Current approaches to the management of new-onset ulcerative colitis.
Current approaches to the management of new-onset ulcerative colitis.
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DOI：
10.2147/ceg.s35942
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发表时间：
2014
影响因子：
2.4
通讯作者：
Kane S
中科院分区：
文献类型：
--
作者：
Marchioni Beery R;Kane S
溃疡性结肠炎（UC）是一种特发性、炎症性结肠胃肠道疾病。作为一种慢性疾病，UC遵循复发和缓解过程，在疾病静止期进行药物维持，在发作期适当增加治疗。最初的治疗策略不仅必须考虑到当前的临床表现（特别是疾病活动的程度和严重程度），还必须考虑到长期的治疗方案。以下综述提供了一种治疗新发UC的方法，重点是早期治疗策略。沿着介绍了疾病实体以及初步诊断的方法。基于临床参数、疾病程度和疾病严重程度的患者分层对于确定治疗过程至关重要。需要频繁评估以确定临床应答，如果未适当达到预期改善目标，可能需要加强治疗。轻中度UC可使用氨基水杨酸盐、美沙拉嗪和外用皮质类固醇治疗，口服皮质类固醇保留用于无反应病例。中重度UC通常需要短期口服或静脉注射皮质类固醇，同时考虑长期管理选择，如生物制剂（作为初始治疗或从类固醇过渡）或硫嘌呤（作为桥接治疗）。对药物治疗无效或出现疾病并发症（如中毒性巨结肠）的重度或暴发性UC患者应考虑进行结肠切除术。对于严重或难治性UC患者，早期手术治疗至关重要，结肠切除术可能是挽救生命的手术。作者提供了一种全面的循证方法，用于新发UC的当前治疗选择，并讨论了长期治疗疗效和安全性，以患者为中心的观点，包括生活质量和药物依从性，以及相关炎症性肠病护理的未来方向。
Ulcerative colitis (UC) is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity) but must also take into consideration treatment options for the long-term. The following review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to- moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids) or thiopurines (as bridging therapy). Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon) should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide a comprehensive evidence-based approach to current treatment options for new-onset UC with discussion of long-term therapeutic efficacy and safety, patient-centered perspectives including quality of life and medication compliance, and future directions in related inflammatory bowel disease care.