Inflammatory bowel disease in Hubei Province of China

Bing Xia, S. Shivananda, Gui Shui Zhang, Ji Yun Yi, JBA Crusius,  AS Peka

Subject headings  colitis, ulcerative;Crohn¡äs disease

Xia B, Shivananda S, Zhang GS, Yi JY, Crusius JBA, Peka AS.Inflammatory bowel disease in Hubei Province of China.
China Nati J New Gastroenterol, 1997;3(2):119-120

Abstract

AIM  To investigate the inpatients with inflammatory bowel disease admitted to The Second Hospital, Hubei Medical University from 1986 to 1995 and analyze clinical features and follow up results of the patients in Hubei area.

METHODS  Data was collected retrospectively from 74 patients with inflammatory bowel disease (66 patients with ulcerative colitis and 8 patients with Crohn¡äs disease) hospitalized in The Second Hospital, Hubei Medical University from 1986 to 1995.

RESULTS  Abdominal pain, diarrhea, bloody and mucus stool and constipation are commonest symptoms of inflammatory bowel disease. Extraintestinal  diseases were not common. The disease was mainly located in sigmoid and left co lon in ulcerative colitis and located in ileum and colon in Crohn¡äs disease. Su lphasalazine and corticosteroid were effective (95%) in the treatment of ulcerat ive colitis, but about 42% patients had recurrence during the follow up of 1.11  years. Of 8 patients with Crohn¡äs disease, 5 had partial intestinal removal , and 3 treated with medicine of anti tuberculosis or metronidazole. Of 4 patie nts followed up for 1¡«8 years, 1 patient died of severe complications after surgery, 2 had recurrence with the medicine and 1 maintained remission with the treatment of sulphasalazine after operation.

CONCLUSION  From our data, family history of inflammatory bowel disease was seen in 5%. About 34% patients were smokers and 32% patients were alcoholic. Epidemiological investigation is urgently needed in Hubei of China to judge the strength of genetics and environmental factors in the pathogenesis of inflammatory bowel diseases.

INTRODUCTION
It is traditionally considered that inflammatory bowel disease (IBD) is rare in China. Epidemiological study showed that incidence of IBD in Europe and north America is about 3¡«14.3/100000/per year for ulcerative colitis (UC) and 0.7¡«11.6/100000/per year for Crohn¡äs disease. The prevalence of UC and CD are 39¡«234/100000 and 34¡«106/100000, respectively^£Û1£Ý. The great difference of distribution of IBD suggested that genetic factor played a role in this ethnic variation^£Û2£Ý. On the other hand, environmental factors may also  contribute to this difference^£Û3£Ý. Up to date there has been no data about the exact incidence of IBD in China. However, the clinical reports ab out IBD were surprisingly increased over the past 10 years. The present paper re viewed 74 patients with IBD from Hubei province (central region of China) hospit alized in The Second Hospital, Hubei Medical University in 1986-1995 and analyz ed the clinical features and followed up the IBD patients in the region.

CLINICAL DATA

Patient characteristics
A total of 74 patients with IBD, including 66 ulcerative colitis (UC) and 8 Crohn¡äs disease (CD), were reviewed. The diagnosis of UC and CD was assessed according to the criteria designed by the Chinese Non-infectious Diarrhea Symposium^£Û4,5£Ý. Of 74 patients with IBD, 52 were males and 22 females (2.4¡Ã1). Mean age was 38 years (range between 16.64). Fifty-one patients came from city, 19 from tow n and 4 from countryside. Twenty five patients (34%) had a history of smoking a nd 24 (32%) were alcoholic. Six patients had a history of schistosomiasis. Only 4(5%) patients had a family history of IBD.

Clinical features
The total duration of illness varied from less than 1 year to 38 years with a mean duration of 3.4 years. Of 74 patients, 36 were mild, 24 moderate and 13 severe. The clinical features are shown in Table 1. The commonest symptoms of UC were abdominal pain, diarrhea, bloody and mucus stool. Of CD, abdominal pain, diarrhea and constipation were dominant. Extraintestinal presentations were not common in our group.
    Colonoscopic appearances of 66 patients with UC included mucosal edema, congestion, frigid, ulceration and polyps. Sometimes white or yellow exudates were seen.  The disease location determined by endoscopy and X-ray barium enema are sh own in Table 2. Of 8 CD patients, 5 were confirmed by surgery, 3 found by endosc opy and histology with stricture of colon and segment diseases.
    Barium enema was carried out in 52 patients with IBD, only 18 (35%) patients were found in accordance with endoscopy, histology or surgery.
Table 1  Clinical manifestations of UC and CD

Table 2  Location of UC and CD

Table 3  Medical treatment of IBD patients

Treatment and follow-up
Medical treatment is shown in Table 3. Sul_phasalazine (SASP), corticosteroids and antibiotics were commonly used in the treatment. Of 66 UC patients, SASP or SASP plus steroids or SASP plus antibiotics (metronidazole, berberine) were effective in 63 (95%) patients in short term observation. We followed up 31 UC patients for 1¡«11 years. Sixteen (52%) patients maintained very well, 13(42%)patients had recurrence. One died of bile duct carcinoma and one of unknown causes. Of 8 CD patients, 5 progressed and underwent intestinal or colonic partial resection. Two patients used antituberculous agents and one used metronidazole.We followed up 4 patients for 1 to 8 years. One patient with partial colonic  resection died of severe complications after three times of operati on. Two patients treated with antiª²tuberculous agents or metronidazole had recurrence during 5 or 8 years respectively. One patient with SASP treatment after ileum resection maintained very well for one year.

DISCUSSION
UC and CD were uncommon in Hubei region in the past. There is an increasing tendency of IBD cases in The Second Hospital, Hubei Medical University as shown in the present survey (1986¡«1995). A family history of IBD was seen in 5%. About 34% patients have a history of smoking and 32% were alcoholic. Epidemiological investigations are urgently needed in Hubei region of China to judge the strength of genetic and environmental factors in the pathogenesis of IBD.
    It is important for differential diagnosis between IBD and infectious colitis and intestinal tuberculosis. The latter two can mimic clinically, radiologically and endoscopically UC and CD.
    From our data, abdominal pain, diarrhea, bloody and mucus stool and constipation are commonest symptoms of IBD. Extraintestinal diseases were not common. The disease was mainly located in sigmoid and left colon in UC and located in ileum and colon in CD.
    SASP and steroids were effective in the treatment of UC. However, about 42% patients with UC had recurrence during the follow up of 1.11 years. For CD patients after surgery, SASP and steroid should be maintained during remission.

REFERENCES
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     a contribution to the pathogenesis and diagnosis. Ph D thesis, Free University of Amsterdam Publishing, 1994:15-17
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3   Shivananda S. IBD in the Asian population in the east and west: a comparison and summary. International Falk Workshop
     Inflammatory Bowel Disease in Asia. March 2, 1996 Hong Kong: 35-38
4   Chinese Non-infectious Diarrhea Symposium. Criteria of diagnosis and therapy for ulcerative colitis.
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¹Department of Gastroenterology, The Second Hospital of Hubei Medical University, Wuhan 430070, Hubei Province, China
²Department of Gastroenterology and Hepathology, University Hospital Maastricht, Postbus 616,6200 MD Maastricht, the Netherlands
³Department of Gastroenterology, Free University Hospital, Postbus 7057, 1007 MB Amsterdam, the Netherlands
Dr. XIA Bing, male, was born on Dec. 26, 1956 in Hubei Province, graduated from Department of Medicine, Hubei Medical University in 1983, Associate Prof essor of internal medicine and director of Department of Science and Technology of the hospital, specialized in the study on inflammatory bowel disease, having 51 papers published.
Correspondence to  Dr. Bing Xia, Department of Gastroenterology, The Second Hospital of Hubei Medical University, Wuhan 430070, Hubei Province, China
Tel:+86¡¤27¡¤7824212-3044.
Received  1996-10-03