Department of Gastroenterology and Hepatology, University Hospital Lausanne/CHUV, Lausanne, Switzerland.
J Crohns Colitis. 2012 May;6(4):412-8. doi: 10.1016/j.crohns.2011.09.008. Epub 2011 Oct 14.
There is increasing evidence for the clinical relevance of mucosal healing (MH) as therapeutic treatment goal in inflammatory bowel disease (IBD). We aimed to investigate by which method gastroenterologists monitor IBD activity in daily practice.
A questionnaire was sent to all board-certified gastroenterologists in Switzerland to specifically address their strategy to monitor IBD between May 2009 and April 2010.
The response rate was 57% (153/270). Fifty-two percent of gastroenterologists worked in private practice and 48% worked in hospitals. Seventy-eight percent judged clinical activity to be the most relevant criterion for monitoring IBD activity, 15% chose endoscopic severity, and 7% chose biomarkers. Seventy percent of gastroenterologists based their therapeutic decisions on clinical activity, 24% on endoscopic severity, and 6% on biomarkers. The following biomarkers were used for IBD activity monitoring: CRP, 94%; differential blood count, 78%; fecal calprotectin (FC), 74%; iron status, 63%; blood sedimentation rate, 3%; protein electrophoresis, 0.7%; fecal neutrophils, 0.7%; and vitamin B12, 0.7%. Gastroenterologists in hospitals and those with ≤ 10 years of professional experience used FC more frequently compared with colleagues in private practice (P=0.035) and those with > 10 years of experience (P<0.001).
Clinical activity is judged to be more relevant for monitoring IBD activity and guiding therapeutic decisions than endoscopic severity and biomarkers. As such, the accumulating scientific evidence on the clinical impact of mucosal healing does not yet seem to influence the management of IBD in daily gastroenterologic practice.
黏膜愈合（MH）作为炎症性肠病（IBD）的治疗目标，其临床相关性证据日益增多。我们旨在研究胃肠病学家在日常实践中通过何种方法来监测 IBD 活动。
我们于 2009 年 5 月至 2010 年 4 月期间，专门向瑞士所有具有资质认证的胃肠病学家发送问卷，以调查他们监测 IBD 的策略。
应答率为 57%（153/270）。52%的胃肠病学家在私人诊所工作，48%在医院工作。78%的医生认为临床活动是监测 IBD 活动最相关的标准，15%选择内镜严重程度，7%选择生物标志物。70%的胃肠病学家根据临床活动来制定治疗决策，24%根据内镜严重程度，6%根据生物标志物。以下生物标志物用于监测 IBD 活动：C 反应蛋白（CRP），94%；全血细胞计数，78%；粪便钙卫蛋白（FC），74%；铁状态，63%；血沉，3%；蛋白电泳，0.7%；粪便中性粒细胞，0.7%；维生素 B12，0.7%。与私人诊所的同行（P=0.035）和经验超过 10 年的同行（P<0.001）相比，医院的胃肠病学家和经验≤10 年的胃肠病学家更频繁地使用 FC。
与内镜严重程度和生物标志物相比，临床活动被认为更能准确监测 IBD 活动并指导治疗决策。尽管黏膜愈合的临床影响方面的科学证据不断增加，但这似乎并未影响到日常胃肠病学实践中 IBD 的管理。
