Abstract：
OBJECTIVE: Crohn\'s Disease (CD) can affect the entire gastrointestinal tract, including the upper sections (UGI), which is often overlooked, especially in Asian populations. There\'s a notable gap in research regarding the impact of UGI involvement on the intricate landscape of ensuing complications. This study aims to address this gap.
METHODS: Conducting a retrospective study at Chang Gung Memorial Hospital from January 2001 to September 2023, we compared CD patients with UGI (Montreal L4) involvement against non-L4 counterparts, focusing on baseline characteristics, post-diagnosis complications, and overall outcomes. Routine UGI endoscopy was performed around the time of diagnosis in all patients followed in our inflammatory bowel disease (IBD) center, and all CD patients with adequate follow-up were included in this study.
RESULTS: The study included 212 CD patients, 111 in the L4 group and 101 in the non-L4 group, with an average follow-up of 40.8 ± 15.1 months. At baseline, individuals in the L4 category demonstrated elevated smoking rates, increased Crohn\'s Disease Activity Index scores, a higher prevalence of strictures, and a more prevalent usage of biologics and proton pump inhibitors. Moreover, this group was characterized by reduced albumin levels. Upon concluding the follow-up, those with L4 involvement continued to show escalated CDAI scores and hospitalization frequencies, alongside heightened C-reactive protein levels and diminished albumin concentrations. Additionally, the occurrence of UGI involvement, stricturing disease at the time of diagnosis, and a younger age at the onset of CD were pinpointed as independent predictors for the development of new-onset strictures.
CONCLUSIONS: CD patients with UGI involvement exhibit elevated disease activity and serve as independent predictors for the development of intestinal strictures. Thorough UGI evaluations at the time of diagnosis, coupled with assertive treatment strategies, are essential for managing these patients effectively.
METHODS: Conducting a retrospective study at Chang Gung Memorial Hospital from January 2001 to September 2023, we compared CD patients with UGI (Montreal L4) involvement against non-L4 counterparts, focusing on baseline characteristics, post-diagnosis complications, and overall outcomes. Routine UGI endoscopy was performed around the time of diagnosis in all patients followed in our inflammatory bowel disease (IBD) center, and all CD patients with adequate follow-up were included in this study.
RESULTS: The study included 212 CD patients, 111 in the L4 group and 101 in the non-L4 group, with an average follow-up of 40.8 ± 15.1 months. At baseline, individuals in the L4 category demonstrated elevated smoking rates, increased Crohn\'s Disease Activity Index scores, a higher prevalence of strictures, and a more prevalent usage of biologics and proton pump inhibitors. Moreover, this group was characterized by reduced albumin levels. Upon concluding the follow-up, those with L4 involvement continued to show escalated CDAI scores and hospitalization frequencies, alongside heightened C-reactive protein levels and diminished albumin concentrations. Additionally, the occurrence of UGI involvement, stricturing disease at the time of diagnosis, and a younger age at the onset of CD were pinpointed as independent predictors for the development of new-onset strictures.
CONCLUSIONS: CD patients with UGI involvement exhibit elevated disease activity and serve as independent predictors for the development of intestinal strictures. Thorough UGI evaluations at the time of diagnosis, coupled with assertive treatment strategies, are essential for managing these patients effectively.
摘要：
目的：克罗恩病（CD）可影响整个胃肠道，包括上半部分(UGI)，这经常被忽视，尤其是亚洲人群。关于UGI参与对随之而来的并发症的复杂景观的影响的研究存在显着差距。本研究旨在弥补这一差距。
方法：从2001年1月至2023年9月在长庚纪念医院进行了一项回顾性研究，我们比较了患有UGI（蒙特利尔L4）的CD患者与非L4患者，专注于基线特征，诊断后并发症，和总体结果。在我们的炎症性肠病（IBD）中心，所有患者在诊断前后进行常规UGI内镜检查。所有接受充分随访的CD患者均纳入本研究.
结果：该研究包括212名CD患者，L4组111和非L4组101，平均随访40.8±15.1个月。在基线,L4类别的个体显示吸烟率升高，克罗恩病活动指数得分提高，狭窄的患病率更高，以及生物制剂和质子泵抑制剂的更普遍使用。此外，该组的特点是白蛋白水平降低.在结束后续行动后，那些L4参与的患者继续显示出不断升级的CDAI评分和住院频率，C反应蛋白水平升高和白蛋白浓度降低。此外,UGI参与的发生，在诊断时狭窄的疾病，CD发病时年龄较小的患者被确定为新发病狭窄发展的独立预测因子。
结论：UGI受累的CD患者表现出疾病活动性升高，并作为肠狭窄发展的独立预测因子。在诊断时进行彻底的UGI评估，再加上自信的治疗策略，对于有效管理这些患者至关重要。
方法：从2001年1月至2023年9月在长庚纪念医院进行了一项回顾性研究，我们比较了患有UGI（蒙特利尔L4）的CD患者与非L4患者，专注于基线特征，诊断后并发症，和总体结果。在我们的炎症性肠病（IBD）中心，所有患者在诊断前后进行常规UGI内镜检查。所有接受充分随访的CD患者均纳入本研究.
结果：该研究包括212名CD患者，L4组111和非L4组101，平均随访40.8±15.1个月。在基线,L4类别的个体显示吸烟率升高，克罗恩病活动指数得分提高，狭窄的患病率更高，以及生物制剂和质子泵抑制剂的更普遍使用。此外，该组的特点是白蛋白水平降低.在结束后续行动后，那些L4参与的患者继续显示出不断升级的CDAI评分和住院频率，C反应蛋白水平升高和白蛋白浓度降低。此外,UGI参与的发生，在诊断时狭窄的疾病，CD发病时年龄较小的患者被确定为新发病狭窄发展的独立预测因子。
结论：UGI受累的CD患者表现出疾病活动性升高，并作为肠狭窄发展的独立预测因子。在诊断时进行彻底的UGI评估，再加上自信的治疗策略，对于有效管理这些患者至关重要。
