Renna Sara, Orlando Ambrogio, Orlando Rosalba, Cottone Mario
Dipartimento di Medicina, Pneumologia e Fisiologia della Nutrizione Umana, Azienda Ospedaliera Cervello, Università di Palermo.
Recenti Prog Med. 2009 Oct;100(10):469-78.
Crohn's disease is a chronic inflammatory condition that may involve any segment of the gastrointestinal tract. Up to 70% of patients with Crohn's disease will undergo intestinal resection during the course of their disease for complications, but also for the control of symptoms when medical therapy is not useful. At 1 year after a first resection, up to 70% of patients show an endoscopic recurrence and 20-30% have clinical relapse. Ileocolonoscopy is considered the gold standard for postoperative recurrence assessment. Several other risk factors for postoperative recurrence have been identified such as smoking, the disease activity before surgery, the ileocolonic disease, the younger age, the fistulising disease. Several different therapeutic approaches have been evaluated in the prevention of postoperative recurrence. In clinical practice, mesalazine is the first-line treatment used in the postoperative setting, despite considerable controversy as to its efficacy. Immunosuppressive treatment is based on scant evidence but is currently used as a second-line treatment in post-surgical patients at high risk for recurrence, with severe symptoms or with early endoscopic lesions in the neoterminal ileum. Biologic therapy (infliximab) is a candidate new therapy but further controlled trials are needed.
克罗恩病是一种慢性炎症性疾病，可累及胃肠道的任何节段。高达70%的克罗恩病患者在病程中会因并发症而接受肠道切除术，也会在药物治疗无效时为控制症状而接受手术。首次切除术后1年，高达70%的患者出现内镜复发，20%-30%出现临床复发。回结肠镜检查被认为是术后复发评估的金标准。已确定了其他几个术后复发的危险因素，如吸烟、手术前的疾病活动度、回结肠疾病、年轻、存在瘘管的疾病。已对几种不同的治疗方法在预防术后复发方面进行了评估。在临床实践中，美沙拉嗪是术后常用的一线治疗药物，尽管其疗效存在很大争议。免疫抑制治疗的证据不足，但目前在复发风险高、症状严重或新末端回肠有早期内镜病变的术后患者中用作二线治疗。生物治疗（英夫利昔单抗）是一种有潜力的新疗法，但还需要进一步的对照试验。
