溃疡性结肠炎的方方面面.ppt

溃疡性结肠炎的方方面面.ppt

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溃疡性结肠炎溃疡性结肠炎IntroductionIntroductionnIBDIBD是一是一种种病因病因尚尚不十分不十分清清楚的慢性非特楚的慢性非特异异性性肠道炎症，包括道炎症，包括UCUC和和CDCD。

n其其发病率呈逐年上升病率呈逐年上升趋势，且多，且多为青壮青壮年年发病，病，临床表床表现复复杂，并并发症症严重，重，肠外表外表现多多样，严重影重影响个响个人生活人生活质量和社量和社会会生生产力。

力。

n此外，因其有癌此外，因其有癌变的的风险，备受广大受广大医医生的重生的重视。

n近年来在国内外近年来在国内外IBDIBD基础与临床研究高潮迭起，基础研究的成果直接指向临基础与临床研究高潮迭起，基础研究的成果直接指向临床治疗，取得了划时代的进展。

床治疗，取得了划时代的进展。

n探讨和摸索适合国人的治疗方案以降低重症探讨和摸索适合国人的治疗方案以降低重症UCUC的并发症和死亡率显得十分的并发症和死亡率显得十分重要。

重要。

IntroductionnUlcerativecolitisischaracterizedbymucosalinflammationofthecolon.nThepathologyisinflammatoryandthediseasecourseisrelapsingandremittingwithintermittentsymptomsofrectalbleedinganddiarrhea.nApproximately25%ofpatientsdevelopachronicactiveorarapidlyfulminatediseasecourse.nChronicinflammationcanleadtodysplasiaandcancer.nApproximately20%ofpatientsrequirecolectomywithileoanalpouchorstoma.nVelayosFS,TerdimanJP,WalshJM.Effectof5-aminosalicylateuseoncolorectalcanceranddysplasiarisk:

asystematicreviewandmetaanalysisofobservationalstudies.AmJGastroenterol2005;100:

13451353.ConsensusConsensusnStangeEF,TravisSP,VermeireS,ReinischW,GeboesK,BarakauskieneA,etal.Europeanevidence-basedConsensusonthediagnosisandmanagementofulcerativecolitis:

definitionsanddiagnosis.JCrohnsColitis2008;2:

123.nVanAsscheG，DignassA，PanesJ，eta1ThesecondEuropeanevidence-basedConsensusonthediagnosisandmanagementofulcerativecolitis：

DefinitionsanddiagnosisJCrohnsColitis，20104：

727nMowatC,ColeA,WindsorA,AhmadT,ArnottI,DriscollR,etal.Guidelinesforthemanagementofinflammatoryboweldiseaseinadults.Gut2011;60:

571607.nTurnerD,LevineA,EscherJC,GriffithsAM,RussellRK,DignassA,etal.Managementofpediatriculcerativecolitis:

ajointECCOandESPGHANevidence-basedconsensusguidelines.JPediatrGastroenterolNutr2012.nTurnerD,TravisSP,GriffithsAM,RuemmeleFM,LevineA,BenchimolEI,etal.Consensusformanagingacutesevereulcerativecolitisinchildren:

asystematicreviewandjointstatementfromECCO,ESPGHAN,andthePortoIBDWorkingGroupofESPGHAN.AmJGastroenterol2011;106:

57488.ManagementconsensusofinflammatoryboweldiseaseforManagementconsensusofinflammatoryboweldiseasefortheAsiaPacificregiontheAsiaPacificregion20062006nAbstract:

Atthepresenttherearenolarge-scaleepidemiologicdataoninflammatoryboweldisease（IBD）intheAsiaPacificregion,butseveralstudieshaveshownanincreasedincidenceandprevalenceofIBDinthisregion.nComparedtotheWest,thereappearstoexistatimelagphenomenon.WithregardtothetwomainformsofIBD,ulcerativecolitis（UC）ismoreprevalentthanCrohnsdisease（CD）.Inadditiontogeographicdifferences,ethnicdifferenceshavebeenobservedinthemultiracialAsiancountries.Moreover,thegeneticbackgroundsaredifferentintheAsiancomparedtoWesternpatients.Forinstance,NOD2/CARD15variantshavenotbeenfoundinAsianCDpatients.nIngeneral,theclinicalcourseofIBDseemstobelesssevereintheAsiaPacificregionthaninWesterncountries.nDiagnosisofIBDinthisregionposesspecialproblems.ThelackofagoldstandardforthediagnosisofIBD,andtheexistenceofavarietyofinfectiousenterocolitiswithsimilarmanifestationstothoseofIBDmakethedifferentialdiagnosisparticularlydifficult.Sofar,nWesterndiagnosticcriteriahavebeenintroducedforthediagnosisofIBD.Astepwiseapproachtoexcludenon-IBDenterocolitisalsomustbeintroduced,andadefinitediagnosismustincludetypicalhistologicalfeatures.Insomepatients,followupandtherapeutictrialsmightbenecessarytoobtainadefinitivediagnosis.AbetterunderstandingofthepathogenesisofIBDwillallowthedevelopmentofbetterdiagnosticmarkers.nThemanagementofIBDalsoposessomespecialproblemsintheAsiaPacificRegion.ThereisoftenadelayinusingpropermedicationsforIBD,andalternativelocalremediesarestillwidelyused.WithacombinationofWesternguidelinesandregionalexperiences,similarprinciplescanbeusedforinductionandmaintenanceofremission.Astepwiseselectionofmedicationsisadvocateddependingontheextent,activityandseverityofthedisease.ComprehensiveandindividualizedapproachesaresuggestedfordifferentIBDpatients.nDeeperunderstandingofdiseasepathogenesisandtheuniquecharacteristicsofIBDintheAsiaPacificregion,combinedwithreasonableandpracticalguidelinesfordrugmanagementandthefutureuseofbiologicalagentswouldimprovethetherapeuticoutlookofIBDinthisregion.TheAsia-Pacificconsensusonulcerativecolitis2010Europeanevidence-basedconsensusontheEuropeanevidence-basedconsensusonthediagnosis/managementofulcerativecolitis2008diagnosis/managementofulcerativecolitis2008nThisdocumentsetsoutthecurrentEuropeanConsensusonthediagnosisandmanagementofUC,reachedbytheEuropeanCrohnsandColitisOrganisation（ECCO）atameetingheldinBerlinon20thOctobe