The clinical significance of right-sided colonic inflammation in patients with left-sided chronic ulcerative colitis
The clinical significance of right-sided colonic inflammation in patients with left-sided chronic ulcerative colitis
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DOI：
10.1097/00054725-200405000-00006
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发表时间：
2004-05-01
影响因子：
4.9
通讯作者：
Farraye, FA
中科院分区：
文献类型：
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作者：
Mutinga, ML;Odze, RD;Farraye, FA
背景：在左侧慢性溃疡性结肠炎(CUC)患者中，罕见地观察到右半结肠片状炎症，但这一发现的临床意义尚不清楚。因此，本研究的目的是评价左侧结肠炎合并片状右半结肠炎的CUC患者的临床、病理特征和自然病史，并与单侧左侧CUC患者的临床病程进行比较。方法：从1996年至2000年在布里格姆妇女医院接受结肠镜检查的352例CUC患者中，12例经临床和病理证实的左侧CUC患者，同时合并右侧结肠炎。在这个队列中，127名患者患有左侧结肠炎。作为在这种情况下使用对照的第一项研究，在同一时间段内，选择并评估了35名连续的左侧CUC患者，但没有右半结肠斑片性炎症。对所有患者的临床、内窥镜和病理特征的医疗记录进行了复习。结果：研究组患者发病时年龄显著高于对照组(47 17岁对3 5 14年，p=0.048)，但两组患者的性别分布(男性25%对男性40%)、肠外表现患病率(25%对I I%)、非类固醇抗炎药物使用频率(75%对50%)、结肠炎家族史(27%对15%)、目前吸烟情况(8%对3%)、阑尾切除病史(8%比0%)，以及总体疾病严重程度(33%比46%)。研究组中没有一名患者，只有一名对照组患者，疾病进展为泛结肠炎。一名研究患者发展为直肠高度发育不良，需要进行结肠切除术。无一例患者出现克罗恩病的临床或病理特征。结论：左侧慢性溃疡性结肠炎患者很少出现右半结肠斑片状炎症。左侧结肠炎合并片状右半结肠炎的临床特征和自然病史与单纯左侧结肠炎患者相似。
Background: Rarely, patchy right colonic inflammation has been observed in patients with left sided chronic ulcerative colitis (CUC), but the clinical significance of this finding is unknown. Therefore, the aim of this study was to evaluate the clinical and pathologic features and natural history of CUC patients with left-sided colitis combined with patchy right colonic inflammation and to compare the clinical course to a control group of patients with isolated left-sided CUC.Methods: Twelve patients with clinically and pathologically confirmed left-sided CUC, but also with patchy right colonic inflammation, were identified from a cohort of 352 consecutive patients with CUC who underwent colonoscopy at the Brigham and Women's Hospital between 1996 and 2000. In this cohort, 127 patients had left-sided colitis. As the first study to use controls in this setting, 35 consecutive patients with left-sided CUC, but without patchy right colonic inflammation, were selected and evaluated during the same time period. In all patients, the medical records were reviewed for a wide variety of clinical, endoscopic, and pathologic features. The mean follow-up time for the study and control groups was 105 128 and 112 80 months, respectively.Results: Patients in the study group were significantly older than the control group at the time of diagnosis (47 17 years vs 3 5 14 years, p = 0.048), but the two groups had a similar gender distribution (25% male vs 40% male), prevalence of extraintestinal manifestations (25% vs I I%), frequency of nonsteroidal anti-inflammatory drug use (75% vs 50%), family history of colitis (27% vs 15%), current tobacco use (8% vs 3%), history of appendectomy (8% vs 0%), and overall severity of disease (33% vs 46%). None of the patients in the study group, and only one control patient, had disease progression to pancolitis. One study patient developed high-grade dysplasia in the rectum that required a colectomy. None of the study or control patients developed clinical or pathologic features of Crohn's disease.Conclusions: Rarely patients with left-sided CUC may have patchy right colonic inflammation. The clinical features and natural history of patients with left-sided CUC and patchy right colonic inflammation is similar to patients with isolated left-sided CUC.