Objective:To investigate the difference of colectomy rate of acute severe ulcerative colitis (ASUC) treated with accelerated and standard infliximab (IFX) induction as salvage therapy.Methods:Relevant studies comparing accelerated and standard IFX induction in ASUC were systematically searched in PubMed, MEDLINE, EMBASE, Cochrane Library, Scopus from the establishment of the databases to Feb 7th, 2022. Two researchers screened the studies according to the established inclusion and exclusion criteria, evaluated the quality of included studies, and extracted the data. Meta-analysis was performed using R 4.0.3.Results:Ten studies were finally included, including 716 patients. The results of meta-analysis showed that there were no significant difference in colectomy rate of in-hospital ( OR = 0.56, 95% CI: 0.13 - 2.45, P = 0.446) , 3 months ( OR = 1.14, 95% CI: 0.54 - 2.42, P = 0.724) , 1 year ( OR = 0.85, 95% CI: 0.51 - 1.41, P = 0.528) , and 2 years ( OR = 1.01, 95% CI: 0.59 - 1.74, P = 0.962) between accelerated and standard IFX induction in ASUC patients, but there was significant heterogeneity among different studies. Covariate analysis revealed that baseline albumin ( MD = -1.27, 95% CI: -2.31 - -0.23, P = 0.017) and hemoglobin ( MD = -0.60, 95% CI: -1.01 - -0.20, P = 0.004) levels were significantly lower in the accelerated treatment group than those in the standard treatment group. Conclusions:There are no significant difference in short-term and long-term colectomy rates between ASUC patients treated with accelerated and standard infliximab induction, but there is significant difference in baseline disease severity between the two groups. Patients with severe disease activity should be treated with more aggressive accelerated IFX induction.

Objective:To investigate the incidence, clinical characteristics and risk factors of growth retardation in pediatric onset IBD patients.Methods:A cross-sectional study was conducted. IBD patients with the age at diagnosis younger than 18 years old were recruited and screened in the Wechat group of patients in 8 IBD medical centers across the country. Demographic, clinical and growth-related data were collected through questionnaire survey, and the incidences of growth retardation at the time of diagnosis and investigation were calculated. According to whether there was growth retardation at the time of investigation, the patients were divided into growth retardation group and non-growth retardation group. The influencing factors of growth retardation were analyzed by the univariate analysis and multivariate Logistic regression analysis.Results:A total of 97 patients were involved including 8 ulcerative colitis (UC) and 89 Crohn′s disease (CD). There was no growth retardation in UC patients. Among 89 patients with CD, there were 48 males and 41 females, and the age was 15.5 (1.0, 21.0) years old. At the time of investigation, 14 patients (15.7%) with growth retardation were set as the growth retardation group, and 75 without growth retardation were set as the non-growth retardation group. The incidence of growth retardation was 19.0% (16/84) at the time of diagnosis. Univariate analysis results showed that compared with non-growth retardation group, patients in growth retardation group had lower diagnostic age [5.0 (1.0, 13.8) years old vs. 14.0 (12.0, 16.0) years old, P = 0.003], severer disease activity ( P = 0.006), higher proportion of acute gastrointestinal perforation [28.6% (4/14) vs. 2.7% (2/75), P = 0.005], higher proportion of patients in using glucocorticoids [64.3% (9/14) vs. 33.3% (25/75), P = 0.029), and longer time of using glucocorticoids [1.5 (0, 6.5) months vs. 0 (0, 3.0) months, P = 0.040], while the proportion of patients using biological agents was lower [42.9% (6/14) vs. 80.0% (60/75), P = 0.010], and the time of using biological agents was shorter [0 (0, 6.3) months vs. 7.0 (1.0, 12.0) months, P = 0.006]. Logistic regression analysis revealed that the age at diagnosis of CD was still a risk factor for growth retardation after correcting other factors ( OR = 6.909, 95% CI: 1.250-38.195, P = 0.027) . Conclusion:The pediatric onset IBD patients with low diagnostic age are prone to growth retardation, which should be paid attention to.

Objective: To identify the related factors and characteristics of gut microbiota and metabolites in inflammatory bowel disease (IBD) patients with urolithiasis. Methods: A total of 68 IBD patients with urolithiasis and 136 gender-and age-matched IBD patients without urolithiasis in the Department of Gastroenterology, Peking Union Medical College Hospital from January 2014 to December 2019 were recruited. The diagnosis of urolithiasis was confirmed by plain films, ultrasonography, abdominal computed tomography or intravenous urography. The clinical data of patients were collected, and the association between the clinical characteristics and urolithiasis was further analyzed. The fecal samples were collected from 10 patients with urolithiasis and 18 patients without urolithiasis, and the gut microbiota and metabolites composition were analyzed. Results: There were 49 male and 19 female IBD patients with urolithiasis, with a mean age of (36.0±12.4) years, and 98 male and 38 female patients without urolithiasis, with a mean age of (36.1±12.5) years. Univariate analysis revealed that the rate of ileostomy and the resection of small intestine in Crohn's disease (CD) patients with urolithiasis (n=34) was significantly higher than CD patients without urolithiasis (n=68) (26.5% vs 7.4%, P=0.019). And the erythrocyte sedimentation rate was also higher [26.5 (12.0, 40.8) vs 13.0 (7.2, 32.5) mm/1 h, P=0.022] in CD patients with urolithiasis. There were no significant differences in clinical characteristics and biochemical parameters between the ulcerative colitis (UC) patients with urolithiasis (n=34) and without urolithiasis (n=68) (all P>0.05). The multivariate logistic regression analysis indicated that ileostomy and the resection of small intestine were the independent related factors for urolithiasis in CD patients (OR=4.619, 95%CI: 1.178-18.111, P=0.028). There was no significant difference in α and β diversity between the two groups (all P>0.05). At the phylum level, there was no significant difference in the abundance of microbiota (all P>0.05). At the genus level, the abundance of Enterococcus (P=0.049), Eubacterium_eligens (P=0.036) was significantly decreased. At the species level, the abundance of Bacteroides_coprocola was increased in urolithiasis group (P=0.035), while the abundance of Blautia_caecimuris was significantly decreased (P=0.042). No significant difference was found in fecal metabolites between the two groups (all P>0.05). According to LDA effect size (Lefse) analysis, taxa including Sphingomonadales, Fenollaria, Bacteroides_coprocola contributed greatly to the difference between the two groups. Conclusions: Ileostomy and the resection of small intestine are related factors for urolithiasis in patients with CD. Gut microbiota may be involved in the occurrence of urolithiasis in patients with IBD.

Objective:To investigate the clinical characteristics of patients with gastroduodenitis associated with ulcerative colitis (GDUC) .Methods:A descriptive case series study was performed. The clinical data of 6 patients with GDUC in Peking Union Medical College Hospital from January 2016 to December 2020 were collected retrospectively and the clinical characteristics were analyzed.Results:There were 3 males and 3 females. The age of UC onset was 32.1 (20.0-51.0) years old, the age of GDUC onset was 36.5 (25.0-51.0) years old, and the time from UC onset to GDUC onset was 4.4 (0-12.0) years. At the onset of UC, there were 2 patients of E2 type (left colon) and 4 of E3 type (extensive colon) , and the modified Mayo score was 9.2 (8.0-12.0) points. At the onset of GDUC, the modified Mayo score was 9.8 (8.0-12.0) points, the lesions involved the stomach in 3 patients, duodenum in 6 and no esophagus was involved. Two patients had upper gastrointestinal involvement after bowel surgery. Five patients had at least one extraintestinal manifestation. The high-sensitivity C-reactive protein was 43.2 (15.9-77.0) mg/L, the erythrocyte sedimentation rate was 41.7 (12.0-74.0) mm/1 h, and the hemoglobin was 108.2 (80.0-117.0) g/L. The diffuse gastric congestion and edema, duodenal diffuse congestion and punctate erosions were observed under gastroscope. The UC extent was E2 type in 1 patient and E3 type in 4 by colonoscope examination. The average Mayo endoscopic score was 3 points. The colonoscope result indicated that pouchitis was observed in 1 patient after colorectal resection+ileal pouch-anal anastomosis (IPAA) + ileostomy. All of the patients with GDUC were treated with glucocorticoids to induce remission, 2 of them were treated with infliximab to induce remission and maintain remission after relapse, and 4 of them received immunosuppressive maintenance therapy during remission. Six patients were followed up for 2.5 (0.5-3.5) years, 4 patients had complete remission of upper gastrointestinal lesions and 2 had partial remission, the modified Mayo score was 2.8 (0-7.0) points. The activities of GDUC and colitis decreased parallelly.Conclusions:Patients with GDUC have the clinical characteristics of early age of onset, severe activity, extensive colitis, and extraintestinal manifestations. After upgrading the treatment, the inflammatory degree of upper gastrointestinal tract and activity of colitis decrease at the same time.

1病例资料 患者,女,45岁,以全身淋巴结多发肿大伴发热起病,脾脏穿刺活检病理提示周围T细胞淋巴瘤,行5程C-CHOPE方案(西达本胺W2D、环磷酰胺D1、表柔比星D1、长春地辛D1、泼尼松D1～5和依托泊苷D1～3)化疗后(4程后评估完全缓解,既往无化疗相关不良反应),于2019年7月11日入院行下一程化疗.既往史:患者2013年行右乳肿物切除术,病理示炎性病变伴胶原纤维增生.2016年胃镜诊断慢性非萎缩性胃炎伴胆汁反流,规律口服艾司奥美拉唑(耐信)治疗.否认消化性溃疡、胃癌、肝硬化等病史;否认家族遗传病史.近期未食用高温食物或接触其他药物、毒物等.入院体检:血压116/83 mmHg,心、肺、腹部无异常发现.

Objective To investigate the clinical features of patients with inflammatory bowel disease (IBD) complicated with Pneumocystis Jiroveci Pneumonia (PJP). Methods We retrospectively analyzed the clinical data of 5 patients who were hospitalized in Peking Union Medical College Hospital from January 2012 to July 2017 for treatment of IBD complicated with PJP. Demographic characteristics,clinical manifestations,treatments,and outcomes were descriptively analyzed. Results Of these five patients,four had ulcerative colitis (UC) and one had Crohn's disease (CD). All patients were males,with an average age of (61.8±1.9) years. All patients were in active disease status and had symptoms including cough and suffocation. Three patients had hypoxemia,among whom two developed type 1 respiratory failure. Three patients were treated with immunosuppressive medications (corticosteroids and/or immunosuppressant drugs) before the diagnosis of PJP. Lymphocyte counts in three patients were less than 0.6×109/L. CD4+T cells in two patients were less than 200×106/L. Four patients had elevated serum cytomegalovirus DNA. The level of β-D-glucan was elevated in four patients. Chest CT showed bilateral diffuse ground glass opacification. PJP-DNA was positive in sputum or bronchoalveolar lavage fluid in all patients. Two patients with type 1 respiratory failure required invasive mechanical ventilation. All patients received trimethoprim-sulfamethoxazole and methylprednisolone treatment. Four patients recovered completely and one died. Conclusion Elderly (aged>55 years) IBD patients who are receiving immune-suppressive therapy or with decreased peripheral blood lymphocyte count are at higher risk of PJP.

系统性硬化包括CREST[钙质沉积(calcinosis cutis)、雷诺现象(Raynaud phenomenon)、食管运动功能障碍(esophageal dys-motility)、指端硬化(sclerodactyly)、毛细血管扩张(telangiectasia)]综合征,常可累及消化系统,几乎整个胃肠道均可受累,其中以胃食管反流最多见,假性肠梗阻是较为少见的一种合并症,而合并自发性气腹症者,至今国内未见报道.现报道1例我院收治的CREST综合征合并良性自发性气腹症患者,供临床医师参考.

Objective This meta-analysis assessed the value of interferon-γ release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn's disease (CD).Methods Systematic search without language restriction was conducted in the main computerized databases until June 2015.Studies that have evaluated the performance of IGRAs (QuantiFERON-TB Gold or T-SPOT.TB) in distinguishing ITB from CD were eligible.Main outcome measures included sensitivity and specificity.Area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was used to evaluate the accuracy of IGRAs.Results Twelve studies (all from Asia) were finally included.The pooled sensitivity and specificity of IGRAs for the differential diagnosis of ITB from CD were 82.8％ (95％CI 78.4％-86.6％) and 86.7％ (95％ CI 83.2％-89.6％) respectively.The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 6.870 (95％ CI 5.345-8.830) and 0.171 (95％ CI 0.105-0.279).The diagnostic odds ratio was 44.030 (95％ CI 27.964-69.325).And the AUC of sROC was 0.939.Conclusions IGRAs have a high sensitivity and specificity for the diagnosis of ITB,and specificity is consistent from study to study.IGRAs may be considered as a supplementary method in the differential diagnosis of ITB from CD.

近年来老年性乳糜泻被逐渐认识,其特点为消化道症状轻微,贫血、骨质疏松等营养吸收不良表现突出,易发生自身免疫紊乱、难治性乳糜泻、恶变.本文从临床表现、实验室检查、内镜、病理学特征及治疗方面对2例老年性乳糜泻进行报道.