5-氨基水杨酸类药物有效预防炎症性肠病合并结直肠癌

在工业化国家，溃疡性结肠炎(UC)的发病率维持在0．005％-0.01％．其中以瑞典最高，英国和美国次之，我国的UC发病率较低。克罗恩病(CD)的发病率在过去30年内增加了6倍。现约为0．004％。尽管IBD合并的结直肠癌只占普通人群结直肠癌的1％～2％，但结直肠癌仍为IBD的严重并发症，是1／6 IBD患者的死亡原因^[1]。Eaden等^[2]对116项     

炎症性肠病相关进展

炎症性肠病(IBD)包括溃疡性结肠炎(UC)和Crohn’s病(CD)。在亚洲，IBD的发病率和患病率近年来呈上升趋势，但仍低于北美和欧洲。亚洲不同国家IBD发病存在着差异，不同人种的发病率和患病率也不同，例如马来群岛和新加坡的印度人种的发病高于马来西亚人和中国人，而其临床病情没有西方国家报道的那么严重。     

老年炎症性肠病研究进展

目前,老年炎症性肠病( IBD )治疗原则与年轻人类似〔1～5〕.由于老年人独特的生理状况和对疾病的耐受能力降低,所以对于老年患者来说,药物的安全性至关重要.而老年患者更容易受到这种疾病及其治疗的严重不良反应的影响.临床药物试验大多排除老年人、老年人用药相关风险的增加和老年人共病、失禁问题等尚未解决,老年IBD 患者的...     

肠外营养在炎症性肠病中的应用

目的分析和探讨肠外营养在炎症性肠病中的应用。方法 参照１９９３年全国慢性非感染肠道疾病学术研讨会制定的炎症性肠病的诊断标准对武汉同济医院消化内科１９８６年１月至１９９６年１２月的炎症性肠病住院病人进行了分析，着重探讨了以炎症性肠病的内科治疗，尤其是肠外营养的应用。结果 １１年间炎症性脾性病的年平均住院人数有所上升；其内科治疗除以柳氮磺胺吡啶５－氨基水杨酸为主要药物外，合理的肠外营养，明显改善了炎症     

缺血在炎症性肠病发病机制中的作用

炎症性肠病是一种以肠道慢性炎性反应为特征的疾病,主要包括溃疡性结肠炎和克罗恩病,其病因和发病机制尚不明确,可能有多种因素共同参与。临床上炎症性肠病和缺血性肠病之间存在诸多相似之处,此文就血管因素和肠道缺血在炎症性肠病发病机制中的作用作一综述。     

炎症性肠病与妊娠

综术炎症性肠病与妇女妊娠的关系,ＩＢＤ孕妇接受治疗对胎儿或婴儿的影响。     

炎症性肠病患者结直肠癌化学预防研究进展

炎症性肠病（IBD）主要包括溃疡性结肠炎（UC）和克罗恩病（CD）两种疾病。近年我国IBD的发病率不断上升，如未及时治疗，长期炎症将最终导致结直肠癌的发生风险增高。在各种结直肠癌预防措施中，化学预防日益受到关注。本文主要对IBD合并结直肠癌的现状和发病机制作一综述，重点介绍几种用于化学预防的药物。     

炎症性肠病癌变的内镜筛查及化学预防

炎症性肠病患者发生癌变的风险是正常人群的2~5 倍,随着病程的延长其癌变的累积风险逐渐增加。白光 内镜结合随机活检是癌变筛查的通用方法,染色内镜结合靶向活检可以减少活检块数,增加不典型增生和癌变的检 出率。多数研究认为,5- 氨基水杨酸可以降低癌变风险,但仍有争议,而免疫抑制剂、熊去氧胆酸等其他药物预防癌 变的风险并不确切。     

调节性T细胞在炎症性肠病中的作用

炎症性肠病（IBD）是一类病因和发病机制尚未完全明确的非特异性肠道炎性疾病。调节性T 细胞（Treg）有抑制自身免疫的功能,是维持肠道免疫稳态的重要因素。Treg细胞数量减少或功能异常均有可能导致IBD发生。此文就目前国内外关于Treg细胞在IBD中的作用机制及其指导治疗方面的研究现状作一综述。     

Gut microbiota,inflammatory bowel disease and colorectal cancer

The gut microbiota is a complex community of microorganisms that inhabit the digestive tracts of humans, living in symbiosis with the host. Dysbiosis, characterized by an imbalance between the beneficial and opportunistic gut microbiota, is associated with several gastrointestinal disorders, such as irritable bowel syndrome (IBS); inflammatory bowel disease (IBD), represented by ulcerative colitis and Crohn’s disease; and colorectal cancer (CRC). Dysbiosis can disrupt the mucosal barrier, resulting in perpetuation of inflammation and carcinogenesis. The increase in some specific groups of harmful bacteria, such as Escherichia coli (E. coli) and enterotoxigenic Bacteroides fragilis (ETBF), has been associated with chronic tissue inflammation and the release of pro-inflammatory and carcinogenic mediators, increasing the chance of developing CRC, following the inflammation-dysplasia-cancer sequence in IBD patients. Therefore, the aim of the present review was to analyze the correlation between changes in the gut microbiota and the development and maintenance of IBD, CRC, and IBD-associated CRC. Patients with IBD and CRC have shown reduced bacterial diversity and abundance compared to healthy individuals, with enrichment of Firmicute sand Bacteroidetes. Specific bacteria are also associated with the onset and progression of CRC, such as Fusobacterium nucleatum, E. coli, Enterococcus faecalis, Streptococcus gallolyticus, and ETBF. Future research can evaluate the advantages of modulating the gut microbiota as preventive measures in CRC high-risk patients, directly affecting the prognosis of the disease and the quality of life of patients.     

Extraintestinal manifestations in inflammatory bowel disease

Inflammatory bowel diseases (IBD) can be really considered to be systemic diseases since they are often associated with extraintestinal manifestations, complications, and other autoimmune disorders. Indeed, physicians who care for patients with ulcerative colitis and Crohn's disease, the two major forms of IBD, face a new clinical challenge every day, worsened by the very frequent rate of extraintestinal complications. The goal of this review is to provide an overview and an update on the extraintestinal complications occurring in IBD. Indeed, this paper highlights how virtually almost every organ system can be involved, principally eyes, skin, joints, kidneys, liver and biliary tracts, and vasculature (or vascular system) are the most common sites of systemic IBD and their involvement is dependent on different mechanisms.     

炎症性肠病相关性肝病的研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一种累及回肠、结肠、直肠的特发性炎症性疾病,本病主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)。除常见的消化道症状外,研究发现IBD合并肝脏疾病较为常见,是IBD常见的肠外表现之一,其严重影响IBD的预后与转归。本文就IBD相关性肝病的分类和总结作一概述,以期为IBD及其肝脏病变的临床诊疗提供参考。     

Pharmacogenetics in inflammatory bowel disease

Pharmacogenetics is the study of the association between variability in drug response and (or) drug toxicity and polymorphisms in genes. The goal of this field of science is to adapt drugs to a patient's specific genetic background and therefore make them more efficacious and safe. In this article we describe the variants in genes that influence either the efficacy or toxicity of common drugs used in the treatment of inflammatory bowel diseases (IBD), ulcerative colitis (UC), and Crohn's disease (CD) including sulfasalazine and mesalazine, azathioprine (AZA) and 6-mercaptopurine (6-MP), methotrexate (MIX), glucocorticosteroids (CSs) and infliximab. Furthermore, difficulties with pharmacogenetic studies in general and more specifically in IBD are described. Although pharmacogenetics is a promising field that already contributed to a better understanding of some of the underlying mechanisms of action of drugs used in IBD, the only discovery translated until now into daily practice is the relation between thiopurine S-methyltransferase (TPMT) gene polymorphisms and hematological toxicity of thiopurine treatment. In the future it is necessary to organize studies in well characterized patient cohorts who have been uniformly treated and systematically evaluated in order to quantitate drug response more objectively. An effort should be made to collect genomic DNA from all patients enrolled in clinical drug trials after appropriate informed consent for pharmacogenetic studies.     

Pediatric inflammatory bowel disease

Inflammatory bowel disease is an important cause of gastrointestinal pathology in children and adolescents. The incidence of pediatric inflammatory bowel disease is increasing; therefore, it is important for the clinician to be aware of the presentation of this disease in the pediatric population. Laboratory tests, radiology studies, and endoscopic procedures are helpful in diagnosing inflammatory bowel disease and differentiating between Crohn's disease and ulcerative colitis. Once diagnosed, the goal of medical management is to induce remission of disease while minimizing the side effects of the medication. Specific attention needs to be paid to achieving normal growth in this susceptible population. Surgical management is usually indicated for failure of medical management, complication, or malignancy. Algorithms for diagnostic evaluation and treatment of pediatric inflammatory bowel disease are presented. The specific psychosocial issues facing these patients are also discussed in this review as are the future goals of research in the complex problem of pediatric inflammatory bowel disease.     

肠易激综合征与炎症性肠病

近年发现,炎症性肠病(IBD)患者发病早期或缓解期时常表现为肠易激综合征(IBs)症状,且IBD与IBS的临床表现具有一定的相似性。因而IBS与IBD的相关性受到广泛的重视。此文就IBS与IBD的发病机制及临床相关性予以阐述,以期为临床个体化治疗提供借鉴。     

Colorectal cancer surveillance in inflammatory bowel disease： The search continues

Patients with inflammatory bowel disease （IBD） are at increased risk for colorectal cancer （CRC）. Risk factors for the development of CRC in the setting of IBD include disease duration, anatomic extent of disease, age at time of diagnosis, severity of inflammation, family history of colon cancer, and concomitant primary sclerosing cholangitis. The current surveillance strategy of surveillance colonoscopy with multiple random biopsies most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, surveillance colonoscopy also has severe limitations including high cost, sampling error at time of biopsy, and interobserver disagreement in histologically grading dysplasia. Furthermore, once dysplasia is detected there is disagreement about its management. Advances in endoscopic imaging techniques are already underway, and may potentially aid in dysplasia detection and improve overall surveillance outcomes. Management of dysplasia depends predominantly on the degree and focality of dysplasia, with the mainstay of management involving either proctocolectomy or continued colonoscopic surveillance. Lastly, continued research into additional chemopreventive agents may increase our arsenal in attempting to reduce the incidence of IBD-associated CRC.     

ST2在炎症性肠病中的表达及其作用探讨

目的探讨血清中人基质裂解素（ST2）水平的变化在炎症性肠病（IBD）活动性评估中的意义。方法ELISA法（酶联免疫吸附测定）检测IBD患者45例，其中UC患者29例，CD患者16例，已排除IBD的其他胃肠疾病（包括主诉不明原因腹痛、腹泻、胃肠炎）的患者24例和15例健康人血清中ST2水平，20例IBD患者检测治疗前后ST2水平的改变。结果IBD活动期血清中ST2水平为（1884．72±338．38）pg／mL，显著高于缓解期（1292．27±347．73）pg／mL和健康对照组（1026．85±382．35）pg／mL，血清ST2水平在治疗前和治疗后（t=4．067，P〈0．01）、UC患者和CD患者（t=2．202，P=0．035）之间差异具有统计学意义。结论血清中ST2水平可作为炎症性肠病活动性评估和临床治疗效果的评价指标。     

营养与炎症性肠病

营养和炎症性肠病的发病机制及治疗有密切的关系,深入研究两者的关系对临床有重要的意义。此文对饮食中的营养成分是否和发病有关、如何营养支持等问题作一简要概述。     

Endoscopic colorectal cancer surveillance in inflammatory bowel disease: Considerations that we must not forget

Inflammatory bowel disease (IBD), encompassing Crohn''s disease and ulcerative colitis, is a chronic immune-mediated inflammatory disease that primarily affects the gastrointestinal tract and is characterized by periods of activity and remission. The inflammatory activity of the disease involving the colon and rectum increases the risk of colorectal cancer (CRC) over the years. Although prevention strategies are evolving, regular surveillance for early detection of neoplasia as a secondary prevention strategy is paramount in the care of IBD patients. In this review article, we discuss the current evidence of the risks of developing CRC and evaluate the best available strategies for screening and surveillance, as well as future opportunities for cancer prevention.