| Objective:The goal of this study was to retrospectively analyze the clinical information of patients with inflammatory bowel disease(IBD)combined with hepatobiliary and pancreatic(HBP)diseases,summarize their clinical characteristics,explore the association between HBP diseases and IBD,and contribute to the development of reasonable treatment plans for specific IBD comorbidities.Methods:The participants in this study were patients with IBD and confirmed patients with concomitant HBP diseases who were admitted to the Gastroenterology Department of the First Affiliated Hospital of Dalian Medical University between January 2010 and December 2021.IBD patients were divided into two groups depending on whether they had extraintestinal manifestations(EIMs)and among them,the EIMs group was further divided into two groups with and without concomitant HBP illness.According to the diagnostic criteria,each group was further divided into two groups of patients with UC and CD.Results:1.Clinical data of patients with IBDBasic situation:There were 343 patients with IBD,286 patients in the UC group and 57 patients in the CD group.There were 182 males and 161 females,with a male-to-female ratio close to 1.1:1.The age range was 21-71 years,and the average age was 51.5±16.4years.2.Clinical profile of patients with IBD in the combined HBP diseases group versus the uncombined group(1)Basic situationIn terms of gender and age: there was no statistical difference between the two groups(P>0.05).(2)Clinical characteristics.1)Laboratory tests:The mean values of AST,TBA,and ESR were significantly higher in the combined group than in the uncombined group,which was statistically different(P<0.05).However,there was no statistical difference between the two groups compared with other examination indexes(P>0.05).2)Endoscopic examination: Compared with the uncombined group,the rate of mucosal edema,congestion,or erosion with purulent discharge,superficial ulceration,intestinal lumen stricture,and polyp hyperplasia were significantly higher in the combined group,with statistical differences(P<0.05).3)Drug treatment: The proportion of the combined group receiving glucocorticoid enemas was as high as 9.2% compared with the uncombined group,and there was a statistical difference between the two groups for comparison(P<0.05).There was no statistical difference in the proportion of the other medications between the two groups(P>0.05).3.Clinical data of patients with IBD in the combined HBP group(1)Clinical information of UC in the combined and uncombined groups1)Basic characteristics: In the combined group of UC patients,there were 44 male cases,accounting for 57.1%,33 female cases(42.9%).In the uncombined group,there were 106 male cases(50.7%),103 female cases(49.3%).No statistical disparity was observed between the two sets(P>0.05).Among the UC patients in the combined group,48 cases(62.3%)were under 70 years old.130 cases(62.2%)were in the uncombined group.29 cases(37.7%)were 70 years old and above in the combined group and 79 cases(37.8%)were in the uncombined group.There was no statistical difference between the groups(P>0.05).2)Laboratory examination: UC patients in the combined group exhibited a higher meanγ-GT,AST and ALB than those in the uncombined group,with a statistical difference between the two groups(P<0.05).3)Endoscopic examination: Endoscopic examination of UC patients in the combined group showed significantly higher proportions of mucosal edema,congestion,or erosion with purulent discharge,superficial ulceration,intestinal lumen stricture,and polyp hyperplasia than in the uncombined group,with statistical differences between the two groups(P<0.05).In the combined group of UC patients,the percentage of endoscopic findings involving the whole colon(E3)was 35.1%,which was significantly higher than that of the uncombined group,and there was a statistical difference between the groups(P<0.05).4)Drug treatment: In the combined group,6.5% of UC patients were administered with glucocorticoid enemas,a significantly higher rate than in the uncombined group,with statistical differences(P<0.05).5)In disease severity: There were significantly more patients with mild as well as moderate disease in the uncombined group than in the combined group,while the majority of patients in the combined group had severe disease manifestations,which was significantly higher than in the uncombined group,with a statistically significant difference between the two groups(P<0.05).In the uncombined group,the number of patients with UC in remission was significantly higher than that in the combined group,and most patients in the combined group were in the active phase,with statistically significant differences compared with the uncombined group.(2)Clinical data of CD patients in the combined group and the uncombined group1)Basic characteristics: In the combined group of CD patients,6(60.0%)were male and4(40.0%)female.In the uncombined group,28(59.6%)were male and 19(40.4%)female.There was no significant difference between the two groups(P>0.05).There were 10 patients(100%)under 70 years old in the combined group with CD,46patients(97.6%)in the uncombined group.1 patient(2.1%)in the uncombined group aged70 years and above.There was no statistical difference between the groups(P>0.05).2)Laboratory examination: Among the CD patients in the combined group,the mean values of ALB was lower than those in the uncombined group,and there was a statistical difference between the two groups(P<0.05).3)Endoscopy: The difference in the results of colonoscopy between the two groups was not statistically significant(P>0.05).4)Drug treatment: 30.0% of CD patients in the combined group were treated with glucocorticoid enemas,which was significantly higher than that in the uncombined group,and there was a statistical difference(P<0.05).(3)Clinical data of UC group and CD group in combined group of IBD patients1)Disease distribution.The proportion of patients presenting with NAFLD was significantly higher in the UC group than in the CD group,with statistical differences(P<0.05).2)Imaging examinationThe UC patients’ combined group exhibited a significantly higher proportion of cholecystitis and NAFLD than the CD group,with a statistical difference between the two groups(P<0.05).There was no statistical difference between the two groups in terms of the other imaging examinations(P>0.05).3)Drug treatmentThe proportion of patients in the combined UC group treated with biologics was only3.9%,which was much lower than that in the CD group,and there was a statistical difference(P<0.05).There was no statistical difference(P>0.05)between the other proportion of drug therapy for patients in the two groups.Conclusion:1.Patients in the combined group are more likely to have clinically elevated liver enzymes(AST,γ-GT)than those in the uncombined group with IBD,especially in UC patients.Therefore,in clinical practice,patients with IBD,especially those with UC,should be alerted to the possibility of combined HBP diseases if they have abnormal liver enzymes.2.Endoscopic findings in IBD patients,combined with HBP diseases are more likely to show mucosal edema,congestion,erosion,as well as polyp hyperplasia and ulceration.Especially in UC patients,where the lesions are likely to involve the whole colon,and the clinical symptoms are more severe and the disease is mostly in the active stage.3.In terms of treatment,glucocorticoids are more commonly chosen for patients with combined HBP diseases,while patients with CD are often treated with hormones along with biological agents.4.Among the combined HBP diseases in IBD,NAFLD is the most common type,followed by cholelithiasis and cholecystitis,and other types are less common.Patients with UC are prone to having NAFLD,cholecystitis and PSC. |
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