炎症性肠疾病的药物治疗及选择

炎症性肠疾病（IBD）包括溃疡性结肠炎（UC）和克罗恩病（CD）。IBD的传统药物治疗仍以水杨酸类、糖皮质激素、免疫抑制剂三类为主。随着IBD发病机制的深入研究，尤其是在免疫学、细胞分子生物学方面的重大进展推动了IBD治疗的发展。特别是生物制剂的应用，使IBD的治疗有了更有效、安全的选择。     

营养支持在炎症性肠疾病治疗中的价值

炎症性肠疾病（IBD）是一组病因不十分清楚的慢性非特异性疾病。包括溃疡性结肠炎（UC）和克罗恩病（CD），二者在病因、发病机制及临床表现上有许多相似之处。IBD病变范围广泛，反复发作，消化道症状重，易发生营养不良，而药物或手术治疗更加重营养障碍。营养支持不仅使肠道得以休息，减少机械性或化学性刺激，并且可以纠正负氮平衡，促进绀织修复．为下术成功提供可靠的物质保障，因此，营养支持在IBD病人中的价值和地位毋庸置疑，作为治疗手段，其与药物、手术等具有同等重要性。     

加强炎症性肠病外科治疗研究

100年前,人类开始了对溃疡性结肠炎（UC）的首例外科治疗;后50年,克罗恩病（CD）亦为病理学家所证实,并由此纳入外科学界的视野。过去的这100年和50年的发展．手术技术的发展、围手术期药物效能的改善和诊断水平的提高始终成为推动炎症性肠病（IBD）学术研究进步的三大重点领域。虽然手术治疗究竟能从多大程度上解决IBD病患问题和选择手术方法的标准仍是不甚明了,     

炎症性肠疾病治疗难点及预后

炎症性肠疾病包括溃疡性结肠炎和克罗恩病（CD），是一种原因不明的非特异性炎性肠道疾病。目前，炎症性肠疾病在美国的发病率约为1‰～2％，而我国为发展中国家，由于近年来饮食结构的改变，炎症性肠疾病的发病率呈逐年上升的趋势，约为0．32％。近年来，随着对炎症性肠疾病认识的加深，在发病机制和治疗方面有了较大的发展，但是目前仍然没有有效的根治手段，病人多经历长期的治疗过程。随着病程的延长和病情的反复，肠梗阻、肠瘘以及癌变的发生率增加。因此，医生定期的随访和病人定期的复查对于防止上述并发症和控制病情的发展极为重要。     

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…     

炎症性肠病的外科治疗

炎症性肠病(inflammatory bow-el diseases,IBD)主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD)。近十年来IBD患者逐年增加,尤以CD为甚。其中10%~30%的UC患者和70%的CD患者一生中至少需进行一次手术治疗[1]。UC与CD虽同属IBD范畴,但其病理、病程演变存在诸多不同,最明显的区别即在于:UC通常是连续性病变,多数情况下为求根治可选择切除全部结直肠,因而认为是可经外科根治的;而CD呈节段性、多部位发生,且具有难以避免的术后复发等特点,主流意见倾向于有并发症的CD才需外科治疗,手术切除时要求保留尽…     

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。     

炎症性肠病外科治疗的策略和技术

外科治疗是炎症性肠病（IBD）出现肠道并发症或内科治疗失败时的重要手段,而选择合适的手术时机能减少术后并发症,是决定治疗成功与否的关键.过度强调药物治疗、在无效的情况下仍一味延长其疗程,将使患者失去最佳手术时机.同时外科医师需要掌握好IBD急诊手术与择期手术的不同技巧.在多学科合作治疗模式下,各专科医师明确手术的必要性后,应积极调整术前药物治疗、改善患者营养状态,为IBD患者外科治疗争取最佳的生理功能储备,做好围手术期处理.     

炎症性肠疾病的诊断及鉴别诊断

炎症性肠疾病（IBD）包括溃疡性结肠炎（UC）和克罗恩病（CD）。IBD的发病年龄多为10—40岁。近年来关于此病的报道逐渐增多，据不完全统计，我国二者病例总数已超过2万，其中以UC为多，是胃肠道疾病和慢性腹泻的主要原因。IBD的临床诊断相当困难，有文献报道，UC的初诊误诊率约为50％，而CD的误诊率更高达70％，因此应引起临床医生的高度重视。     

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。     

Acute surgical emergencies in inflammatory bowel disease

BACKGROUND: Acute surgical emergencies in patients with inflammatory bowel disease may carry a substantial morbidity, but fortunately today, a low mortality. The aim of this review is to delineate the treatment of acute surgical emergencies that occur in patients with ulcerative colitis and Crohn's disease. METHODS: Suitable English language reports were identified using PubMed search. RESULTS: Inflammatory bowel disease can present in numerous ways as an acute surgical emergency. These include toxic colitis, hemorrhage, perforation, intra-abdominal masses or abscesses with sepsis, and intestinal obstruction. Toxic colitis and perforation are best managed with intestinal resection and fecal diversion. Hemorrhage in ulcerative colitis initially requires colectomy with rectal preservation and ileostomy. In Crohn's disease hemorrhage is often focal and localization and segmental resection are performed. Intra-abdominal abscesses should initially be attempted by computed tomography-guided percutaneous drainage followed subsequently by definitive resection. Perianal disease requires abscess drainage with minimal tissue trauma. Intestinal obstruction should be initially managed nonoperatively, with surgery reserved for complete obstruction or intractability. CONCLUSIONS: Acute surgical emergencies in patients with inflammatory bowel disease are rare and can have a high morbidity. With a multidisciplinary approach, morbidity can be reduced and patients can have a rapid return and improved quality of life.     

BAPS UK inflammatory bowel disease surgical practice survey

Aims

A recent survey of children with inflammatory bowel disease (IBD) identified wide regional variations of care within the UK. The present study was designed to analyse paediatric surgical provision for children with ulcerative colitis and Crohn's disease.

Methods

All UK paediatric surgical centres were contacted to identify surgeons with a subspecialist interest in IBD. A questionnaire was designed to probe specific areas including team working, caseload, and transitional care. Annual consultant caseload was requested for colonoscopy, J-pouch ileoanal anastomosis (IPAA) for ulcerative colitis, and strictureplasty (Crohn's disease). The questionnaire and the accompanying letter were approved by the BAPS Research and Clinical Effectiveness Committee.

Results

The response rate from individual centres was 86% (25/29). In 11% of centres, care was shared between 2 consultants. A transitional care clinic was provided by 77% of centres. The median experience with IPAA was 0.9 cases per year of consultant practice (range, 0-3.7), and 12.5% of surgeons had limited experience of revision pouch surgery. The majority have arrangements for joint operating with adult surgeons for IPAA. Forty percent of surgeons reported experience with strictureplasty. Surgical preference for recalcitrant left-side Crohn's colitis favoured segmental resection (60%), compared to subtotal/panproctocolectomy.

Conclusions

Paediatric surgeons use a diversity of surgical management options in IBD. Experience with IPAA is limited for most surgeons. Whether children should undergo elective IPAA independent of experienced adult practitioners, who naturally assume responsibility after transition, requires careful debate.     

Nutritional support of surgical patients with inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) in need of surgery are often malnourished, which in turn increases the risk for postoperative complications. Malnutrition in IBD patients who must undergo surgery is due to the disordered activity of the diseased intestine, decreased dietary intake, and adverse effects of potent medications. IBD operations predispose patients to both macronutrient and micronutrient deficiencies. If the gut can be used safely it is the preferential route for feeding, though preoperative and postoperative parenteral nutrition remains a viable alternative for severely malnourished patients. New nutrient therapies include immunonutrition, fish oils, and probiotics.     

Current status of treatment of inflammatory bowel disease

Inflammatory bowel disease encompasses a group of diseases with poorly defined etiology that affect the digestive tract. These diseases are characterized by their chronic course and by periods of disease activity, of variable severity, that alternate with periods of clinical remission. In the last few years, inflammatory bowel disease has been the object of intense research, which has increased knowledge of the physiopathogenic mechanisms involved. This has enabled the development of a new generation of biotechnological drugs effective in patients previously considered to be refractory to medical treatment and has allowed the accumulated corticosteroid dose to be reduced and the indications for surgery and hospital admissions to be decreased, thus improving quality of life. In addition, some classical drugs have been demonstrated to be effective in recurrence prevention after surgery for Crohn's disease and in the prevention of dysplasia and colorectal cancer in inflammatory bowel disease.     

New therapies for the treatment of inflammatory bowel disease

Medical therapy of IBD has made remarkable progress in recent years, driven forward by new knowledge about mechanisms of disease and advances in biotechnology. As we continue to learn about how best to use the agents currently in our hands, the addition of new drugs will further improve outcomes, and will bring new insights into the fundamental causes of these diseases.