Diagnostic and Management Considerations for the IPAA With Crohn’s Disease-Like Features
Diagnostic and Management Considerations for the IPAA With Crohn’s Disease-Like Features
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具有类似克罗恩病特征的 IPAA 的诊断和管理注意事项
DOI：
10.1097/dcr.0000000000002547
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Rubin David T.
中科院分区：
文献类型：
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作者：
Akiyama Shintaro;Dyer Emma C.;Rubin David T.
背景：溃疡性结肠炎患者常发生难治性结肠炎症或结直肠肿瘤，约10%-15%的患者需要手术治疗。最常见的外科手术是采用IPAA进行的恢复性直肠结肠切除术。即使术前诊断为溃疡性结肠炎，大约10%的患者会出现类似克罗恩病表型的炎性囊袋症状。目的：本研究旨在回顾具有克罗恩病样特征的IPAA的诊断方法、预后和管理。数据来源：数据来源包括电子数据库检索。研究选择：本叙述性综述包括关注具有克罗恩病样特征的囊袋的研究。主要结局指标：本文综述的主要内容包括克罗恩病样袋的发病机制、危险因素、诊断、表型、预后和药物治疗。诊断方法的邮袋条件类似克罗恩病的表型应根据病史，以评估其风险因素和内镜评估的邮袋。先前的病史和病理，邮袋并发症的位置，并发症的时间提供了线索，这种表型的鉴别诊断。我们主张使用更具描述性的术语“具有克罗恩病样特征的囊袋”，并将术语“囊袋克罗恩病”保留给接受IPAA并在结肠切除术前诊断为克罗恩病或结肠切除术病理学显示克罗恩病的患者。通常用于传统克罗恩病的药物在具有克罗恩病样特征的袋中也显示出功效。与袋克罗恩病样功能，特别是瘘管化表型的预后不良，强调了积极监测和治疗intervention.LIMITATIONS的重要性：局限性包括没有明确的标准文章selections.CONCLUSIONS：本次审查表明，未来的研究应寻求了解这些类型的袋表型的自然历史和有意义的短期和长期的治疗目标。需要长期随访和前瞻性术前和术后干预试验的治疗和预防策略。
BACKGROUND:Patients with ulcerative colitis often develop medically refractory colonic inflammation or colorectal neoplasia, and approximately 10% to 15% of patients require surgery. The most common surgical procedure is a restorative proctocolectomy with IPAA. Even if the preoperative diagnosis is ulcerative colitis, approximately 10% of patients can develop inflammatory pouch conditions resembling a Crohn’s disease phenotype.OBJECTIVE:This study aimed to review the diagnostic approach, prognosis, and management of IPAA with Crohn's disease–like features.DATA SOURCES:The data sources include search in electronic databases.STUDY SELECTION:This narrative review included studies focusing on pouches with Crohn's disease–like features.MAIN OUTCOME MEASURES:The main topics in this review included the pathogenesis, risk factors, diagnosis, phenotypes, prognosis, and medications of pouches with Crohn's disease–like features.RESULTS:A diagnostic approach for the pouch conditions resembling a Crohn's disease phenotype should be based on history–taking to evaluate its risk factors and endoscopic assessment of the pouch. Prior disease history and pathology, location of pouch complications, and timing of complications offer clues for the differential diagnosis of this phenotype. We advocate for the more descriptive term “pouch with Crohn's disease–like features” and reserve the term “Crohn's disease of the pouch” for patients who undergo IPAA and have a precolectomy diagnosis of Crohn's disease or whose colectomy pathology revealed Crohn's disease. Medications, which are often used for traditional Crohn's disease, show efficacy in pouches with Crohn's disease–like features as well. The poor prognosis associated with pouches with Crohn's disease–like features, particularly the fistulizing phenotype, underscores the importance of proactive monitoring and therapeutic intervention.LIMITATIONS:The limitations include no explicit criteria for article selection.CONCLUSIONS:This review suggests future research should seek to understand the natural history and meaningful shorter and longer term therapeutic targets for these types of pouch phenotypes. Long-term follow-up and prospective preoperative and postoperative interventional trials of treatments and prevention strategies are needed.