Ludwig D, Stange E F
Department of Internal Medicine, University of Lübeck, Germany.
Hepatogastroenterology. 2000 Jan-Feb;47(31):83-9.
In recent years new standards for the treatment of ulcerative colitis have evolved. This review updates evidence based therapy for the various clinical situations as well as some novel approaches. The literature search was based on Medline, Cochrane database (CD-ROM) and handsearch of relevant papers including quoted literature. There is clear-cut evidence-based support for the use of local 5-aminosalicylates in mild/moderate distal and oral 5-aminosalicylates in extensive ulcerative colitis. The administration of corticosteroids is definitely indicated in severe disease. Fulminant attacks are treated by intravenous cyclosporine or colectomy. In chronic active disease azathioprine is probably helpful. Relapse prevention again is a domain of 5-aminosalicylates or, as a novel development, E. coli Nissle. The various meta-analyses as well as the controlled trials performed in the various clinical situations typical for the manifestations of ulcerative colitis form a solid base of evidence to guide individual treatment decisions.
近年来，溃疡性结肠炎的治疗出现了新的标准。本综述更新了针对各种临床情况的循证治疗方法以及一些新方法。文献检索基于医学文献数据库（Medline）、考克兰数据库（光盘版），并对相关论文（包括引用文献）进行了手工检索。有明确的循证依据支持在轻度/中度远端溃疡性结肠炎中使用局部5-氨基水杨酸制剂，在广泛性溃疡性结肠炎中使用口服5-氨基水杨酸制剂。重症疾病肯定需要使用皮质类固醇。暴发性发作采用静脉注射环孢素或结肠切除术治疗。在慢性活动性疾病中，硫唑嘌呤可能有帮助。预防复发仍是5-氨基水杨酸制剂的领域，或者作为一项新进展，使用嗜酸乳杆菌。在溃疡性结肠炎典型表现的各种临床情况下进行的各种荟萃分析以及对照试验，为指导个体化治疗决策奠定了坚实的证据基础。
