Retrospective Analysis And Follow-Up On 294 Inpatients With Inflammatory Bowel Disease

BackgroundInflammatory bowel disease(IBD)is a chronic,relapsing,inflammatory disorder of the gastrointestinal tract,which mainly occurred in young adults.A westernized diet,susceptible genetic background,environmental factors,disordered intestinal flora and immune function have been found to contribute to the pathogenesis of IBD.Currently,the etiology and pathogenesis of IBD are still poorly understood,patients are suffered from diarrhea,abdominal pain,mucopurulent bloody stool and abdominal mass etc,some severe cases may also suffer fever,anemia,hypoalbuminemia and malnutrition besides intestinal symptoms.Meanwhile extra-intestinal manifestation such as arthritis,erythema annulare,oral ulcer,hematuresis,albuminuria may occur in some patients and some chronic cases may lead to severe complication:enterobrosis,archosyrinx,rectovaginal fistula,intestinal obstruction and peritoneal abscess etc.The therapeutic drugs of IBD are 5-aminosalicylic acid(5-ASA),glucocorticoid,immunosuppressant and biological agent,which pharmacological functions are inhibiting the level of immunity.Nowadays,IBD is divided into two clinical subtypes:ulcerative colitis(UC)and crohn's disease(CD).UC is a chronic inflammatory disorder of the gastrointestinal tract which mainly affect the mucous layer of Colon,it always begin with rectum and spread across through sigmoid,ascending colon,transverse colon,descending colon and ileocecus.Repeated diarrhea,abdominal pain,mucopurulent bloody stool and tenesmus are the main complainment of patients.Swelling and hyperemia of mucous layer,diffuse erosion and ulcer may find when patients go though colonoscopy.CD is a chronic granulomatous disease,which may occur at any part of the gastrointestinal tract and the ileocecus is the most vulnerable parts.Patients also can suffer from repeated abdominal pain and diarrhea,but fistulation,abdominal mass and perianal abscess are more frequently occured in CD comparing with UC.The typical endoscopic manifestations of CD are cobblestone like nodules and longitudinal ulcer.Typical UC and CD are easy to distinguish,but some patients,s initial symptom can be so confused and can easily misdiagnosed as acute appendicitis,enterophthisis and carcinoma of colon etc.Our study intend to collect and analyse the inpatient,s data of IBD at our hospital from January 2005 to december 2014,comparing the difference between UC and CD in epidemiologic feature,clinical manifestation,endoscopic manifestations,assistant examination,therapeutic drug and complication rate etc.And following their complication rates,intraepithelial neoplasia rates,colectomy rates and IBD related mortality by phone calls.ObjectivesTo collect and analyse the inpatient,s data of IBD at our hospital from January 2005 to december 2014,comparing the difference between UC and CD in epidemiologic feature,clinical manifestation,endoscopic manifestations,assistant examination,therapeutic drug and complication rate etc.And following their complication rates,intraepithelial neoplasia rates,colectomy rates and IBD related mortality by phone calls.Methods1.Collecting the inpatient,s data of IBD at our hospital from January 2005 to december 2014.From January 2005 to december 2014,total cases were 373.at last 294 cases were enrolled in our study according to the “diagnosis and treatment of inflammatory bowel disease consensus”made in Guangzhou at 2012.The enrolled cases were divided into two groups(UC group and CD group)according the final diagnosis.Analysing were made to explore the difference between the two groups in the aspect of epidemiology,clinical manifestations,endoscopic manifestations,laboratory examinations,therapeutic drug and complication rates.2.following their complication rates,intraepithelial neoplasia rates,colectomy rates and IBD related mortality by phone calls.From January 2005 to december 2014,294 cases were enrolled in our study and phone calls were made to explore the prognosis of these patients,which included the complication rates,intraepithelial neoplasia rates,colectomy rates and IBD related mortality.ResultsThe number of IBD inpatients were climbing yearly from january 2005 to december 2014.Both diseases were mainly occurred in young adults and had an equal gender distribution,but peak age of diagnosis were different:UC,s peak age of diagnosis was 40-49 years old and CD,s 20-29 years old/50-59 years old.In the aspect of clinical characteristics,UC outstanding clinical manifestation were diarrhea,bloody stool,tenesmus while the CD presented as abdominal mass(P<0.05).In the aspect of endoscopic manifestation,swelling and hyperemia of mucous layer,diffuse erosion and ulcer were always found in UC,s patients while CD mainly presented as bowel stiff / narrow,polyps and cobblestone like nodules(P<0.05).In prognosis,the intraepithelial neoplasia rates and IBD related mortality are resemble(P>0.05)in our study,but the CD,s colectomy rates were significantly high than UC(P<0.05).ConclusionsThe number of IBD inpatients were climbing yearly from January 2005 to december 2014.By the year of 2014,IBD inpatients,s total number were increased 6.3 times comparing to 2005.UC,s vulnerable populations were young adults,especially the age between 40 to 49 years old,and the main clinical manifestations were diarrhea,bloody stool and tenesmus.Damage were found most severe in the mucosal layer in UC,s patients when colonoscopy was used.While the damage of CD involved whole layer of intestinal wall and could easily cause intestinal obstruction and enterobrosis.And finally in prognosis,UC has a lower complication rates and colectomy rates comparing to CD.