qin ouyang, yufang wang, renwei hu department of medicine ...€¦ · ulcerative colitis 20...
TRANSCRIPT
![Page 1: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/1.jpg)
Qin Ouyang, Yufang Wang, Renwei HuDepartment of medicine
West China Hospital, Chengdu,China
Epidemiology of Inflammatory Bowel Disease
In China
![Page 2: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/2.jpg)
IBD cases progressively increased in recent 20 years.
5~6 times hospitalized cases than before in some medical centers.
No large scale study on epidemiology of IBD in this country but more scientific reports published on Chinese literatures.
![Page 3: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/3.jpg)
A literature review on CBM relevant to IBD in China
A Multicentral Clinical Analysis of Hospitalized IBD in China
Some risk factors of IBD reviewed from recent literature
![Page 4: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/4.jpg)
Review and Analysis of Literatures Relevant to IBD
from 1989 to 2003
![Page 5: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/5.jpg)
Materials and Methods
Literatures 1989.1-2003.12 were searched through computer .
1400 kinds of journals, such as series of Chinese medical journals,over 12 million pieces of medical articles.
3384 articles on IBD published
143,511 cases of IBD reported in various Chinese medical journals in recent 15 years.
![Page 6: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/6.jpg)
IBD Articles in Recent 15 Years
2076(1021)
860(474)
255(136)
IBD
32(0)223(136)89-93
122(41)738(433)94-98
274(8)1974(1013)99-03
Year CDUC
Total 2956(1582) 428(49) 3384(1631)
( ) Traditional Chinese medicine
![Page 7: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/7.jpg)
General Data of IBD
C DU CContent
2.84.5Average course(year)
37.543.8Average Age
1.37/11.36/1Ratio of male
to female
![Page 8: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/8.jpg)
Clinical Type in UC
Chr oni cr el apsed
58%
Chr oni cper si st ant
23%
Fi r st at t ack18%
Ful mi nant1%
![Page 9: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/9.jpg)
Smal l bowel40. 2%
I l eocol onni c21. 4%
Col oni c36. 2%
ot her s( esophagus, st omach)
2. 2%
Clinical Type in CD
![Page 10: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/10.jpg)
Clinical Severity in UC
Sever e18% Mi l d
36%
Moder at e46%
![Page 11: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/11.jpg)
Surgery and Mortality Rate
1.410.06Mortality
30.70.1Surgery
CD(%)UC(%)Rate
![Page 12: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/12.jpg)
Articles on Extraintestinal manifestations
7.231CD
2.162UC
%NumbersDisease
Skin rashes23. 8%
Arthritis 35. 9%
Others 11. 9%
Oral ulcers28. 4%
Ski nl esi ons31. 3%
Or alul cer s29. 3%
Joi ntl esi ons
20. 7%
Ot her s18. 7%
UC CD
![Page 13: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/13.jpg)
Articles Relevant to Complications
19.282CD
2.678UC
%NumbersDisease
Per f or at i on22%
Megcol on20%
Per i analabcess
10%
Obst r uci on8%
Ot her s7%
Hemor r hage15%
Col on cancer18%
Ot her s5. 4%f i st ul a
5. 7%
Hemor r hage23. 3% Obst r uct i on
27. 2%
Per f or at i on29. 3%
UC CD
![Page 14: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/14.jpg)
Diagnosis of IBD in China
Only 6.9% articles discussed about diagnosis
40.6% papers mentioned about diagnostic criteria
Even lesser commonly used of new revised criteria in 2000.
![Page 15: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/15.jpg)
Misdiagnosed Cases of IBD
Misdiagnosed Rate(%) 60.932.1
C DU C
Others 4. 2%
Infectiouscolitis67. 3%
Hemorroids4. 7%IBS 11. 0%Colonic
cancer 7. 9%
Ischemiccolitis 4.9%
Obstruction 26.7%
Others 14.6%
TB 30.8%Appendicitis 27.9%
UC CD
![Page 16: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/16.jpg)
Articles on IBD Treatment
2084 Total
1994 (95.7%) UC
90 (4.3%) CD
1533 (73.56%) clinical trials
![Page 17: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/17.jpg)
Articles on IBD Clinical Trial
3154
3436
4933TCM
Combined with TCM andWestern medicine
Western Medicine
CD UC Classification
![Page 18: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/18.jpg)
Type and Strength of Evidence in Evidence Base Medicine
![Page 19: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/19.jpg)
Strength of Evidence in these Articles
1
11
516
0
12
38
0 1
6
02
12
1
10
100
1000
1 2 3 4 5 6 Gr ade
Amou
nt o
f ar
ticl
es UCCD
![Page 20: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/20.jpg)
Efficacy of Chinese and Western Medicine
386(87.9%)819(87.4%)93(59.2%)>90
9(2.1%)5(0.5%)15(9.6%)70-79
439(28.7)%937(61.1%)157((10.2%)
39(8.9%)112(12.0%)48(30.6%)80-89
5(1.1%)1(0.1%)1(0.6%)<70
Combined medicineTCMW. Medicine
Articles Efficient
rate
![Page 21: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/21.jpg)
Common Recipes in Chinese Medicine
Common Chinese medical prescriptions:Pulsatilla Decoction(白头翁汤)Powder of Gingseng Poriand Bighead Atractylodes (参苓白术散)Black Pulm Decoction(乌梅汤),etc.
Common Chinese patent medicine:Powder of natural indigo(青黛散)Powder for treating thoat disease(锡类散)Yunnan white drug(云南白药), etc.
Common component in prescriptions:Bletilla rhizome(白芨), Pulsatilla root(白头翁)Largehead atractylodes rhizome(白术), White peony root(白芍)Coptis root(黄连), Amur corktree bark (黄柏)Baikal skullcap root(黄芩), Membarnous milkvetch rootand(黄芪)etc
![Page 22: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/22.jpg)
Review and Analysis of Review and Analysis of Literatures Relevant to IBDLiteratures Relevant to IBD
from 2003 to 2007from 2003 to 2007
![Page 23: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/23.jpg)
2549 articles on IBD published
132,385 patients with IBD were reported.
There are totally 124,142 UC and 8,243CD
![Page 24: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/24.jpg)
Surgery and Mortality Rate
0.80.05Mortality
37.00.5Surgery
CD(%)UC(%)Rate
![Page 25: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/25.jpg)
Extraintestinal manifestations and Complications
11.1
1.5
Extraintestinalmanifestations(%)
49.8CD
0.6UC
Complications(%)
Disease
![Page 26: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/26.jpg)
Diagnosis of IBD in China
Only 5.6% articles discussed about diagnosis
70.6% papers mentioned about diagnostic criteria
69.3% used of new revised criteria in 2000.
![Page 27: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/27.jpg)
Misdiagnosed Cases of IBD
Misdiagnosed Rate(%) 52.30.8
C DU C
![Page 28: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/28.jpg)
Fi gur e 1. I cr easi ng number of UC pat i ent s r epor t edi n Chi nese ar t i cl es dur i ng a 19- year per i od
05000
10000150002000025000300003500040000
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
Year
Tota
l nu
mber
of
pati
ents
![Page 29: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/29.jpg)
Fi gur e 2. I ncr easi ng number of CD pat i ent sr epor t ed i n Chi nese ar t i cl es dur i ng a 19- year
per i od
0500
1000150020002500300035004000
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
Year
Tota
l nu
mber
of
pati
ents
![Page 30: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/30.jpg)
020000400006000080000
100000120000140000
Tot alnumber
ofpat i ent s
1989-1993
1994-1998
1999-2003
2004-2007
Year
Increasing number of UC Cases every 5 years from 1989-2007
![Page 31: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/31.jpg)
0100020003000400050006000700080009000
Tot alnumber
ofpat i ent s
1989-1993
1994-1998
1999-2003
2004-2007
Year
Increasing number of CD Cases Increasing number of CD Cases every 5 years from 1989every 5 years from 1989--20072007
![Page 32: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/32.jpg)
Conclusion
The incidence and prevalence of IBD are increasing in
recent 19 years.
The differential diagnosis complicated , and the level
of diagnosis needs to be improved.
The therapeutic strategy should be optimized and
clinical trial need to be standardized .
![Page 33: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/33.jpg)
A Clinical Analysis Of
Hospitalized IBD
![Page 34: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/34.jpg)
Patients and Methods
Hospitalized IBD from 23 medical centers in 11 cities
from 1990 to 2003 collected.
Rechecked with Diagnostic criteria
(suggested guideline for the diagnosis and treatment
of IBD in China , 2000. )
Uniform questionnaire
Training courses for Uniformity
Survey time:Jan,2004 to April , 2004
![Page 35: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/35.jpg)
General Data
3100 UC and 515 CD collected and analyzed.
The male to female ratio:
UC: 1.34:1
CD: 1.67:1
![Page 36: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/36.jpg)
050
100150200250300350400450
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003 Year
Numb
er
Number ofhospi t al i zedUC
Number of UCscr eened byendoscopy
Numbers of UC hospitalized and screened
by endoscopy from 1990-2003
0
50
100
150200
250
300
350
1990
1992
1994
1996
1998
2000
2002 year
rati
o(1/
1000
0)
Const i t ut i onal r at i o ofhospi t al i zedUC and GIcases
Const i t ut i onal r at i o ofendoscopi cf i ndi ng
Constitutional ratio of UC hospitalized and endoscopy
0102030405060708090
100
1990
1992
1994
1996
1998
2000
2002 year
Numb
er
Number ofhospi t al i zedCD
Number of CDscr eened byendoscopy
Numbers of CD hospitalized and endoscopy
Constitutional ratio of CD
hospitalized and endoscopy
![Page 37: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/37.jpg)
Age Distribution of UC And CD
0. 5
3. 7
14. 5
22. 624. 6
16. 8
12. 3
4. 5
0. 52
13. 1
20. 9
26. 6
19. 5
8. 57. 4
1 1
0
5
10
15
20
25
30
<10
10- 1920- 2930- 3940- 4950- 5960- 6970- 79>80
AGE
%
UC 44. 0± 15. 1
CD 37. 7± 20. 5
![Page 38: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/38.jpg)
10.3 10.3
10.5 10.5
36.7 36.7
27.0 27.0
15.5 15.5
CD (%)CD (%)
9.89.8〉〉1010yy
11.511.555--1010yy
36.636.611-- 55yy
34.034.011mm--11yy
8.28.2〈〈11mm
UC (%)UC (%)Course
Clinical Course of IBD
![Page 39: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/39.jpg)
Mild
35.4%
Severe
21.7%
Moderate
42.9%
Clinical Severity in IBD
Severe
33.4%
Moderate
50.5%
Mild
16.1%
UC CD
![Page 40: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/40.jpg)
14.0434Total
1.71.75252Ocular lesionsOcular lesions
0.550.551717Anal fistulaAnal fistula
1.91.95959Oral ulcerOral ulcer
1.91.96060RashRash
7.17.1221221ArthralgiaArthralgia
0.390.391212Anal fissureAnal fissure
0.420.421313Anal abscessAnal abscess
%%NumberManifestations
Extraintestinal manifestations of 3100 UC
![Page 41: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/41.jpg)
2.32.31212Ocular lesionsOcular lesions
%%NumberManifestations
22.322.3115115TotalTotal
2.92.91515BiliaryBiliary
3.13.11616RashRash
4.94.92525Oral ulcerOral ulcer
9.19.14747ArthralgiaArthralgia
Extraintestinal manifestations of 515 CD
![Page 42: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/42.jpg)
Lef t col onExt ensi vePancol onRegi onal
Location of 2726 Active UC
66.2%
1.7%
25.8%
6.3%
![Page 43: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/43.jpg)
Location of 515 CD
Smal l bowel28. 0%
I l eocol onni c31. 0%
Col oni c41. 0%
![Page 44: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/44.jpg)
5Others (1 for each disease)
2Intestinal obstruction
8Acute colitis
26Colonic Amebiasis
76Hemorrhoids
3Pseudomembranous colits
3Hypersensitivity colits
3Hemorrhagic colitis
2Typhoid fever
4Intestinal Tuberculosis
4Irritable Bowel Syndrome
2Appendicitis
189711(22.9%)
Chronic colitis Total
5Polyp of colon
6Crohn disease
373Dysentery
NumberMisdiagnosis
Misdiagnoses of 711 UC
![Page 45: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/45.jpg)
2Eosinophilic gastroenteritis
13Chronic colitis
40Intestinal carcinoma
30Intestinal Tuberculosis
10Peptic ulcer
4Acute pancreatitis
3Allergic purpura
2Behcet’s disease
16Infectious colitis
15lymphoma
292 (56.7%)Total
20Ulcerative colitis
27appendicitis
110Unknown origin
NumberMisdiagnosis
Misdiagnoses of 292 CD
![Page 46: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/46.jpg)
9.6298Total
0.031Cerebral infarction
0.031Intussusception
0.14Toxic megacolon
0.25Infectious shock
0.062Lymphoma
0.411Carcinoma of colon
0.411Intestinal Obstruction
0.826Intestinal perforation
7.6237Severe bleeding
%NumberComplications
Main Complications of 3100 UC
![Page 47: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/47.jpg)
2.111Others
%NumberComplications
0.63Inflamed mass
68.8354Total
4.724Abscess
6.232Perforation
11.358Fistula
17.992Obstruction
26.0134Hemorrhage
Main Complications of 515 CD
![Page 48: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/48.jpg)
32.532.5980980Topical treatmentTopical treatment
9494
6262
115115
16871687
498498
791791
20152015
NumbersNumbers
3.03.0OperationOperation
2.12.1Immunosuppressive Immunosuppressive agentagent
3.73.7Chinese traditional Chinese traditional medicine (oral/topical)medicine (oral/topical)
66.066.0Antibiotics Antibiotics
16.516.5Intravenous SteroidsIntravenous Steroids
26.226.2Oral steroidsOral steroids
66.866.8SASP/5ASASASP/5ASA
%%
Main therapy methods in 3015 UC
![Page 49: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/49.jpg)
33.2 171Operation
13.6 70Immunosuppressive agent
22.7 117Steroids
28.3 146SASP/5ASA
%Number
Main Therapy Methods in 435 CD
![Page 50: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/50.jpg)
UC
80. 9%
11. 6%6. 9%
0. 6%
Outcome of IBD
CD
41. 6%
5. 0%1. 4%
52. 0%
CRPRNRdeat h
![Page 51: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/51.jpg)
Conclusion
A true increase of IBD in China
A slightly male predominance of IBD.
A relatively later onset of illness with no second peak age
occurrence after 50 years.
Most IBD cases run a milder clinical course in China.
Extraintestinal manifestations and complications were
comparatively less.
A fewer fistulae and perianal complications diseases in Chinese
CD.
![Page 52: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/52.jpg)
RISK FACTORS
![Page 53: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/53.jpg)
Familial history of IBD
Articles in China reported that 4.4 - 5.6% patients with UC
had a family history
Which is lower than the 10–20% in developed countries.
Chinese IBD Working Group. Chin J Dig 2008; (in press).
Yuan AL, Xia B, et al. Chin J Dig 2003; 23: 245–6 (in Chinese).
![Page 54: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/54.jpg)
Smoking
Most studies in China suggested that cigarette smoking
was protective factors for UC, while increases the risk
for CD.
Chinese IBD Working Group. Chin J Dig 2008; (in press).Jiang L, Xia B. J Clin Gastroenterol. 2007; 41(3): 280-4.Yuan AL, Xia B, et al. Chin J Dig 2003; 23: 245–6.
No relation between smoking and severity of UC was
detected in a large population of Chinese patients.
Jiang XL.World J Gastroenterol 2002;8:158-161
![Page 55: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/55.jpg)
AAppendectomyppendectomy
As found in western countries, the case-control study of 177 UC cases in Hubei,China also showed that appendectomy had a negative association with development of UC.
Jiang L, Xia B. J Clin Gastroenterol. 2007; 41(3): 280-4
Another study cannot find appendectomy had an association with development of UC in China
Chinese IBD Working Group. Chin J Dig 2008; (in press).
![Page 56: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/56.jpg)
Infectious Enterocolitis
A muticenter case-control study of 745 UC cases showed that
infectious enterocolitis was risk factor of UC
In contrast, others have suggested that absence of infections might be a risk factor.
Chinese IBD Working Group. Chin J Dig 2008; (in press).
Gent AE, Hellier MD, Grace RH, et al.Lancet.1994 Mar 26;343(8900):766-7
![Page 57: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/57.jpg)
Tea Consumption
Many studies in other countries showed the intake of vitamin C was negatively related to IBD risk
A muticenter case-control study of 745 UC cases showed that tea consumption was protective factor
Chinese IBD Working Group. Chin J Dig 2008; (in press).
![Page 58: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/58.jpg)
Breast Feeding
Study in western countries showed that CD patients were three times less likely to have been breastfed.
S. Koletzko, P. Sherman, M. Corey,et al. BMJ. 1989 June 17; 298: 1617–1618
A muticenter case-control study of 745 UC cases in China showed breast feeding was protective factor for UC
Chinese IBD Working Group. Chin J Dig 2008; (in press).
![Page 59: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/59.jpg)
Occupation and Education
IBD is generally more common among those of higher socioeconomic status in most.
A retrospective survey of 452 patients with IBD in China showed IBD is associated with young adult professional males and high level of education
Jiang L, Xia B, Li J, et al. Inflamm Bowel Dis. 2006; 12(3):212-7
![Page 60: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/60.jpg)
Mycobacterium avium paratuberculosis
Studies in China showed an animal model of granulomatousenteritis (mimicing CD) has been established by Mycobacterium avium paratuberculosis inoculated intraperitoneally
Miao Ying-lei;Du Yan;On-yang Qin;et al. Clin Dig Dis.1999
There appears to be a strong association between M. aviumparatuberculosis and Crohn's disease
But the causality of this association is unknown.
Gan Huatian;Ouyang Qin;Bu Hong;et al.. J Internal Med.1997 (Chinese).
![Page 61: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/61.jpg)
![Page 62: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/62.jpg)
ITBITB
![Page 63: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/63.jpg)
1. Despite a time lag with the West, above data indicate a true increase of IBD in China with a lot of complicated clinical problems which offers potential opportunities to study the disease prospectively and identify the etiologic factors.
2. An increased IBD seems parallel with Chinese GDP and improvement of quality of life, which help us consider about environmental factors, but not solely genetics, in the pathogenesis of IBD.
3. Now a day, Chinese IBD database has been established and willbe completed throughout to the whole country by COIBD, which will be very helpful for data collecting and analyzing late on.
Summary
![Page 64: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/64.jpg)
Thank You!
![Page 65: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/65.jpg)
Types of IBD Articles
326
128
198
Others
428477641136CD
3384
2956
total
1878212434534Total
1831136393398UC
TherapyDiagnosisBasicReview
![Page 66: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/66.jpg)
Types of IBD Articles
18.4
Others
100
total
51.95.615.98.2(%)
TherapyDiagnosisBasicReview
![Page 67: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/67.jpg)
Chr oni cr el apsed
49%
Chr oni cper si st ant
20%
Fi r st at t ack30%
Ful mi nant1%
Clinical Type in UC
![Page 68: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/68.jpg)
Smal l bowel41. 9%
I l eocol onni c28. 8%
Col oni c26. 1%
ot her s( esophagus, st omach)
3. 2%
Clinical Type in CD
![Page 69: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/69.jpg)
Clinical Severity in UC
Sever e19% Mi l d
39%
Moder at e42%
![Page 70: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/70.jpg)
2. 4%34. 6%
46. 0%
17. 0% Ful mi nant t ype
Fi r st onset
Chr oni c r el apsi ng
Chr oni c per si st ent
Clinical Types of 3100 UC Cases
![Page 71: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/71.jpg)
Genetic factors
NOD2/CARD15 variants in locus of 16q112(IBD1) have not been found in Chinese CD and UC. (Detected in 74 UC patients, 15 CD patients and 172 healthy individuals. )
Guo QS, Xia B. World Journal of Gastroenterology. 2004; 10: 1069-71.
A higher mutation rate of P268S of NOD2/CARD15 in CD (5/30) but none of UC and control, indicating its possible susceptibility to Chinese CD
Long JH, Zhi FC. Gastroenterol (Chinese). 2007; 12(6): 327-9.
![Page 72: Qin Ouyang, Yufang Wang, Renwei Hu Department of medicine ...€¦ · Ulcerative colitis 20 appendicitis 27 Unknown origin 110 Misdiagnosis Number Misdiagnoses of 292 CD. Total 298](https://reader031.vdocuments.site/reader031/viewer/2022011906/5f40d99275992c658d725600/html5/thumbnails/72.jpg)
An association with HLA-DQ α1c allele was detected in ANCA+ UC Chinese but not in white patients, (Detected in 18 ANCA-positive UC patients and 104 controls).
Lee YT,Sung JJ. Scand J Gastroenteral 1998;33:623-627.
No difference in CTLA4 gene polymorphism between Chinese and Dutch patients. (Detected in 139 UC , 163 CD, 174 healthy controls of Dutch Caucasian origin as well as 35 patients with UC and 62 healthy controls from the Chinese Han population ).
Genetic factors
Xia B. Scand J Gastroenteral 2002;37:1296-1300