patients accounted for 38.9%.Conclusions1.The most common clinical symptoms of ileocecal ulcer lesions are abdominal pain.The incidence of men is greater than women,and the age of onset is more common in middle-aged patients.Among them,non-neoplastic lesions are the most common.UC and non-specific inflammation of the ileocecal area account for a high proportion.The diagnosis rate of colonoscopy and pathological biopsy is high,while the differential diagnosis of CD,ITB and BD is difficult.Neoplastic lesions are more common in colon cancer,and the pathological diagnosis rate is relatively high.2.CT enterography has a high diagnostic rate for CD.Colonoscopy and pathological biopsy have low diagnostic rate for CD,BD and ITB.Additiobally,the diagnosis of abdominal CT examination and/or CT enterography combined with colonoscopy pathology are more sensitive than abdominal CT and or CT enterography alone.Abdominal CT examination is of great significance in determining whether patients with colon cancer are complicated with metastasis and guiding the next treatment.3.The treatment of non-neoplastic lesions is mainly drug therapy,the purpose is to control inflammation,orevent recurrence,and the prognosis is good.Neoplastic lesions are mainly resection of the lesion,mainly to slow down the progression of the tumor and prolong the survival period,and the prognosis is generally poor.The incidence of non-neoplastic lesions is high,and the differential diagnosis is difficuIt,especially CD,ITB and BD.The time from initial onset to diagnosis is longer.Close follow-up and experimental anti-tuberculosis therapy are very important for diagnosis.Some special serological and imaging examinations have guiding significance for the identification of diseases,and it is very important to actively seek specific indicators.