显微镜下结肠炎的诊断与管理
Diagnosis and management of microscopic colitis.
作者信息
Abdo Ayman A, Beck Paul
机构信息
Division of Gastroenterology, University of Calgary, Alberta.
出版信息
Can Fam Physician. 2003 Nov;49:1473-8.
OBJECTIVE
To describe microscopic colitis (MC) and a stepwise approach to its diagnosis and management.
QUALITY OF EVIDENCE
MEDLINE was searched from January 1996 to August 2002. Controlled trials were sought, but due to their relative rarity, most articles cited are well designed retrospective studies and reviews.
MAIN MESSAGE
Microscopic colitis in both its collagenous and lymphocytic forms is a relatively common and important cause of diarrhea in middle-aged and elderly patients. It usually presents as chronic watery diarrhea. Results of endoscopic and radiologic examinations are normal; specific histologic findings are seen on colonic biopsy. Once the diagnosis is confirmed, we suggest a stepwise approach to therapy. First-line therapies include antidiarrheal agents; second-line include bismuth subsalicylates and budesonide; third-line include cholestyramine and 5-aminosalicylic acid agents. When patients fail to respond to these therapies, oral corticosteroids or immune modulatory therapy should be considered. For severe unresponsive cases, colectomy is the last resort.
CONCLUSION
Microscopic colitis is an important cause of chronic diarrhea. Once the diagnosis is confirmed, a stepwise approach to treatment is suggested.
目的
描述显微镜下结肠炎（MC）及其诊断和管理的逐步方法。
证据质量
检索了1996年1月至2002年8月的MEDLINE。寻找对照试验，但由于其相对罕见，引用的大多数文章是设计良好的回顾性研究和综述。
主要信息
胶原性和淋巴细胞性显微镜下结肠炎是中老年患者腹泻的相对常见且重要的原因。通常表现为慢性水样腹泻。内镜和放射学检查结果正常；结肠活检可见特定的组织学发现。一旦确诊，我们建议采用逐步治疗方法。一线治疗包括止泻药；二线包括次水杨酸铋和布地奈德；三线包括考来烯胺和5-氨基水杨酸制剂。当患者对这些治疗无反应时，应考虑口服皮质类固醇或免疫调节治疗。对于严重无反应的病例，结肠切除术是最后的手段。
结论
显微镜下结肠炎是慢性腹泻的重要原因。一旦确诊，建议采用逐步治疗方法。
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