EXACERBATION OF ULCERATIVE-COLITIS
EXACERBATION OF ULCERATIVE-COLITIS
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DOI：
10.1016/0016-5085(91)90487-6
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发表时间：
1991-07-01
期刊：
影响因子：
29.4
通讯作者：
MINER, PB
中科院分区：
文献类型：
--
作者：
HERMENS, DJ;MINER, PB
特发性溃疡性结肠炎的诊断是在入院前4年做出的，基于结肠炎症状、内镜下的全结肠炎和明确的组织学改变。患者开始使用磺胺氮嗪和强的松治疗，但未能达到完全缓解。入院前一年，她每天有三次带血腹泻。她的药物是强的松，每天30毫克，磺胺嘧啶，每天1克。她主诉强的松导致无法忍受的情绪波动，但逐渐减少导致持续腹泻。她的结肠粘膜从中降结肠到直肠呈水肿，红斑，颗粒状，易碎。患者对每天一次4克美沙拉胺灌肠反应良好，类固醇治疗在接下来的8个月内完全逐渐减少。患者入院前3个月短暂复发，表现为腹部绞痛，每天2 - 3次带血稀便。病人认为这次复发是由于她几天前感染了病毒性上呼吸道感染。她观察到她的结肠炎“每次感冒时”都会发作。随着口服磺胺嘧啶和美沙拉胺灌肠量的增加，复发得以缓解。入院前10周就诊时，患者临床和乙状窦镜缓解，无疼痛、腹泻或出血症状，给予每日2g磺胺氮嗪和每日2g美沙拉胺灌肠治疗。病人计划切除一个毛囊囊肿。该病例与外科医生进行了讨论，外科医生同意围手术期不使用抗生素，除非治疗特定感染，因为担心引起抗生素引起的腹泻或dijjkile梭状芽胞杆菌结肠炎。
The diagnosis of idiopathic ulcerative colitis was made 4 years before admission and was based on colitis symptoms, endoscopic pancolitis, and unequivocal histological changes. The patient was started on sulfasalazine and prednisone therapy but failed to achieve a complete remission. One year before admission she was having three episodes of bloody diarrhea daily. Her medications were prednisone, 30 mg daily, and sulfasalazine, 1 g tid She complained of intolerable mood swings due to prednisone, but tapering resulted in continuous diarrhea. Her colonic mucosa was edematous, erythematous, granular, and friable from the mid-descending colon to the rectum. The patient responded well to the addition of one 4-g mesalamine enema per day, and steroid therapy was tapered off completely over the next 8 months. She experienced a brief relapse 3 months before admission manifest by abdominal cramping and two to three blood-streaked, loose stools per day. The patient attributed this relapse to a viral upper respiratory infection she had contracted several days earlier. She observed that her colitis flared “every time she had a cold.” This relapse resolved with an increase in oral sulfasalazine and mesalamine enemas. When the patient was seen 10 weeks before admission she was in clinical and sigmoidoscopic remission, with no complaints of pain, diarrhea, or bleeding on a regimen of sulfasalazine, 2 g daily, and mesalamine enemas, 2 g daily. The patient was scheduled to have a pilonidal cyst excised. The case was discussed with the surgeon, who agreed not to use antibiotics perioperatively unless treating a specific infection because of the concern about provoking antibiotic-induced diarrhea or Clostridium dijjkile colitis.