Daperno M, Sostegni R, Pera A, Rognone D, Rigazio C, Ercole E, Crocellà L, Lavagna A, Rocca R
Inflammatory Bowel Disease Center, Gastroenterology Division, ASO Ordine Mauriziano, Torino, Italy.
Dig Liver Dis. 2008 Jul;40 Suppl 2:S220-4. doi: 10.1016/S1590-8658(08)60529-0.
Endoscopic evaluation of mucosal appearance is important for the clinical management of ulcerative colitis patients, as it offers valuable prognostic tools and data useful to change the management and treatment strategies. In the field of severe ulcerative colitis, partial endoscopy and bioptic sampling allows to obtain additional and relevant prognostic information: if severe endoscopic lesions are present, response to standard treatment is less likely, and if CMV superinfection is detected, anti-viral treatment should be added to conventional treatments. When clinical remission is obtained with conventional treatments, distal colonoscopy may add valuable data: the occurrence of complete endoscopic healing is a major predictor of long-term remission with no clinical activity. Finally, biologic treatments, and mainly infliximab, were shown to induce remarkable and significant mucosal healing also in ulcerative colitis, and patients with complete endoscopic healing in response to infliximab were shown to be more likely to experience fewer clinical relapses during the follow-up. Therefore endoscopic evaluation has to be considered a major prognostic marker in ulcerative colitis. In this review data from the Literature supporting this role will be reviewed.
内镜下对黏膜外观的评估对于溃疡性结肠炎患者的临床管理非常重要，因为它提供了有价值的预后工具以及有助于改变管理和治疗策略的数据。在重症溃疡性结肠炎领域，部分内镜检查和活检采样能够获取额外且相关的预后信息：如果存在严重的内镜病变，对标准治疗的反应可能性较小；如果检测到巨细胞病毒（CMV）重叠感染，则应在传统治疗基础上加用抗病毒治疗。当通过传统治疗获得临床缓解时，远端结肠镜检查可能会提供有价值的数据：内镜完全愈合的发生是无临床活动的长期缓解的主要预测指标。最后，生物治疗，主要是英夫利昔单抗，在溃疡性结肠炎中也显示出能诱导显著的黏膜愈合，并且对英夫利昔单抗有反应且内镜完全愈合的患者在随访期间临床复发较少。因此，内镜评估应被视为溃疡性结肠炎的一个主要预后标志物。在本综述中，将回顾支持这一作用的文献数据。
