AO San Camillo Forlanini, UOC Gastroenterologia, Roma, Italy.
Dig Dis. 2012;30(4):420-4. doi: 10.1159/000338145. Epub 2012 Jul 12.
Infections and malignancies are a major issue for clinicians in the management of patients with IBD because of concerns about the safety of drugs currently used in treatment, including immunosuppressive agents, steroids and tumor necrosis factor (TNF) antagonists. Infections are strongly associated with IBD both in their etiopathogenesis and in their clinical course. A number of viral infections, tuberculosis and other therapy-related infections create challenges for the successful management of intestinal disease with immunosuppressive agents or TNF antagonists. Recently published guidelines offer a strong support to deal with these issues. Major concern about IBD patients with malignancies is related to the consequences of chemotherapy on the intestinal disease, the risk of maintaining immunosuppressant or anti-TNF therapy after the diagnosis of malignancy and the management of a clinical relapse of IBD in patients with a recent diagnosis of malignancy. Further research is required to optimize strategies for IBD patients with malignancies. At the moment, all therapeutic choice is made on an individual basis, with an integrative multidisciplinary approach.
感染和恶性肿瘤是 IBD 患者管理中临床医生面临的主要问题，因为人们担心目前用于治疗的药物的安全性，包括免疫抑制剂、类固醇和肿瘤坏死因子（TNF）拮抗剂。感染与 IBD 在发病机制和临床过程中都有很强的关联。一些病毒感染、结核病和其他与治疗相关的感染给使用免疫抑制剂或 TNF 拮抗剂成功治疗肠道疾病带来了挑战。最近发布的指南为应对这些问题提供了有力支持。IBD 合并恶性肿瘤患者的主要关注点与化疗对肠道疾病的影响、恶性肿瘤诊断后维持免疫抑制剂或抗 TNF 治疗的风险以及近期诊断为恶性肿瘤的患者中 IBD 临床复发的管理有关。需要进一步研究以优化恶性肿瘤患者的治疗策略。目前，所有的治疗选择都是基于个体化的，采用综合多学科的方法。
