探究不同亚型上消化道克罗恩病（CD）患者的临床特点和预后差异。

连续性纳入2017—2021年上海瑞金医院初诊CD患者，结合内镜与病理结果将患者分为上消化道累及组（UGI＋组）和非上消化道累及组（UGI－组）。分析CD患者上消化道累及率、UGI＋组内镜下特点及严重程度；采用Kaplan-Meier方法描绘生存曲线，分析UGI＋组与UGI－组3年持续无手术率与无并发症率差异性。并进一步将UGI＋组患者按是否十二指肠球部受累进行分组，比较不同亚型间预后的差异性。

76例患者纳入研究，在上消化道内镜检查中发现46例（60.5%）患者存在68处阳性内镜表现。内镜特点多样，其中胃底竹节样外观是发生率最高的上消化道内镜表现形式（20.6%），其次依次为十二指肠球部溃疡（17.6%）和十二指肠球部结节样增生（14.7%）。随访后得出UGI＋组与UGI－组在3年持续无手术率和无并发症率间无明显差异（P>0.05）。进一步分组分析发现：UGI－组、CD上消化道累及非十二指肠球部组（UGI＋DB－组）与CD上消化道累及十二指肠球部组（UGI＋DB＋组）的3年持续无事件率分别为88.9%、87.9%、68.0%。其中UGI＋DB＋组的3年无事件率显著低于UGI－组和UGI＋DB－组（P<0.05）。

初诊CD患者上消化道累及现象并非少见，其内镜下表现形式多样。提倡初诊CD患者无论有无上消化道症状均进行胃镜检查。当患者累及部位为十二指肠球部则在随访中表现为明显的手术率或并发症率增高，对于该部分患者应尽早给予积极治疗，以期改善预后。

To analyze the clinical characteristics and prognosis in different subtypes of upper gastrointestinal Crohn's disease (CD) patients.

CD patients treated at Shanghai Ruijin Hospital from 2017 to 2021 were enrolled. They were divided into the upper gastrointestinal tract involvement (UGI+) group and non-upper gastrointestinal tract involvement (UGI-) group based on endoscopic and pathological findings. The upper gastrointestinal tract involvement rate of CD patients, the endoscopic characteristics and severity of UGI+ group were analyzed. Kaplan Meier method was used to survival curve, and the differences of 3-year continuous operation-free rate and complication free rate between UGI+ and UGI- group were analyzed. Patients in the UGI+ group were further divided according to whether duodenal bulb was involved, and the difference of prognosis among different subtypes was compared.

A total of 76 patients were included in this study, among which 46 cases had 68 positive endoscopic findings. Endoscopic features were diverse and the bamboo joint-like appearance of the gastric fundus had the highest incidence (20.6%), followed by duodenal ulcers (17.6%) and protruding lesions of the duodenal bulb (14.7%). After follow-up, there was no significant difference between the UGI+ group and the UGI- group in the 3-year continuous operation-free rate (P>0.05). Further subgroup analysis showed that the 3-year event-free rate in the UGI- group, CD upper digestive tract involving non-duodenal bulb group (UGI+DB- group) and CD upper digestive tract involving duodenal bulb group (UGI+DB+ group) were 88.9%, 87.9% and 68.0%, respectively. The 3-year event-free rate of the UGI+DB+ group was significantly lower than that in the UGI- group and UGI+DB- group (P<0.05).

Upper gastrointestinal involvement is not uncommon in newly diagnosed CD patients, and its endoscopic manifestations are varied. Endoscopy should be recommended to newly diagnosed CD patients regardless of asymptomatic gastrointestinal symptoms. UGI+ patients with duodenal bulb involvement have significantly higher rates of surgery or complications. Therefore, active treatment should be promptly provided to this subgroup of patients to improve their prognosis.