Winther K V, Føgh P, Thomsen O Ø, Brynskov J
Department of Internal Medicine and Gastroenterology C, Herlev Hospital, University of Copenhagen, Denmark.
Drugs Today (Barc). 1998 Nov;34(11):935-42. doi: 10.1358/dot.1998.34.11.487477.
Chronic inflammatory bowel diseases (i.e., ulcerative colitis and Crohn's disease) are syndromes in which standardized criteria are necessary in the diagnostic process. The present review is based on the diagnostic criteria used at our institution. We base the diagnosis of ulcerative colitis and Crohn's disease on combined information from the patient history, and radiological, endoscopic and histological findings after exclusion of neoplastic and infectious disease. The patient history must include precise information on the nature and duration of symptoms as well as the presence of relevant influential factors such as travel activity, drug intake and sexual habits. In immunocompromised patients extensive microbiological investigations are required to exclude infection. Typical radiological and colonoscopic findings in ulcerative colitis are mucosal inflammatory changes extending circumferentially and continuously from the rectum and proximally in the colon. In contrast, Crohn's disease is most frequently located in the small bowel and in case of colonic involvement, the rectum is often spared. The best predictors of Crohn's disease are discontinuous lesions, cobblestones and apthous ulceration. Histological changes such as abnormal mucosal architecture and lamina propria cellularity, neutrophil polymorph infiltration and epithelial cell abnormality are useful and reproducible features in the evaluation of colorectal biopsy specimens. The inflammatory bowel diseases, ulcerative colitis and Crohn's disease, continue to be etiological and diagnostic challenges. Increased use of standardized criteria and diagnostic algorithms are essential instruments to improve the overall quality of the management of patients with these diseases.
慢性炎症性肠病（即溃疡性结肠炎和克罗恩病）是在诊断过程中需要标准化标准的综合征。本综述基于我们机构使用的诊断标准。我们根据患者病史以及排除肿瘤性和感染性疾病后的放射学、内镜和组织学检查结果，对溃疡性结肠炎和克罗恩病进行诊断。患者病史必须包括症状的性质和持续时间的精确信息，以及旅行活动、药物摄入和性行为习惯等相关影响因素的存在情况。对于免疫功能低下的患者，需要进行广泛的微生物学检查以排除感染。溃疡性结肠炎典型的放射学和结肠镜检查结果是黏膜炎症性改变，从直肠开始沿结肠周向连续扩展至近端。相比之下，克罗恩病最常累及小肠，若累及结肠，直肠通常不受累。克罗恩病的最佳预测指标是病变不连续、鹅卵石样改变和阿弗他溃疡。组织学改变，如黏膜结构异常、固有层细胞增多、中性粒细胞多形核浸润和上皮细胞异常，是评估结直肠活检标本时有用且可重复的特征。炎症性肠病，即溃疡性结肠炎和克罗恩病，仍然是病因学和诊断方面的挑战。增加标准化标准和诊断算法的使用是提高这些疾病患者整体管理质量的重要手段。
