Medizinische Klinik II, Klinikum St. Marien, Amberg, Deutschland. gross.volker @ klinikum-amberg.de
Dig Dis. 2012;30 Suppl 3:92-9. doi: 10.1159/000342730. Epub 2013 Jan 3.
Topical therapy with mesalazine and/or corticosteroids is the standard treatment for patients with distal ulcerative colitis. Rectal mesalazine is more effective than rectal systemically active corticosteroids or topically active corticosteroids like budesonide. In patients with mild to moderately active distal ulcerative colitis, topical mesalazine is therefore the treatment of choice. Doses of 1 g or higher are equally effective. The period of treatment is important (4 weeks are more effective than 2 weeks). In the case of nonresponse or nontolerability of rectal mesalazine, rectal budesonide is indicated. The standard dose of budesonide is 2 mg/day. This does not usually induce any corticosteroid-associated adverse events. Treatment with rectal mesalazine plus rectal topically active corticosteroids is even more effective than treatment with either substance alone. To overcome adherence problems with rectal therapy, rectal foam preparations have been developed which are usually better tolerated than enemas.
局部用美沙拉嗪和/或皮质类固醇是治疗远端溃疡性结肠炎患者的标准治疗方法。直肠美沙拉嗪比直肠全身作用皮质类固醇或布地奈德等局部作用皮质类固醇更有效。在轻度至中度活动的远端溃疡性结肠炎患者中，局部用美沙拉嗪是首选治疗方法。1 克或更高剂量同样有效。治疗时间很重要（4 周比 2 周更有效）。如果直肠美沙拉嗪无反应或不耐受，则应使用直肠布地奈德。布地奈德的标准剂量为 2 毫克/天。这通常不会引起任何与皮质类固醇相关的不良反应。直肠美沙拉嗪联合直肠局部作用皮质类固醇治疗比单独使用任何一种药物更有效。为了克服直肠治疗的顺应性问题，已经开发出直肠泡沫制剂，通常比灌肠剂更耐受。
