Division of Gastroenterology, University of California, San Diego, CA 92093-0956, USA.
Lancet. 2012 Nov 3;380(9853):1606-19. doi: 10.1016/S0140-6736(12)60150-0. Epub 2012 Aug 20.
Ulcerative colitis is an idiopathic, chronic inflammatory disorder of the colonic mucosa, which starts in the rectum and generally extends proximally in a continuous manner through part of, or the entire, colon; however, some patients with proctitis or left-sided colitis might have a caecal patch of inflammation. Bloody diarrhoea is the characteristic symptom of the disease. The clinical course is unpredictable, marked by alternating periods of exacerbation and remission. In this Seminar we discuss the epidemiology, pathophysiology, diagnostic approach, natural history, medical and surgical management, and main disease-related complications of ulcerative colitis, and briefly outline novel treatment options. Enhanced understanding of how the interaction between environmental factors, genetics, and the immune system results in mucosal inflammation has increased knowledge of disease pathophysiology. We provide practical therapeutic algorithms that are easily applicable in daily clinical practice, emphasising present controversies in treatment management and novel therapies.
溃疡性结肠炎是一种特发性、慢性的结肠黏膜炎症性疾病，起始于直肠，通常连续向近端延伸，累及部分或整个结肠；然而，部分直肠炎或左结肠炎患者可能存在回盲部炎症斑块。血性腹泻是该病的特征性症状。疾病的临床过程不可预测，以加重和缓解交替为特征。在本次研讨会中，我们讨论了溃疡性结肠炎的流行病学、病理生理学、诊断方法、自然病史、药物和手术治疗以及主要与疾病相关的并发症，并简要概述了新的治疗选择。人们对环境因素、遗传因素和免疫系统相互作用导致黏膜炎症的机制有了更深入的了解，从而增加了对疾病病理生理学的认识。我们提供了实用的治疗算法，这些算法在日常临床实践中易于应用，强调了治疗管理中的当前争议和新的治疗方法。
