炎症性肠病与结直肠癌

炎症性肠病(inflammatory bowel disease,IBD)包括溃疡性结肠炎(ulcerative colonitis,UC)和克罗恩病(Crohn病，CD)，是由环境、基因和免疫因子联合影响，产生免疫反应引起的慢性非特异性炎症，其病因目前尚未完全明了。首例UC并发肠癌报道于1925年。IBD通过多步骤介导肿瘤发生，其中UC并发结     

炎症性肠病135例临床分析

目的探讨溃疡性结肠炎(UC)和克罗恩病(CD)的诊断和治疗方法。方法回顾性分析1985～2004年的135例符合中华医学会消化病分会制定的炎症性肠病诊断治疗规范标准的病人的临床、肠镜及治疗方法和效果。结果31例CD主要临床症状为糊状腹泻,腹痛多位于脐周或右下腹,内镜下主要表现为节段性、非对称性的黏膜炎症,阿弗他溃疡。104例UC主要表现为反复发作的黏液脓血便,腹痛多位于下腹和左侧,内镜下主要表现为多发性浅表溃疡、弥漫性充血糜烂、假息肉。UC结肠镜确诊率为100%,但CD结肠镜确诊率仅为41.9%。UC内外科治疗完全缓解率33.6%,有效率82.7%;CD完全缓解率为22.6%,有效率为64.5%,UC的治疗有效率明显高于CD(P<0.05)。结论结肠镜是诊断UC的最有效方法,CD的诊断须依靠临床、内镜、X线及手术探查资料进行综合评价。合理的内科治疗和选择性外科治疗可提高IBD治疗效果。     

炎症性肠病的治疗进展

炎症性肠病 (Inflammatory Bowel Disease,IBD)包括克隆氏病 (Crohn' s Disease,CD)和溃疡性结肠炎 (Ulcerative Colitis,UC) ,为一类病类尚未完全明确的肠道非特异性炎症。近年来 ,随着对其病理生理学研究的进一步深入 ,治疗方面也取得了相应的进展 ,兹简要综述如下。1　传统治疗　　 IBD的传统治疗包括应用抗菌药物及激素治疗。前者包括磺胺类药物及抗生素 ,后者包括糖皮质激素和促肾上腺皮质激素 (ACTH)。　　磺胺类药物早在 40年代就开始用于 IBD的治疗 ,效果较好的是水杨酸偶氮磺胺吡啶 (SASP) ,用量一般为 2～ 6 g/d,症状…     

炎症性肠病152例临床病理分析

为探讨炎症性肠病（IBD）的临床病理特点和治疗方法,回顾性分析152例IBD患者的临床资料,肠镜、病理检查及治疗方法。结果显示,临床主要表现：93例溃疡性结肠炎（UC）以腹泻为主,伴有腹痛和黏液脓血便,腹痛多位于左下腹和左腰腹部;59例克罗恩病（CD）以腹痛为主,伴有腹泻和黏液或水样便,腹痛多位于右下腹和脐周。病变范围：UC以直肠和全结肠为主;CD以末端回肠及其邻近结肠为主。临床类型：UC以初发型及慢性复发型多见;CD以狭窄型为主。内镜及病理大体检查：UC为多发性表浅溃疡、连续性弥漫性黏膜充血糜烂,病理检查镜下隐窝脓肿较多见;CD为节段性、非对称性的黏膜炎症,病理检查镜下黏膜下层见结节样肉芽肿。CD并发症较多,主要为肠梗阻、瘘管及肠穿孔。UC结肠镜病理活检确诊率为96．8％,3．2％的病例是经手术标本病理活检确诊。CD结肠镜病理活检确诊率为59．3％,40．7％的病例是经手术标本病理活检而确诊。结果表明,IBD临床表现多样,CD并发症较UC多见,误诊率较高,结肠镜病理活检是诊断UC和CD的有效方法。合理内科治疗和选择性外科治疗可提高IBD的治疗效果。     

炎症性肠病的腹腔镜手术治疗

广义的炎症性肠病（inflammatory bowel disease,IBD）,是以肠道炎症为主要表现的不同疾病的总称。而狭义的IBD则特指一组病因尚不卜分清楚的慢性特异性肠道炎症性疾病,主要包括溃疡性结肠炎（ulcerative colitis,UC）和克罗恩病（Crohn’s disease,CD）。IBD在西方国家的发病率较高[UC为（2～10）／10万,CD为（6～10）／10万1,多为青壮年发病,并发症多且重．严重影响病人的生活和劳动能力。     

粪便钙卫蛋白在炎症性肠病和功能性肠病鉴别诊断中的临床应用

目的:探讨粪便钙卫蛋白(CPT)在炎症性肠病(IBD)及功能性肠病鉴别诊断中的应用价值.方法:选择2018年5—11月在南京医科大学第一附属医院初诊为IBD的住院患者221例,其中溃疡性结肠炎(UC)57例,克罗恩病(CD)164例;另选同期肠易激综合征(IBS)30例,正常对照120例.收集患者内镜检查前的粪便,采用酶联免疫吸附法(ELISA)检测各组粪便CPT水平.结果:CD与UC患者的粪便CPT水平均显著高于IBS组和对照组(P<0.001),而IBS组和对照组之间差异无统计学意义(P>0.05).IBD患者中,UC组的粪便CPT含量显著高于CD组(P<0.05),且当按UC内镜下严重度指数及CD内镜活动评分分组时,UC轻度者的粪便CPT含量明显高于CD轻度者(P<0.05),UC中、重度者与CD中、重度者之间差异无统计学意义(P>0.05).结论:粪便CPT水平可作为IBD活动性评估以及与IBS鉴别诊断的指标.     

内镜在炎症性肠病中的价值

内镜检查在炎症性肠病的诊治中至关重要,对该病的诊断、疾病活动性以及恶变的监测均具有重要意义,过去数十年里内镜技术已经取得飞速的进步,除能观察到病变肠道,且能活检组织和进行各种治疗。本文将对内镜在炎症性肠病中的价值进行综述,为临床医师提供自己的心得。     

炎性肠病45例手术治疗及疗效评价

目的 探讨炎性肠病的手术治疗方法 及疗效评估.方法 回顾性分析近6年经外科手术治疗的45例炎性肠病患者的临床资料.结果 急诊手术16例,Crohn病9例,溃疡性结肠炎(UC)7例.择期手术29例,Crohn病4例,UC 25例.其中13例Crohn病患者行小肠部分切除6例,内瘘者行小肠及结肠部分切除、吻合术1例,回肠穿...     

炎性肠病外科治疗进展

炎性肠病（IBD）是一组特发性的慢性炎性肠道疾病。主要包括克罗恩病（CD）和溃疡性结肠炎（UC）。IBD整体发病率处于上升趋势。与西方国家相比．我国男性发病率略高;UC患者发病年龄相对晚;大多数病变为轻中度,瘘及肛周病变少。虽然IBD药物治疗近些年取得了长足发展．但仍有30％以上的UC患者需手术治疗．有70％的CD患者毕生要接受至少1次手术。本文就近年来IBD的外科治疗进展作一综述。     

Evidence against a systemic arterial defect in patients with inflammatory bowel disease

Background

Despite increasing interest in local microvascular alterations associated with inflammatory bowel disease (IBD), the potential contribution of a primary systemic vascular defect in the etiology of IBD is unknown. We compared reactivity of large diameter mesenteric arteries from segments affected by Crohn disease (CD) or ulcerative colitis (UC) to an uninvolved vascular bed in both IBD and control patients.

Methods

Mesenteric and omental arteries were obtained from UC, CD, and non-IBD patients. Isometric arterial contractions were recorded in response to extracellular potassium (K⁺) and cumulative additions of norepinephrine (NE). In addition, relaxation in response to pinacidil, an activator of adenosine triphosphate-sensitive K⁺ channels was examined.

Results

Contraction to K⁺ and sensitivity to NE were not significantly different in arteries from CD, UC, and controls. Relaxation to pinacidil was also similar between groups.

Conclusions

Potassium-induced contractions and sensitivity to NE and pinacidil were not significantly different in large diameter mesenteric and omental arteries obtained from IBD patients. Furthermore, there was no significant difference in the sensitivity to K⁺, NE, and pinacidil between mesenteric and omental arteries of CD and UC patients and those from non-IBD patients. Our results suggest an underlying vascular defect systemic to CD or UC patients is unlikely to contribute to the etiology of IBD.     

The burden of surgery and postoperative complications in children with inflammatory bowel disease

Background

Pediatric inflammatory bowel disease (IBD) may be associated with a higher burden of surgery and postoperative complications. This study aimed to measure the burden in pediatric IBD over a 20-year period in a large tertiary referral center.

Postoperative complications of pediatric patients with inflammatory bowel disease treated with vedolizumab

Background

Vedolizumab is a biologic, which inhibits leukocyte adhesion in the gut and is used to treat ulcerative colitis (UC) and Crohn's disease (CD). Little is known of the surgical outcomes in patients treated with vedolizumab. We reviewed the postoperative complications in a cohort of pediatric UC and CD patients treated with vedolizumab.

Effect of inflammatory bowel disease treatments on patients with diabetes mellitus

As medical care progresses and the number of patients with chronic conditions increases there is the inevitable challenge of managing patients with multiple co-morbidities. Inflammatory bowel disease (IBD) is an umbrella term for are inflammatory conditions affecting the gastrointestinal tract, the two most common forms being Ulcerative Colitis and Crohn’s disease. These diseases, usually diagnosed in young adults, exhibit a relapsing and remitting course and usually require long-term treatment. IBD can be treated with a number of topical and systemic treatments. We conducted a review of the current published evidence for the effects these medications can have on diabetes mellitus (DM) and glycaemic control. Searches were conducted on medline and embase with a timeframe from 1947 (the date from which studies on embase are recorded) to November 2020. Suitable publications were selected and reviewed. Current evidence of the impact of aminosalicylates, corticosteroids, thiopurines, and biologic agents was reviewed. Though there was limited evidence for certain agents, IBD medications have been shown to have an effect of DM and these effects should be considered in managing patients with dual pathologies. The effects of steroids on blood sugar control is well documented, but consideration of other agents is also important. In patients requiring steroids for Ulcerative Colitis, locally acting steroid agents delivered rectally may be preferred to minimise side effects in those with distal bowel Ulcerative Colitis. A switch to other agents should be considered as soon as possible in people with diabetes to limit the impact on glycaemic control. 5-aminosalicylates appear to play a role in the reduction of hemoglobin A1c (HbA1c), although the literature suggests these may be falsely low readings. Consequently, monitoring of people with diabetes on these agents may require daily monitoring of capillary blood sugars rather than relying simply on HbA1c; for example fructosamine performed 3-6 monthly, although this risks missing the rise in readings. There is only limited evidence of the effects of thiopurines on diabetes and further investigation is needed into the possible relationship between them. However, given the current available evidence it may be preferable to commence patients with diabetes on thiopurines as soon as possible, whilst also monitoring for side effects such as pancreatitis. There appears to be more evidence supporting a link between tumor necrosis factor-α inhibitors and DM. Both infliximab and adalimumab have evidence suggesting that both can cause reduced blood sugar levels. Further studies on the effects of the various biological agents mentioned are required alongside any novel biologic therapy and the impact of dual biologic therapy in the future.     

Laparoscopically assisted bowel surgery for inflammatory bowel disease

Background: Laparoscopic bowel surgery was evaluated in 44 consecutive patients who underwent surgery for inflammatory bowel disease (IBD). We studied feasibility, results, and final outcome. Methods: At two academic institutes, 44 laparoscopically assisted colectomies and laparoscopic ileostomies or colostomies were attempted. All patients had histologically proven IBD and no prior surgery for IBD. Loop ileostomy (n= 4), end colostomy (n= 1), ileocecal resection (n= 26) and (procto)colectomy (n= 13) were performed. All resections were laparoscopically assisted with extracorporal resection and anastomosis. Results: Only in two patients (ileocecal resection in both) was conversion to open surgery necessary. Two patients with laparoscopic ileocolic resection had intra-abdominal abscesses, which were drained percutaneously in both. One patient in the laparoscopically assisted colectomy group had a subphrenic abscess that was drained percutaneously, and one patient had a generalized candidiasis. Conclusions: Laparoscopically assisted colectomies can be performed safely in treating IBD. The laparoscopic method with use of a small vertical umbilical or Pfannenstiel's incision seems acceptable with regard to operating time and overall costs, also allowing superior cosmesis to be maintained. Received: 12 August 1998/Accepted: 13 January 1999     

The association of inflammatory bowel disease and immediate postoperative outcomes following lumbar fusion

Background Context

The United States Centers for Disease Control and Prevention estimates the prevalence of inflammatory bowel disease (IBD) at more than 3.1 million people. As diagnostic techniques and treatment options for IBD improve, the prevalence of IBD is expected to increase. For spine surgeons, patients with IBD have a unique complication profile because patients with IBD may present with poor nutritional status and because the medications used to manage IBD have been associated with poor vertebral bone mineralization and immunosuppression. Presently, there are very limited data regarding perioperative outcomes among patients with IBD who undergo spinal surgery. The present study begins to address this knowledge gap by describing trends in patients with IBD undergoing lumbar fusion and by quantifying the association between IBD and immediate postoperative outcomes using a large, national database.

Positive correlation between latent Epstein-Barr virus infection and severity of illness in inflammatory bowel disease patients

BACKGROUND Emerging studies indicate the critical involvement of microorganisms, such as Epstein-Barr virus(EBV), in the pathogenesis of inflammatory bowel disease(IBD). Immunosuppressive therapies for IBD can reactivate latent EBV, complicating the clinical course of IBD. Moreover, the clinical significance of EBV expression in B lymphocytes derived from IBD patients’ intestinal tissues has not been explored in detail.AIM To explore the clinical significance of latent EBV infection in IBD patie...