Improved Diagnosis of Crohn's Disease in a Low Endemic Area: A 15-Year Hospital-Based Study

背景/目的：克隆氏症(CD)的盛行率在亞洲和太平洋地區在過去的20年裡持續增加。克隆氏症的診斷並無一個單一的診斷標準。克隆氏症的診斷通常是結合臨床，內視鏡，組織學及影像學檢查後所得到的診斷。在過去此前克隆氏症通常是由術後病理檢查而得到確診。這項研究的目的是探討在過去15年中，本院對於克隆氏症診斷方式的進展。方法：本研究針對於2000年1月至2014年10月間，總共有36個CD患者在彰化基督教醫院接受診斷及治療。這些克隆氏症病患的臨床資料和內視鏡發現，組織學報告及影像學檢查等進行了分析。結果：在過去15年的非依靠手術診斷的克隆氏症病患顯著增加。以2011 年前後兩個時期相比，2011年之前比2011年以後有較多的病患是在手術之後才得到診斷(35%對6.3%，p = 0.042)。手術後診斷的克隆氏症患者其迴腸疾病(p = 0.03)，腸道狹窄症狀(p = 0.046)和影像學發現有管腔狹窄(80%，p = 0.047)的比率較非手術診斷的克隆氏症患者為高。在非手術診斷的患者中，其以發炎性症狀表現的比率(p = 0.044)和內視鏡下發現有口瘡性潰瘍的(54.2%，p = 0.025)比率較經手術診斷的患者為高。經手術標本中觀察到的非乾酪性肉芽腫較內視鏡活檢相比頻率更高(50.0%對7.4%，p = 0.016)。在依靠或非依靠手術診斷的克隆氏症病患相比，其性別，年齡及肛周疾病的比率沒有顯著的差異。結論：克隆氏症在臺灣在過去15年裡持續成長。在較早的時期克隆氏症往往在發生穿孔或梗阻等併發症後才被確診。缺乏臨床上的懷疑以及單靠內視鏡活檢的診斷，造成克隆氏症診斷上的延誤。近年來因為對於疾病診斷知識的進步，自2011年以來，本院克隆氏症經由非手術方式的診斷持續增加。

關鍵字

克隆氏症；診斷；內視鏡；小腸鏡；發炎性腸道疾病

並列摘要

Background/Purpose: Crohn's disease (CD) has increased in the Asia-Pacific area in the past two decades. There is not a single gold standard for diagnosing CD; diagnosis is usually made through a combination of clinical, endoscopic, histological, and radiological investigations. Previously, CD was usually diagnosed postoperatively by histological examination. The aim of this study was to elucidate the change in the diagnostic pattern for CD in our hospital over the past 15 years. Methods: A total of 36 CD patients were retrospectively enrolled from the electronic clinical database of Changhua Christian Hospital, Taiwan in the period of January 2000- October 2014. The clinical characteristics and pathological, endoscopic, and radiological findings were analyzed. Results: There was a significant increase in non-surgical diagnosis of CD over the past 15 years. Comparing CD data before and after 2011, the percentage of diagnoses made after surgery was higher before 2011 than after 2011 (35% vs. 6.3%, p = 0.042). Higher proportions of ileal disease (p = 0.03), stricturing disease (p = 0.046), and radiologic evidence of luminal stenosis (80%, p = 0.047) were noted among patients diagnosed with CD postoperatively. Inflammatory disease (p = 0.044) and an endoscopic finding of aphthous ulcers (54.2%, p = 0.025) were found more frequently in patients diagnosed with CD without surgery. Pathological findings of non-caseating granuloma were observed more frequently in surgical specimens as compared with endoscopic specimens (50.0% vs. 7.4%, p = 0.016). There were no significant differences in terms of age of diagnosis, sex, and perianal disease between patients diagnosed with CD with or without surgery. Conclusion: CD has increased in Taiwan in the past 15 years. In the early period, CD was diagnosed when complications occurred postoperatively, i.e., perforation or obstruction. The low yield rate of endoscopic biopsies and a lack of clinical suspicion contributed to delayed diagnosis of CD. There has been an increase in nonsurgical diagnosis of CD since 2011; early diagnosis has been more common in recent years due to clinical awareness of the disease, which has changed the diagnostic pattern.

並列關鍵字

Crohn’s disease ； diagnosis ； endoscopy ； enteroscopy ； inflammatory bowel disease

國際替代計量

Improved Diagnosis of Crohn's Disease in a Low Endemic Area: A 15-Year Hospital-Based Study

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