Langan Robert C, Gotsch Patricia B, Krafczyk Michael A, Skillinge David D
St. Luke's Family Medicine Residency, Bethlehem, Pennsylvania 18017, USA.
Am Fam Physician. 2007 Nov 1;76(9):1323-30.
Ulcerative colitis is a chronic disease with recurrent symptoms and significant morbidity. The precise etiology is still unknown. As many as 25 percent of patients with ulcerative colitis have extraintestinal manifestations. The diagnosis is made endoscopically. Tests such as perinuclear antineutrophilic cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies are promising, but not yet recommended for routine use. Treatment is based on the extent and severity of the disease. Rectal therapy with 5-aminosalicylic acid compounds is used for proctitis. More extensive disease requires treatment with oral 5-aminosalicylic acid compounds and oral corticosteroids. The side effects of steroids limit their usefulness for chronic therapy. Patients who do not respond to treatment with oral corticosteroids require hospitalization and intravenous steroids. Refractory symptoms may be treated with azathioprine or infliximab. Surgical treatment of ulcerative colitis is reserved for patients who fail medical therapy or who develop severe hemorrhage, perforation, or cancer. Longstanding ulcerative colitis is associated with an increased risk of colon cancer. Patients should receive an initial screening colonoscopy eight years after the onset of pancolitis and 12 to 15 years after the onset of left-sided disease; follow-up colonoscopy should be repeated every two to three years.
溃疡性结肠炎是一种具有复发性症状且发病率较高的慢性疾病。确切病因尚不清楚。多达25%的溃疡性结肠炎患者有肠外表现。诊断通过内镜检查进行。诸如核周抗中性粒细胞胞浆抗体和抗酿酒酵母抗体等检测很有前景，但尚未推荐用于常规检查。治疗基于疾病的范围和严重程度。用5-氨基水杨酸化合物进行直肠治疗用于直肠炎。病情更广泛则需要口服5-氨基水杨酸化合物和口服皮质类固醇治疗。类固醇的副作用限制了它们在慢性治疗中的效用。对口服皮质类固醇治疗无反应的患者需要住院并静脉注射类固醇。难治性症状可用硫唑嘌呤或英夫利昔单抗治疗。溃疡性结肠炎的手术治疗适用于药物治疗失败或出现严重出血、穿孔或癌症的患者。长期溃疡性结肠炎与结肠癌风险增加有关。全结肠炎发病8年后以及左侧疾病发病12至15年后，患者应接受首次结肠镜筛查；后续结肠镜检查应每两到三年重复一次。
