Cooke D M
St. Louis University School of Nursing.
Nurse Pract. 1991 Aug;16(8):27-30, 35-6, 38-9.
Inflammatory bowel disease encompasses both ulcerative colitis and Crohn's disease, two conditions so alike clinically that they are frequently indistinguishable from one another. Inflammatory bowel disease occurs at a rate of approximately five per 100,000 people. It tends to cluster in families and is seen four to five times more often in Jewish Caucasians than in other Caucasians. The etiology is unknown. Increasing attention is being paid to autoimmune factors, genetic factors and food allergies, and the notion that inflammatory bowel disease has its roots in a psychological disorder continues to pale for want of empirically sound evidence. Disease pattern is one of remission and exacerbation. The aim of therapy is to maintain an optimal lifestyle in remission through an individually tailored protocol of medications. Sulfasalazine remains the medication of choice; corticosteroids have short-term utility in exacerbation; and immunosuppressants, though controversial, are thought to have some steroid-sparing benefits during acute flare-ups. Indications for surgery vary, depending on whether or not a clear differential diagnosis has been made between ulcerative colitis and Crohn's disease. There is no cure for inflammatory bowel disease except for total colectomy in clearly diagnosed ulcerative colitis. Current research endeavors seek a cause or causes for inflammatory bowel disease, but the literature does not solidly support any one possibility above other rival etiologies.
炎症性肠病包括溃疡性结肠炎和克罗恩病，这两种病症在临床上极为相似，以至于常常难以相互区分。炎症性肠病的发病率约为每10万人中有5人患病。它往往具有家族聚集性，在犹太白种人中的发病率比其他白种人高出四到五倍。其病因尚不清楚。人们越来越关注自身免疫因素、遗传因素和食物过敏，而炎症性肠病源于心理障碍这一观点，因缺乏可靠的实证依据而逐渐失色。疾病表现为缓解期和加重期交替。治疗的目标是通过个性化定制的药物方案，在缓解期维持最佳生活方式。柳氮磺胺吡啶仍然是首选药物；皮质类固醇在病情加重时有短期疗效；免疫抑制剂虽然存在争议，但在急性发作期被认为有一些节省类固醇的益处。手术指征各不相同，这取决于溃疡性结肠炎和克罗恩病之间是否已做出明确的鉴别诊断。除了对明确诊断的溃疡性结肠炎进行全结肠切除术外，炎症性肠病无法治愈。目前的研究致力于寻找炎症性肠病的一个或多个病因，但文献并未有力支持任何一种可能性优于其他竞争病因。
