| ObjectivesTo investigate epidemiological and clinical characters of diarrhea-predominant Crohn’s disease and further analysis was carried out to identify the influence factors of different stages and severity of Crohn’s disease in Guangdong province. To improve the understanding of Crohn’s disease and provide scientific basis to identify and prevent Crohn’s disease.MethodsFour hospitals from Guangdong province were selected and200Crohn’s disease patients diagnosed between year2008and2013were studied. Their medical records were retrospectively collected, including the patients’epidemiological characters, clinical manifestations, syndrome pattern of traditional Chinese medicine (TCM), treatment methods and so on. Further analysis of relation between disease stages and TCM syndrome type, hospital types were carried out. We also studied the relation between severity of disease and district, age, sex.Result1.226cases were included in our study.60(26.5%) of them were from Chinese medicine hospitals and the other166(73.5%) cases were from Western medicine hospitals.155were males and71were females. The ratio was2.1:1.157(74.1%) cases of212cases were from developed regions and55(25.9%)cases were from developing areas. About etiology, no obvious risk factors (199cases,88.1%), eating contaminated food(18cases,8.0%), eating spicy food (7cases), emotional factors (2cases). The average incidence age was30.22years old(7-79years old) and most of them were betweenl6-25years(39.8%).The average age of cases was34.82years old (12-84years old). The mean course was4.10years (2months-31years). All of the cases have no disease history.2. Clinical types:For the stage of the disease,164(72.6%) cases were in activity period and62(27.4%)cases were in remission period. For case severity,63(27.3%)cases were mild, and124(54.9%) cases were moderate, and39(17.3%)cases were severe. Clinical classification by Montreal Crohn’s disease phenotype (diagnosis age),≤16years old (23cases,10.2%),17-40years old(147cases,65%),>40years old (50cases,22.1%). For lesions, L1terminal ileum (88cases,38.9%), cecum L2colon (78cases,34.5%), L3ileocolon(48cases,21.2%), the L4upper gastrointestinal (4cases). In addition, ileum (22cases), ileocecal junction (6cases), the jejunum (9cases), small intestine(47cases), rectum (13cases). For disease regions, one region (86cases,38.1%), two regions (119cases,52.7%), three regions and above (13cases,5.8%). For disease behavior, non-narrow and non-penetrating(113cases,50%), stenosis (80cases,35.4%), penetration (8cases,3.5%).3. Clinical manifestations. Gastrointestinal manifestations:abdominal pain(209cases,92.5%), diarrhea(134cases,59.3%), mucous stool (63cases,27.9%), the bloody stool (21cases,9.3%), abdominal mass(56cases,24.8%), intestinal fistula (14cases,6.2%). Systemic symptoms:fever (60cases,26.5%), marcor (95cases,42%), anemia (158cases,69.9%),loss of appetite(49cases,21.7%),fatigue(41cases,18.1%), Extraintestinal manifestations:arthritis/disease(14cases,6.2%), erythema nodosum (3cases), oral ulcers (13cases,5.8%), dermatitis (5cases), Complications:intestinal stenosis (59cases,26.1%), intestinal obstruction(56cases,24.8%), perianal lesions(49cases,21.7%), fistula (20cases,8.8%), the intestinal perforation(11cases,4.9%), inflammatory mass or abscess (8cases,3.5%), intra-abdominal abscess (7cases,3.1%), astrointestinal bleeding (7cases,3.1%). None of them were complicated with colorectal cancer.4.Treatment methods:1kind treatment (60cases,26.5%):with5-ASA in38(16.8%)cases, single immunosuppressant in6cases, single biological agents use in7cases, single surgical in7patients, single hormone in2cases. Two kinds of treatment (66cases,29.2%):5-ASA plus hormone in39patients(17.3%),5-ASA plus immunosuppressant in9cases,5-ASA plus surgery in4cases,5-ASA plus biological agents in3cases, hormone plus immunosuppressant in3cases, hormone plus biologies in3cases, immunosuppressant plus biological agents in2cases, immunosuppressive agents plus surgery in1case, biological agents plus surgery in2cases. Three kinds of treatment (50cases,22.1%):5-ASA plus hormones and immunosuppressive agents in16patients(7.1%),5-ASA plus hormone and biological agents in17cases(7.5%),5-ASA plus hormone and surgery in6cases,5-ASA plus immunosuppressants and biological agents in4cases,5-ASA plus biologics and surgery in5cases, steroid plus immunosuppressive agents and biological agents in2cases. Four kinds of treatment:5-ASA plus hormone, immunosuppressive agents, and biological agents in1case,5-ASA plus hormone, immunosuppressive agents, and surgery in2cases, steroid plus immunosuppressive agents, biological inhibitors and surgery in1case. Five kinds of treatment:5-ASA plus hormones, immunosuppressive agents, biological agents and surgery in4cases. Only17cases were just treated with symptomatic treatment or Chinese medicine.31cases were treated with operation (13.72%).5.TCM syndrome types:60cases have TCM syndrome types information. For basic syndrome types, patterns of spleen and stomach deficiency(22cases,36.7%), QI-blood deficient syndrome (20cases,33.3%), dampness-heat of the spleen and stomach pattern(8cases), syndrome of cold-dampness disturbing spleen(3cases), Qi stagnation and blood stasis pattern (1case), others (5cases). For asthenia and sthenia syndrome types, deficiency syndrome (11cases,18.3%), demonstration (10cases,16.7%), both of them(39cases,65%). For cold and heat syndrome types,cold syndrome (34cases,56.7%), heat syndrome (9cases,15%), both of them(17cases,28.3%).6. The chi-square test indicated that, the difference of disease stage between Western and Chinese traditional hospitals was statistically significant (P<0.05). The disease stages between deficiency syndrome and demonstration, cold and heat syndrome type were not statistically significant (P>0.05). The disease regions between different districts, gender were not statistically significant (P>0.05). The disease severity between different districts was statistically significant (P<0.05). The ANOVA analysis found the disease regions among different age people were not statistically significant (P>0.05), but the incidence age of different severity cases were statistically significant (P<0.05).ConclusionOur study showed that the Crohn’s disease epidemiological characters in Guangdong province were different from western developed countries. There were more male patients in Guangdong, as in other Aisa countries. But in European countries and the United States, the incidence of females was higher than males. There were more cases in developed areas rather than developing areas in Guangdong and the peak age of onset age was16-25year-old. For most of the cases, their etiology was not obvious. All cases had no family history of disease and it indicated the disease was not an inherited disease. Lesions mainly located in the back to the colon, but the location was mainly in the colon in Western developed countries. There were more severe cases in developed areas than in developing areas. More old of onset age, more severity of disease. There were more remission cases in Chinese medicine hospital than those in western hospitals. |
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