Ouyang Qin, Tandon Rakesh, Goh K L, Pan Guo-Zong, Fock K M, Fiocchi Claudio, Lam S K, Xiao Shu-Dong
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.
J Gastroenterol Hepatol. 2006 Dec;21(12):1772-82. doi: 10.1111/j.1440-1746.2006.04674.x.
At the present there are no large-scale epidemiologic data on inflammatory bowel disease (IBD) in the Asia-Pacific region, but several studies have shown an increased incidence and prevalence of IBD in this region. Compared to the West, there appears to exist a time lag phenomenon. With regard to the two main forms of IBD, ulcerative colitis (UC) is more prevalent than Crohn's disease (CD). In addition to geographic differences, ethnic differences have been observed in the multiracial Asian countries. Moreover, the genetic backgrounds are different in the Asian compared to Western patients. For instance, NOD2/CARD15 variants have not been found in Asian CD patients. In general, the clinical course of IBD seems to be less severe in the Asia-Pacific region than in Western countries. Diagnosis of IBD in this region poses special problems. The lack of a gold standard for the diagnosis of IBD, and the existence of a variety of infectious enterocolitis with similar manifestations to those of IBD make the differential diagnosis particularly difficult. So far, Western diagnostic criteria have been introduced for the diagnosis of IBD. A stepwise approach to exclude non-IBD enterocolitis also must be introduced, and a definite diagnosis must include typical histological features. In some patients, follow up and therapeutic trials might be necessary to obtain a definitive diagnosis. A better understanding of the pathogenesis of IBD will allow the development of better diagnostic markers. The management of IBD also poses some special problems in the Asia-Pacific Region. There is often a delay in using proper medications for IBD, and alternative local remedies are still widely used. With a combination of Western guidelines and regional experiences, similar principles can be used for induction and maintenance of remission. A stepwise selection of medications is advocated depending on the extent, activity and severity of the disease. Comprehensive and individualized approaches are suggested for different IBD patients. Deeper understanding of disease pathogenesis and the unique characteristics of IBD in the Asia-Pacific region, combined with reasonable and practical guidelines for drug management and the future use of biological agents would improve the therapeutic outlook of IBD in this region.
目前亚太地区尚无关于炎症性肠病（IBD）的大规模流行病学数据，但多项研究表明该地区IBD的发病率和患病率呈上升趋势。与西方相比，似乎存在时间滞后现象。关于IBD的两种主要形式，溃疡性结肠炎（UC）比克罗恩病（CD）更为普遍。除了地理差异外，在多民族的亚洲国家还观察到了种族差异。此外，与西方患者相比，亚洲患者的遗传背景也有所不同。例如，在亚洲CD患者中未发现NOD2/CARD15变体。总体而言，亚太地区IBD的临床病程似乎不如西方国家严重。该地区IBD的诊断存在特殊问题。缺乏IBD诊断的金标准，以及存在多种与IBD表现相似的感染性小肠结肠炎，使得鉴别诊断尤为困难。到目前为止，已引入西方诊断标准用于IBD的诊断。还必须引入逐步排除非IBD小肠结肠炎的方法，明确诊断必须包括典型的组织学特征。在一些患者中，可能需要进行随访和治疗试验以获得明确诊断。对IBD发病机制的更好理解将有助于开发更好的诊断标志物。IBD的管理在亚太地区也存在一些特殊问题。IBD患者使用适当药物往往会延迟，并且替代的当地疗法仍被广泛使用。结合西方指南和地区经验，可采用类似原则诱导和维持缓解。提倡根据疾病的范围、活动度和严重程度逐步选择药物。建议针对不同的IBD患者采取综合和个体化的方法。对疾病发病机制以及亚太地区IBD独特特征的更深入理解，结合合理实用的药物管理指南和生物制剂的未来使用，将改善该地区IBD的治疗前景。
