炎性肠病肠道微生态改变及益生茵的治疗价值

炎性肠病（inflaminatory boweldisease．IBD）是一类反复发作的慢性炎性肠道病变,主要包括溃疡性结肠炎（ulcerative colitis．UC）和克罗恩病（Crohn disease,CD）。目前．对炎性肠病的治疗主要集中于减轻炎性反应的急性发作而不能做到根治．原因主要是炎性肠病的病因和发病机制尚未完全明确。根据流行病学统计,IBD发病主要与社会的发达程度（发达国家发病率高）、     

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炎性肠病包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(crohn disease,CD)。炎性肠病病变范围广泛,消化道症状重,病情反复,病程长,加之代谢改变,极易发生营养不良。炎性肠病病人在初诊时多已伴有营养不良,而病情进展、药物或手术治疗则更加重了营养障碍,故作为炎性肠病的治疗手段,营养支持与药物、手术等同等重要,     

克罗恩病合并骶前脓肿

炎性肠病（inflammatory bowel disease．IBD）是一种病因尚不明确的慢性非特异性肠道炎性疾病．包括溃疡性结肠炎（ulcerative colitis,UC）和克罗恩病（Crohn disease,CD）。CD是一种慢性肉芽肿性炎性反应．病变可累及胃肠道各部位,以末段回肠及其邻近结肠为主,呈穿壁性炎性反应．多呈节段性、非对称性分布。CD常合并肠梗阻、瘘管、炎性包块或脓肿、出血、肠穿孔等并发症,部分并发症需接受外科治疗。目前,我国对炎性肠病缺少规范的治疗模式。     

努力提高对炎性肠病的诊治认识

炎性肠病 (ｉｎｆｌａｍｍａｔｏｒｙｂｏｗｅｌｄｉｓｅａｓｅ ,ＩＢＤ)应包括特异性肠道疾病 (如肠结核、肠伤寒、阿米巴性肠炎等 )和非特异性肠道疾病。前者已列入传染性疾病 ,后者则指溃疡性结肠炎 (ｕｌｃｅｒａｔｉｖｅｃｏｌｉｔｉｓ ,ＵＣ)、克罗恩病 (Ｃｒｏｈｎｄｉｓｅａｓｅ ,ＣＤ)以及非典型结肠炎。临床上ＵＣ及ＣＤ较多见 ,2 0世纪 30年代欧美已有文献报告 ,但在我国则属少见病例 ;近 2 0年来我国已有多篇病例报告 ,临床上该病已逐渐增多。由于术前诊断率不高 ,常以出血、穿孔、炎性包块、肿瘤等在手术探查中发现 ,这说明是…     

炎症性肠疾病的免疫学基础及免疫治疗

炎症性肠疾病（IBD）主要指克罗恩病（CD）和溃疡性结肠炎（UC），是一种遗传因素、环境因素和免疫因素共同参与的肠道持续性炎症疾病。大量的研究显示肠道黏膜免疫机制紊乱是IBD发病的重要机制。近年来，IBD的免疫学发病机制研究取得了很大进展，而且炎症性肠疾病的免疫学治疗也取得了良好效果。本文就IBD的免疫学发病机制及免疫学治疗进行简要评述。     

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炎症性肠病(inflammatory bowel disease,IBD)是一类特殊肠道炎症性疾病,包括克罗恩病(Crohn’s disease,CD)和溃疡性结肠炎(ulcerative colitis,UC)。近年来,多学科协作治疗模式(multiple disciplinary therapy,MDT)在IBD的治疗中逐渐得到体现,     

肠道炎性疾病的外科治疗

炎症性肠病是一种病因尚不十分清楚的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎和克罗恩病。两者均属于内科系统疾病,只有内科治疗无法控制病情发展或出现并发症时才需要外科治疗,但二者的外科治疗原则和方法截然不同。外科治疗应根据病情选择手术方式。     

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。     

炎性肠病癌变及其机制研究近况

炎性肠病(inflammatory bowel disease,IBD)包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD)。众所周知,长期慢性IBD可发生癌变,此种结直肠癌被称为IBD相关结直肠癌。尽管仅有约1％结直肠癌为IBD相关结直肠癌,但这是UC患者的主要死因之一。因此,研究其癌变机制和如何预防及早期诊断IBD相关结直肠癌具有重要的临床意义。     

微小RNA对肠黏膜紧密连接蛋白表达的调节研究进展

紧密连接蛋白（TJP）是肠黏膜机械屏障的重要组成部分,TJP表达量异常将会引起肠黏膜屏障功能损伤,导致克罗恩病、溃疡性结肠炎、肠易激综合征等疾病的发生。微小RNA(miRNA)在转录后水平广泛参与人体蛋白表达的调控,其中包含TJP。笔者回顾近年的相关文献,将引起mi RNA表达异常的因素分为细胞因子、肠道疾病和其他3种情况,针对mi RNA对肠黏膜TJP表达调节的相关机制进行综述,提出未来需要进一步研究和努力的方向,以期为临床诊断和治疗肠黏膜TJP表达异常相关性疾病提供思路。     

The long-term benefit of surgery on health-related quality of life in patients with inflammatory bowel disease

HYPOTHESES: Health-related quality of life (HRQL) has been shown to improve dramatically shortly after surgery in patients with inflammatory bowel disease (IBD). Our hypotheses were that (1) improved HRQL would be maintained long term in patients after surgery for ulcerative colitis and (2) the improved HRQL in patients with Crohn disease would decline with long-term follow-up. DESIGN: Consecutive series of patients undergoing surgery for IBD between June 1994 and January 2000 prospectively investigated as a cohort outcomes study. PATIENTS: Data were obtained in 139 patients. The diagnoses were Crohn disease (n = 56) and ulcerative colitis (n = 83). INTERVENTION: Patients with Crohn disease underwent resections with or without stricturoplasties; all but 5 patients with ulcerative colitis underwent ileal pouch-anal anastomoses. MAIN OUTCOME MEASURE: Health status was measured using the Health Status Questionnaire (HSQ) preoperatively and then every 3 months postoperatively. RESULTS: Preoperative HSQ scores were very low in all 8 scales of the HSQ. Postoperatively, HRQL measures improved significantly (P<.05) both in patients with Crohn disease and ulcerative colitis, with scores equal to or better than published scores in the general population. In patients with Crohn disease, the scores improved significantly after surgical resection and steadily increased despite disease recurrence and reoperations. The HRQL at last follow-up was equivalent to the general population. The improvements were statistically significant in patients followed up for more than 1 year in 7 of 8 scales of the HSQ. CONCLUSIONS: These results confirm that HRQL is poor in patients with IBD referred for possible operation. Surgical resection resulted in significant improvement in HRQL. More important, the results were durable. With follow-up up to 6 years, the HRQL in this cohort was equal to or better than norms for the general population both in patients with ulcerative colitis and with Crohn disease. We believe these data justify aggressive surgical intervention in many patients with IBD and support the prospective study of HRQL by surgeons treating patients with chronic diseases.     

Management of Crohn’s disease and ulcerative colitis

Crohn’s disease and ulcerative colitis (UC) are complex, contrasting disease processes that require multidisciplinary team management. The treatment modalities in inflammatory bowel disease are varied and the indications and threshold for surgery quite different in patients with UC compared with Crohn’s disease. We discuss the panoply of surgical techniques available to the surgeon and IBD patient while highlighting the potential sequelae, complimentary medical therapies, nutritional considerations and innovative techniques for reconstruction of the gastrointestinal tract.     

MICI en 2012 : que retenir ?

In 2012, IBD literature focused on immunosuppressive and antiTNF treatments management: long term safety outcome, top-down treatment management, non invasive inflammatory markers. After the ??damage score??, a new index was developed: the disability score. Adalimumab was approved in Europe in first and second line for moderate to severe ulcerative colitis. Novel therapeutic strategies are studied in Crohn??s disease and ulcerative colitis.     

Is Modern Medical Management Changing Ultimate Patient Outcomes in Inflammatory Bowel Disease?

Background

The impact of modern medical management of inflammatory bowel disease (IBD) on surgical necessity and outcomes remains unclear. We hypothesized that surgery rates have decreased while outcomes have worsened due to operating on “sicker” patients since the introduction of biologic medications.

Methods

The Nationwide Inpatient Sample and ICD-9-CM codes were used to identify inpatient admissions for Crohn’s disease and ulcerative colitis. Trends in IBD nutrition, surgeries, and postoperative complications were determined.

Results

There were 191,743 admissions for IBD during the study period. Surgery rates were largely unchanged over the study period, ranging from 9 to 12 % of admissions in both Crohn’s disease and ulcerative colitis. The rate of poor nutrition increased by 67 % in ulcerative colitis and by 83 % in Crohn’s disease. Rates of postoperative anastomotic leak (10.2–13.9 %) were unchanged over the years. Postoperative infection rates decreased by 17 % in Crohn’s disease (18 % in 2003 to 15 % in 2012; P?<?0.001) but did not show a trend in any direction in ulcerative colitis.

Conclusions

Rates of IBD surgery have remained stable while postoperative infectious complications have remained stable or decreased since the implementation of biologic therapies. We identified an increase in poor nutrition in surgical patients.

     

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。     

Intestinal tuberculosis, Crohn's disease and ulcerative colitis in an urban black population

The clinical, epidemiological and pathological manifestations of intestinal tuberculosis, Crohn's disease and ulcerative colitis in the Johannesburg Black population are reviewed. Crohn's disease and particularly ulcerative colitis have emerged as definite disease entities in urban Blacks. There is an evident similarity between the clinical manifestations of intestinal tuberculosis and of Crohn's disease, and also between those of Crohn's disease and ulcerative colitis. Furthermore the data suggest that genetic and environmental factors play a vital role in susceptibility to these diseases. The similarity between the clinicopathological manifestations of intestinal tuberculosis and those of Crohn's disease lends support to the view that microbial, viral or cellular toxic agents are involved in the aetiology of Crohn's disease. Moreover, the clinical and epidemiological features of ulcerative colitis support the concept that environmental factors present in an urbanized milieu are important in its aetiology.     

Colorectal carcinoma in inflammatory bowel disease: a comparison between Crohn’s and ulcerative colitis

Aim The study assessed the clinicopathological features and survival rates of inflammatory bowel disease (IBD) patients with colorectal carcinoma (CRC), which accounts for ～15% of all IBD associated death. Method The medical records of patients operated on for CRC in three institutions between 1992 and 2009 were reviewed, and those with Crohn’s colitis (CC) and ulcerative colitis (UC) were identified. Data on age, gender, disease duration, colitis severity, surgical procedure, tumour stage and survival were retrieved. Results Fifty‐three patients (40 UC and 13 CC, 27 men, mean age at operation 54 years) were found. All parameters were comparable between the groups. Mean disease duration before CRC was 22.7 years for UC and 16.6 years for CC patients (P = 0.04). CRC was diagnosed preoperatively in 43 (81%) patients. Twenty‐eight patients had colon cancer, 23 had rectal cancer and two patients had more than one cancer. All malignancies were located in segments with colitis. Over one‐half were diagnosed at an advanced stage (36% stage III; 17% stage IV). At a mean follow up of 56 ± 65 months, 60% were alive (54% disease free) and 40% were dead from cancer‐related causes. The 5‐year survival rate was 61% for the UC and 37% for the CC patients (P = NS). Conclusion CRC in IBD patients is frequently diagnosed at an advanced stage, a factor that contributes to poor prognosis. The risk of CRC in CC patients is comparable to those with UC. Long‐term surveillance is recommended for patients with long‐standing CC and UC.     

Inflammatory bowel disease in the pediatric patient

Inflammatory bowel disease (IBD) is a general term used to describe two chronic bowel disorders, Crohn's disease (CD) and ulcerative colitis (UC), both of which are characterized by autoimmune-related inflammation of the intestines. UC is limited to the colonic mucosa, whereas CD can involve any part of the intestinal tract from the mouth to the anus. The true etiology of UC and CD is still unknown, although extensive research has identified some genetic and environmental factors. This article discusses current clinical concepts of both diseases in the pediatric population.