| Objective:The aim of this study is to analysis the clinical phenotypes and characteristics of Crohn’s Disease(CD)patients in Jiangxi province in the past 10 years according to the Montreal typology,and reviewed the clinical manifestations and prognosis of patients with small bowel Crohn’s disease(SBCD)using a comparison analysis between groups.The clinical features and prognosis of patients with small bowel Crohn’s disease(SBCD)were studied and analyzed,and the factors influencing poor prognosis were analyzed to guide the clinical formulation of treatment plans and early assessment of patient prognosis.Methods:This retrospective study Collected the data of outpatient and inpatient patients of the Gastroenterology Department of the First Affiliated Hospital of Nanchang University between January 2012 and October 2021,who also met the diagnostic criteria of the Consensus Statement on Diagnosis and Treatment of Inflammatory Bowel Disease(2018,Beijing)and had complete clinical information,380 cases in total.Their clinical characteristics were retrospectively analyzed according to the Montreal typing.The clinical features and prognosis of these SBCD patients were concluded and analyzed,and the factors affecting their prognosis were analyzed.Results:1.Montreal typing analysis of 380 CD patientsThe male-to-female ratio of CD patients in our province in the past 10 years was2.45:1.The age distribution of diagnosis ranged from 10 to 72 years,with a mean age of 30.48±12.84 years,including 44 patients(11.6%)with type A1(<16 years old);262 patients(68.9%)with type A2(17-40 years old);and 74 patients(19.5%)with type A3(>40 years old).In terms of lesion involvement,134 patients(35.3%)were of type L1(terminal ileum);60 patients(15.8%)were of type L2(colonic);172 patients(45.3%)were of type L3(ileocolonic);and 14 patients(3.7%)were of type L4(upper gastrointestinal tract).Regarding disease behavior,there were 239 cases(62.9%)of type B1(non-stenotic non-penetrating),101 cases(26.6%)of type B2(stenotic),and40 cases(10.5%)of type B3(penetrating).2.Analysis of initial treatment in 380 CD patientsOf the 380 patients with CD,184 patients(48.4%)were remedied with biologicals,including 165 patients(43.4%)with IFX,15 patients(3.9%)with ADA,and 4 patients(1.1%)with VDZ.Prophylactic antituberculosis treatment was administered to 38 patients(23.0%)of the 165 patients treated with IFX.118(31.1%)of the 168(44.2%)patients treated with immunosuppressive received azathioprine to induce remission,49 patients(12.9%)received thalidomide,and 1 patients(0.3%)received methotrexate.A total of 85 patients(22.4%)were remedied with mesalazine for induction of remission during the course of the disease,102 patients(26.8%)were used the glucocorticoid therapy during the course of the disease,19 patients(5.0%)were remedied with anti-infective therapy for active perianal lesions,32 patients(8.4%)were remedied with antiviral therapy for co-infection with chronic hepatitis B virus,15 patients(3.9%)were remedied with enteral nutrition by nasojejunal tube placement,14 patients(3.7%)were remedied with surgical resection,of which 6cases(1.6%)underwent partial resection of intestinal segment due to intestinal obstruction,5 cases(1.3%)underwent dissection due to intestinal perforation/enteral fistula,and another 1 case(0.3%)underwent surgical resection due to suspected tumor,1 case(0.3%)was misdiagnosed as appendicitis,and 1 case(0.3%)was misdiagnosed as gallbladder stone.3.Analysis of clinical characteristics of 148 patients with SBCD111(75.0%)of 148 cases were male among SBCD patients in our province.The mean age at diagnosis of SBCD was 33.16±13.5 years,mainly young and middle-aged,of which 114 patients(77.0%)were under 40 years old.57(38.5%)SBCD patients had stenotic lesions,the proportion of which was significantly higher than the remaining two types of CD patients.The proportion of elevated serological inflammatory indices such as ESR and CRP was lower than that of patients with ileal and colonic type CD,and the difference was statistically significant(P<0.001).Age<16 years(OR 1.030,95% CI 1.005-1.055),small bowel involvement(OR 3.047,95% CI 1.883-4.931),and decreased HB(OR 1.885,95% CI 1.168-3.043)were independent risk factors for the development of stenotic lesions in CD.Conclusion:1.The clinical phenotype of CD in our province is similarly to that of other regions in China: it is more common in males,more frequent in middle-aged and young adults,and most of the types are non-stenotic,non-penetrating.Our study results were different from foreign research.2.In recent years,the choice of treatment for CD patients in our province has gradually shifted from traditional immunosuppressive agents to biologics.3.For patients with SBCD,there are problems such as difficulty in early diagnosis,higher incidence of stenosis and perforation at diagnosis,higher rate of surgery,and worse prognosis. |
