亚太地区溃疡性结肠炎共识。
The Asia-Pacific consensus on ulcerative colitis.
机构信息
Department of Gastroenterology and Hepatology, Duke-NUS Graduate Medical School and Singapore General Hospital, Singapore.
出版信息
J Gastroenterol Hepatol. 2010 Mar;25(3):453-68. doi: 10.1111/j.1440-1746.2010.06241.x.
Inflammatory bowel disease (IBD) is increasing in many parts of the Asia-Pacific region. There is a need to improve the awareness of IBD and develop diagnostic and management recommendations relevant to the region. This evidence-based consensus focuses on the definition, epidemiology and management of ulcerative colitis (UC) in Asia. A multi-disciplinary group developed the consensus statements, reviewed the relevant literature, and voted on them anonymously using the Delphi method. The finalized statements were reviewed to determine the level of consensus, evidence quality and strength of recommendation. Infectious colitis must be excluded prior to diagnosing UC. Typical histology and macroscopic extent of the disease seen in the West is found in the Asia-Pacific region. Ulcerative colitis is increasing in many parts of Asia with gender distribution and age of diagnosis similar to the West. Extra-intestinal manifestations including primary sclerosing cholangitis are rarer than in the West. Clinical stratification of disease severity guides management. In Japan, leukocytapheresis is a treatment option. Access to biologic agents remains limited due to high cost and concern over opportunistic infections. The high endemic rates of hepatitis B virus infection require stringent screening before initiating immune-suppressive agents. Vaccination and prophylactic therapies should be initiated on a case-by-case basis and in accordance with local practice. Colorectal cancer complicates chronic colitis. A recent increase in UC is reported in the Asia-Pacific region. These consensus statements aim to improve the recognition of UC and assist clinicians in its management with particular relevance to the region.
炎症性肠病(IBD)在亚太地区的许多地方都呈上升趋势。需要提高对 IBD 的认识,并制定与该地区相关的诊断和管理建议。本循证共识重点关注亚洲溃疡性结肠炎(UC)的定义、流行病学和管理。一个多学科小组制定了共识声明,审查了相关文献,并使用 Delphi 方法匿名对其进行投票。对最终确定的声明进行了审查,以确定共识水平、证据质量和推荐强度。在诊断 UC 之前,必须排除感染性结肠炎。在亚太地区可以看到与西方所见类似的典型组织学和疾病宏观范围。溃疡性结肠炎在亚洲许多地区呈上升趋势,其性别分布和诊断年龄与西方相似。肠外表现,包括原发性硬化性胆管炎,比西方少见。疾病严重程度的临床分层指导管理。在日本,白细胞吸附是一种治疗选择。由于成本高和对机会性感染的担忧,生物制剂的获得仍然受到限制。乙型肝炎病毒感染的高流行率要求在开始免疫抑制治疗前进行严格的筛查。应根据当地情况逐例启动疫苗接种和预防性治疗。结直肠癌使慢性结肠炎复杂化。据报道,亚太地区溃疡性结肠炎的发病率最近有所上升。这些共识声明旨在提高对 UC 的认识,并协助临床医生对其进行管理,特别是针对该地区。