Epidemiological And Clinical Characteristics Of Inflammatory Bowel Disease In A Single Center

Objective:To analyze and discuss the epidemiological and clinical characteristics of IBD in the Second Hospital of Lanzhou University as a single center.Methods:The basic data and clinical data of all hospitalized patients with inflammatory bowel disease(IBD)from June 2011 to June 2022 in the Second Hospital of Lanzhou University were collected and collated and divided into UC group and CD group.The epidemiological characteristics of IBD and the clinical characteristics of the disease in a single center of our hospital were analyzed and summarized,such as crude incidence rate,characteristics of the affected population,course of disease,age of onset,clinical symptoms,main laboratory parameters,imaging,disease phenotype,endoscopy,pathology,and use of therapeutic drugs.Data analysis processing was performed using SPSS 25.0 software.Results:1.In recent 10 years,357 patients with IBD were treated in our hospital,including270 patients with ulcerative colitis(UC)and 87 patients with Crohn’s disease(CD).2.Crude incidence in our province:The crude incidence of IBD is about 0.02-0.207/100,000 people,the crude incidence of UC is about 0.004-0.172/100,000 people,and the crude incidence of CD is about 0.016-0.052/100,000 people.3.Demographic characteristics:(1)Age:the median age of onset of IBD is 41.06years,the average age of onset of UC is 42.98±14.65 years,and its high incidence age is located in 40-59 years;the average age of onset of CD is 35.10±14.25 years,and its high incidence age is 20-39 years;(2)Gender:the male to female ratio of UC group is1.16:1;the male to female ratio of CD group is 1.64:1;(3)Ethnicity:the Han nationality accounts for the highest proportion of all IBD patients is 92.7%,followed by other nationalities accounting for 7.3%;(4)Number of hospitalizations and course of disease:a total of 118 patients were repeatedly hospitalized,and the number of hospitalizations was positively correlated with disease activity,with statistical significance(2=103.274,P<0.05),about 50%of patients had a course of disease greater than 1 year;(5)Education level and occupation:109 cases(30.6%)received college degree education or above in this study;in the occupational distribution,farmers accounted for up to33.6%,The proportion of civil servants and employees was about 20.4%;(6)Family history and intestinal surgery history:No family history cases were found in this study,and the rate of intestinal surgery history in the CD group was significantly higher than that in the UC group,and the difference between the two groups was statistically significant(2=98.573,P<0.001).4.Clinical manifestations of IBD:(1)Digestive system and systemic symptoms:Diarrhea,mucopurulent bloody stools,and tenesmus were more common in the UC group than in the CD group,and there was a statistically significant difference between the two groups(P<0.05);(2)Extraintestinal manifestations:about 10.7%in the UC group showed extraintestinal manifestations,and 11.5%in the CD group were accompanied by extraintestinal manifestations.5.Laboratory tests:In this study,ESR and CRP in CD group were higher than those in UC group,and the differences between the two groups were statistically significant(P<0.05).ALB and Ca ~2+were significantly correlated with disease activity.The positive rate of autoantibodies,the positive rate of fecal occult blood and the detection rate of fecal leukocytes in UC group were higher than those in CD group,and the differences between the two groups were statistically significant(P<0.05).6.UC clinical phenotype:In this study,the lesion sites in the UC group were E1(20.4%),E2(37.0%),and E3(42.6%),and the constituent ratios of disease severity classification were mild(20.0%),moderate(54.8%),and severe(24.1%).There was no significant association between different age groups of UC onset and disease location and disease severity(P>0.05).7.CD clinical phenotype:age of onset segment:A1(9.2%),A2(54.0%),A3(36.8%);lesion site distribution:L1(29.9%),L2(24.1%),L3(37.9%),L1+L4(6.9%),L2+L4(1.1%);disease behavior:B1(9.2%),B2(54%),B3(36.8%);disease activity:mild activity(20.7%),moderate activity(24.1%),severe activity(42.5%),remission12.6%.There was a certain association between different age of onset and disease severity,with a significant difference in disease severity between patients in groups A1and A2(P=0.047).8.Imaging features of IBD:102patients in IBD underwent CTE and 71 patients underwent MRE.It is mainly characterized by edema and thickening of the intestinal wall,luminal narrowing,rigidity in course,and some visible per intestinal exudation,and the lesion site is basically confined to the colorectum.In the CD group,5 cases showed vascular"wooden comb sign"and 4 cases of anal fistula and perianal abscess formation.9.Endoscopic features:UC:Retrograde diffuse lesions of the intestine;erosion,congestion,edema of the intestinal mucosa,and inflammatory polypoid hyperplasia;intestinal ulcer formation,purulent secretions,white coating at the bottom of some ulcers,and exudation around the bowel;and in severe cases,stenosis and stiffness of the diseased bowel,brittle lesions,and easy bleeding to touch.CD:Intestinal lesions showed segmental distribution,and may involve the entire digestive tract;intestinal mucosal congestion,edema,roughness showed fine granular,inflammatory polypoid hyperplasia;large ulcer formation was observed in the intestine,ulcer fusion and cobblestone-like changes were also observed;some patients underwent partial intestinal resection,and anastomotic ulcers were observed;the ileocecal valve was twisted,deformed,and narrow;the disease was brittle and easy to bleed by touch.10.Pathological features:UC pathology is mainly characterized by mucosal inflammation,inflammatory cell infiltration,changes in the number of glands,granulation tissue hyperplasia,and cryptitis/abscess formation.The main pathological features of CD were granulation tissue hyperplasia,ulcer formation and inflammatory cell infiltration,and typical non-caseating granulomas were observed in 6 cases.11.IBD:97.41%UC patients received 5-ASAs,17.78%corticosteroids,4.07%biologics,and 0.74%immunosuppressants.IN the CD group,32.18%were treated with5-ASAs,20.69%with corticosteroids,50.57%with biologics,22.99%with immunosuppressants,5.75%with thalidomide,and 1.15%with cyclosporine.11.49%of the patients finally received surgical treatment.Almost all 357 patients in our hospital were treated with a combination of probiotics.Conclusion:1.The number of IBD cases in our hospital has been increasing year by year in the past 10 years,with UC being the most common.Our hospital is a regional IBD diagnosis and treatment center.Represented by our single center,it is roughly estimated that the crude incidence rate of IBD in our province is 0.164/100,000 people,the crude incidence rate of UC is 0.112/100,000 people,and the crude incidence rate of CD is0.052/100,000 people.The above crude incidence rate is generally lower than the actual level.2.The clinical symptoms,endoscopic findings and pathological findings of IBD in our hospital are basically in line with the typical characteristics of the disease,but the clinical phenotype distribution is not in good agreement with domestic and foreign studies and needs to be confirmed by further multicenter studies.3.The main drugs for the treatment of UC in our hospital are 5-ASA and glucocorticoid.Moderate to severe UC are often used in combination,while CD mostly selects biological agents and immunosuppressive agents.The intestinal surgery rate of CD is also higher than that of UC.