DIAGNOSIS AND CLINICAL COURSE OF ULCERATIVE GASTRODUODENAL LESION ASSOCIATED WITH ULCERATIVE COLITIS: POSSIBLE RELATIONSHIP WITH POUCHITIS
DIAGNOSIS AND CLINICAL COURSE OF ULCERATIVE GASTRODUODENAL LESION ASSOCIATED WITH ULCERATIVE COLITIS: POSSIBLE RELATIONSHIP WITH POUCHITIS
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DOI：
10.1111/j.1443-1661.2010.01006.x
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发表时间：
2010-10-01
影响因子：
5.3
通讯作者：
Futami, Kitaro
中科院分区：
文献类型：
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作者：
Hisabe, Takashi;Matsui, Toshiyuki;Futami, Kitaro
背景与目的：溃疡性结肠炎（UC）不仅表现为局限于结肠黏膜的病理病变，还表现为包括术后袋炎在内的多种累及其他器官的并发症。在这些并发症中，弥漫性胃十二指肠炎的病变与结肠病变相似，尽管很少报道。本研究的目的是试图描述作为UC并发症发生的上胃肠道病变的特征，并评估这些病变的频率和临床病程。方法：回顾性分析322例UC患者行上消化道内镜检查的资料。我们评估了内镜发现的频率，包括类似结肠病变的弥漫性胃十二指肠病变。如果溃疡性胃十二指肠病变（UGDL）符合以下标准，则诊断为UC相关病变：(i) UC治疗后病变改善；和/或（ii）病理表现与UC相似。结果：322例患者中有15例（4.7%）UGDL符合上述标准。15例患者均有UGDL合并全结肠炎或直结肠切除术后。146例全结肠炎患者的发生率为6.2%（9例），81例行直结肠切除术的患者的发生率为7.4%（6例）。4例弥漫性溃疡性上消化道黏膜炎症（DUMI）患者并发小囊炎。除1例患者外，所有患者的病变均可通过药物治疗轻松消退。结论：在半数以上的直结肠切除术后患者中，UGDL与袋炎的发生有关。UC的诊断和治疗必须考虑到特征性UGDL的存在，UGDL可能与袋炎的发生有关。
Background and Aim:Ulcerative colitis (UC) is not only characterized by pathological lesions localized to colonic mucosa, but also to various complications involving other organs, including postoperative pouchitis. Among these complications, diffuse gastroduodenitis with lesions resembling colonic lesions has been reported, albeit rarely. The aim of the present study was to attempt to characterize the lesions of the upper gastrointestinal tract occurring as a complication of UC, and to assess the frequency and clinical course of these lesions.Methods:A total of 322 UC patients who had undergone upper gastrointestinal endoscopy were retrospectively analyzed. We assessed the frequency of endoscopic findings, including diffuse gastroduodenal lesions resembling colonic lesions. Ulcerative gastroduodenal lesion (UGDL) associated with UC was diagnosed if lesions satisfied the following criteria: (i) improvement of the lesions with treatment of UC; and/or (ii) resemblance to UC in pathological findings.Results:UGDL satisfying the aforementioned criteria was found in 15 (4.7%) of 322 patients. All the 15 patients had UGDL accompanied by pancolitis or after proctocolectomy. Frequency in 146 patients with pancolitis was 6.2% (nine patients) and that in 81 patients who had undergone proctocolectomy was 7.4% (six patients). Four patients with diffuse ulcerative upper-gastrointestinal mucosal inflammation (DUMI) had pouchitis. In all patients except one, the lesions resolved easily with medical treatment.Conclusions:In more than half of the post-proctocolectomy patients, UGDL was related to the occurrence of pouchitis. The existence of characteristic UGDL must be taken into account in the diagnosis and treatment of UC, and UGDL is possibly related to the occurrence of pouchitis.