Dolejsí Mojmír
Universita Karlova v Praze, 1. lékarská fakulta, IV. Interní klinika VFN.
Cas Lek Cesk. 2011;150(12):651-5.
The article is a summary paper aimed at new knowledge, concerning the classification, diagnostics, medication and endoscopic treatment of diverticular disease of colon. Briefly mentioned are the issues of functional disorder in the field of diverticulosis--symptomatic uncomplicated diverticular disease of colon. Diverticular bleeding is explained in terms of its pathogenesis and diagnostics. The problem with estimation the ration of diverticular bleedings in the total number of bleedings into the lower digestive tract is caused by diverse criteria for selecting patients and two levels of diagnostic of diverticular bleeding (definite and presumptive). Attention is paid also to diverticular colitis. Synonyms, endoscopic and histological classification are listed. The main endoscopic findings represent areas of erythema, which are visible on the mucosa between diverticula. Diverticulitis is seen as the most significant complication and the diagnostics of diverticulitis is discussed in detail. The first recommended step in the diagnosis is an urgent abdominal ultrasound; the gold standard is a CT examination of the abdomen, in special situations, some other imaging methods should be used: MRI, colonoscopy. The article ends with an overview of modern therapeutic options in the treatment of diverticular colitis and diverticulitis, particularly the use of antibiotics, probiotics, mesalasine and antispasmodics. Negative effect of NSAIDs on the course of diverticulitis and induction diverticular bleeding is listed.
本文是一篇综述性论文,旨在介绍有关结肠憩室病的分类、诊断、药物治疗及内镜治疗的新知识。简要提及了憩室病领域的功能障碍问题——有症状的非复杂性结肠憩室病。从发病机制和诊断方面对憩室出血进行了解释。估计憩室出血在整个下消化道出血总数中所占比例存在问题,这是由选择患者的不同标准以及憩室出血的两个诊断水平(确诊和推定)导致的。还关注了憩室性结肠炎。列出了同义词、内镜和组织学分类。主要的内镜检查发现是红斑区域,在憩室之间的黏膜上可见。憩室炎被视为最严重的并发症,并对憩室炎的诊断进行了详细讨论。诊断时首先推荐的步骤是紧急腹部超声检查;金标准是腹部CT检查,在特殊情况下,应使用其他一些成像方法:MRI、结肠镜检查。文章最后概述了憩室性结肠炎和憩室炎的现代治疗选择,特别是抗生素、益生菌、美沙拉嗪和抗痉挛药的使用。列出了非甾体抗炎药对憩室炎病程的负面影响以及诱发憩室出血的情况。