Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Curr Opin Gastroenterol. 2013 Jan;29(1):60-5. doi: 10.1097/MOG.0b013e32835abc93.
This article summarizes the latest developments for three types of idiopathic colitis: ulcerative colitis, Crohn's disease, and microscopic colitis.
Crohn's disease and ulcerative colitis are highly related genetically. Colonoscopy remains the gold standard for making a diagnosis. The addition of chromoendoscopy can aid in identification and removal of colonic dysplasia in both disorders. The therapy for ulcerative colitis and Crohn's disease has been transformed with the introduction of anti-TNF treatment. For ulcerative colitis, recent data show that prolonged use of infliximab is effective, well tolerated and that early mucosal healing is associated with decreased risk of colectomy. There is no evidence of a significant increased risk for anti-TNF-induced malignancies. Combination therapy with azathioprine and infliximab for ulcerative colitis has now been shown to be superior to monotherapy. Natalizumab is effective in anti-TNF failures and patients can be risk stratified for progressive multifocal leukoencephalopathy by testing for John Cunningham virus antibodies. Microscopic colitis can often be related to medications, and symptoms may be worsened by coexisting celiac disease.
Combination therapy with an anti-TNF and a thiopurine is currently the most effective treatment for moderate-to-severe Crohn's disease or ulcerative colitis. Stem cell therapy for perianal fistulas in patients with Crohn's disease is a promising new therapy approach.
本文总结了三种特发性结肠炎（溃疡性结肠炎、克罗恩病和显微镜下结肠炎）的最新进展。
克罗恩病和溃疡性结肠炎在遗传上高度相关。结肠镜检查仍然是诊断的金标准。染色内镜的应用有助于识别和切除两种疾病中的结肠异型增生。抗 TNF 治疗的应用改变了溃疡性结肠炎和克罗恩病的治疗方法。对于溃疡性结肠炎，最近的数据表明，延长使用英夫利昔单抗是有效且耐受良好的，早期黏膜愈合与降低结肠切除风险相关。没有证据表明抗 TNF 诱导的恶性肿瘤风险显著增加。对于溃疡性结肠炎，联合使用硫唑嘌呤和英夫利昔单抗已被证明优于单药治疗。那他珠单抗对 TNF 失败的患者有效，并且可以通过检测巨细胞病毒抗体对进行性多灶性白质脑病进行风险分层。显微镜下结肠炎通常与药物有关，并存的乳糜泻可能会使症状恶化。
目前，联合使用抗 TNF 和硫嘌呤是治疗中重度克罗恩病或溃疡性结肠炎最有效的方法。对于克罗恩病的肛周瘘，干细胞治疗是一种很有前途的新治疗方法。
