| Objective:To retrospectively analyze the clinical characteristics of patients with inflammatory bowel disease(IBD) in a less developed region of China-Jiangxi Province, and to assess the efficacy and tolerability of thalidomide in Crohn’s disease(CD).Methods:From January 2013 to December 2015, the data of 329 hospitalized and outpatient patients diagnosed as IBD and 21 CD patients who were treated with thalidomide were retrospectively analyzed. The diagnosis was based on “The national consensus on the diagnosis and treatment of IBD by the digestive disease branch of chinese medical association”.Results:(1)The rate of growth in numbers in IBD, UC and CD patients was 1.64 times,1.98 times and 1.40 times during 3 years, respectively. The crescendo increase of CD were greater than that of UC.(2)The Man/Female rate is 1.30 in UC and 1.56 in CD. The onset peak age of UC and CD was among 36 to 45 years and 16 to 25 years, and the average onset age was 42.99±13.21 years and 31.04±12.71 years,respectively. Only one(0.62%) CD patient had family history.(3) The most common clinical features were bloody stool(83.93%),mucus stool(82.74%) and diarrhea(48.21%) in UC, while abdominal pain(69.57%),diarrhea(65.22%) and weight loss(42.86%) in CD. The incidence of exra-intestinal symptoms(oral cavity ulcer, joint disease and liver disease) in UC and CD patients accounted for 18% and 37%, respectively. The operation rate of CD and UC patients was 1.79% and 8.7% respectively.(4) Most IBD patients were treated with medical therapy. 4 of 168 UC cases recieved fecal bacteria transplantation(FMT) and three UC cases recieved infiximab therapy(IFX). 35 of 161 CD cases recieved infiximab therapy(IFX) and 21 CDpatients recieved thalidomide therapy.(5)The reason for changing to this novel medication(thalidomide) were the side effects of azathioprine(66.67%),digestive hemorrhage(9.52%) and hormone dependent(19.05%).(6)Twenty-one CD patients who underwent thalidomide treatment were followed up from 0.25 months to 27 months(median:9 months). Twenty patients completed 3months follow-up and their CDAI scores declined compared with the previous data,showing the effctive rate was 95.24%. During median follow-up period, 9 remission patients(42.86%) and 11 active patients(52.38%) underwent clinical remission after been treated with thalidomide.(7)Five active patients who were treated with thalidomide for 3 months underwent colonoscopy and two of them received mucosal healing. 13 cases in the remission stage who were treated with thalidomide for 6 months underwent colonoscopy and four of them received mucosal healing. During the whole median follow-up period, ten patients experienced mucosal healing, and 4 patients maintained mucosal healing.(8) Six CD patients underwent steroids combined with thalidomide. All of them were able to steroid withdrawnby median time 10w(6w-14w).(9)The side effects: 17 of 21 cases had 32 side effects total, including neuropathy(11/21).Four patients stopped medication due to adverse effect.Conclusion:(1)There has been an increasing number of hospitalized IBD in recent years. The growth incidence of CD is greater than that of UC in the past 3years.(2)The clinical characteristics of patients with IBD in Jiangxi and other regions are different.(3) Thalidomide can be used for induction and maintenance for CD patients.Although the incidence of side effects is high, most of them can be relieved and were mild and tolerable. |
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