Abstract
BackgroundChronic intestinal schistosomiasis has been reported to be associated with colonic polyps, colorectal cancer and ulcerative colitis. We aim to investigate the clinical characteristics of intestinal-related lesions caused by chronic intestinal schistosomiasis japonicum.MethodsPatients with and without chronic intestinal schistosomiasis were retrospectively enrolled from the endoscopy center of Wuhan Union Hospital from September 1, 2014, to June 30, 2019 with a ratio of 4:1. The characteristics of infected intestinal segments were analyzed in patients with chronic intestinal schistosomiasis. We also compared the characteristics of intestinal-related lesions, including colorectal polyps, colorectal cancer (CRC), ulceration or erosion of the intestinal mucosa and hemorrhoids, between the two groups.ResultsA total of 248 patients with chronic intestinal schistosomiasis and 992 patients without chronic intestinal schistosomiasis were analyzed. The most common sites of chronic intestinal schistosomiasis were the sigmoid colon (79.0%) and rectum (84.7%). The frequency of intestinal polyps (64.5% vs. 42.8%, p < 0.001), especially rectal polyps (62.5% vs. 45.0%, p = 0.002), in the intestinal schistosomiasis group was significantly higher than that in the control group. Morphologically, type IIa polyps were more common in the schistosomiasis enteropathy group (68.5% vs. 60.7%, p = 0.001). Female patients with intestinal schistosomiasis had a higher detection rate of CRC than women in the control group (13.8% vs. 5.4%, p = 0.017). There was no significant difference in the incidence of ulcerative colitis between the two groups (0.8% vs. 0.6%, p = 0.664). In addition, the schistosomiasis enteropathy patients had a higher detection rate of internal hemorrhoids (58.9% vs. 51.0%, p = 0.027).ConclusionsChronic intestinal schistosomiasis mainly involved the rectum and sigmoid colon and was more likely to induce intestinal polyps, especially rectal polyps and internal hemorrhoids. Women with chronic schistosomiasis have a higher risk of colorectal cancer.
Highlights
Chronic intestinal schistosomiasis has been reported to be associated with colonic polyps, colorectal cancer and ulcerative colitis
Inclusion criteria were in accordance with the diagnostic criteria of schistosomiasis (WS261-2006) issued by the Ministry of Health, People’s Republic of China (PRC): (1) patient was from schistosomiasis endemic areas; (2) patient with or without diarrhea, abdominal pain and other symptoms, 3) calcified Schistosoma eggs identified by colorectal mucosal biopsy or HE staining
Intestinal infection site of Schistosoma The typical yellow nodules, miliary changes and microscopic appearance of the mucosa caused by schistosomiasis are shown in Figs. 1 and 2
Summary
Chronic intestinal schistosomiasis has been reported to be associated with colonic polyps, colorectal cancer and ulcerative colitis. We aim to investigate the clinical characteristics of intestinal-related lesions caused by chronic intestinal schistosomiasis japonicum. The acute and chronic intestinal inflammation caused by Schistosoma is called intestinal schistosomiasis. A few patients may present with symptoms of acute appendicitis due to noncalcified eggs deposited in the appendix [3, 4]. Chronic infection manifests as intestinal wall vascular network disorder, smooth or prominent mucous membrane yellow-white or grayishyellow nodules, colonic polyps, and intestinal lumen stenosis. The yellow nodules are mostly the presentations of calcified worm egg deposition, fibrous tissue thickening and atrophy of the overlying mucosa. Acute and chronic inflammatory changes coexist in the intestinal mucosal tissues of people in some epidemic areas due to repeated infection with Schistosoma, and their clinical symptoms are varied [3, 6, 7]
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