Service de Gastroentérologie et Nutrition, Hôpital St-Antoine and Pierre-et-Marie Curie University (Paris VI), Paris, France.
Gastroenterology. 2011 May;140(6):1785-94. doi: 10.1053/j.gastro.2011.01.055.
In the West, the incidence and prevalence of inflammatory bowel diseases has increased in the past 50 years, up to 8-14/100,000 and 120-200/100,000 persons, respectively, for ulcerative colitis (UC) and 6-15/100,000 and 50-200/100,000 persons, respectively, for Crohn's disease (CD). Studies of migrant populations and populations of developing countries demonstrated a recent, slow increase in the incidence of UC, whereas that of CD remained low, but CD incidence eventually increased to the level of UC. CD and UC are incurable; they begin in young adulthood and continue throughout life. The anatomic evolution of CD has been determined from studies of postoperative recurrence; CD begins with aphthous ulcers that develop into strictures or fistulas. Lesions usually arise in a single digestive segment; this site tends to be stable over time. Strictures and fistulas are more frequent in patients with ileal disease, whereas Crohn's colitis remains uncomplicated for many years. Among patients with CD, intestinal surgery is required for as many as 80% and a permanent stoma required in more than 10%. In patients with UC, the lesions usually remain superficial and extend proximally; colectomy is required for 10%-30% of patients. Prognosis is difficult to determine. The mortality of patients with UC is not greater than that of the population, but patients with CD have greater mortality than the population. It has been proposed that only aggressive therapeutic approaches, based on treatment of early recurrent lesions in asymptomatic individuals, have a significant impact on progression of these chronic diseases.
在过去的 50 年中，西方国家炎症性肠病的发病率和患病率有所增加，溃疡性结肠炎（UC）分别达到 8-14/10 万和 120-200/10 万，克罗恩病（CD）分别达到 6-15/10 万和 50-200/10 万。移民人群和发展中国家人群的研究表明，UC 的发病率最近有所缓慢增加，而 CD 的发病率仍然较低，但 CD 的发病率最终上升到与 UC 相同的水平。UC 和 CD 是不可治愈的；它们始于成年早期，并持续终生。CD 的解剖学演变是通过术后复发研究确定的；CD 始于口疮性溃疡，发展为狭窄或瘘管。病变通常发生在单个消化道节段；该部位随着时间的推移趋于稳定。狭窄和瘘管在患有回肠疾病的患者中更为常见，而克罗恩结肠炎在多年内仍保持简单。在 CD 患者中，多达 80%需要进行肠道手术，超过 10%需要永久性造口术。在 UC 患者中，病变通常保持在浅层并向近端延伸；10%-30%的患者需要结肠切除术。预后难以确定。UC 患者的死亡率不比普通人群高，但 CD 患者的死亡率高于普通人群。有人提出，只有基于对无症状个体早期复发性病变的积极治疗方法，才能对这些慢性疾病的进展产生重大影响。
