Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Inflamm Bowel Dis. 2013 Mar-Apr;19(4):856-9. doi: 10.1097/MIB.0b013e3182802c21.
Patients who have undergone intestinal resection for Crohn's disease frequently develop endoscopic and clinical recurrence of their disease. Active smokers and those with perforating disease appear to be at a higher risk of this development. A number of agents have been shown in randomized controlled trials to reduce the risk of endoscopic and clinical recurrence, but international guidelines are currently ambiguous on which agent should be used. Because there are wide-ranging efficacy estimates, safety profiles, and costs for the various proven prophylactic agents, physicians should personalize the management of individual patients based on their estimated probability of clinical recurrence (low/high). Such risk stratification could be based on the patient's clinical profile with or without early postoperative endoscopic surveillance. Ongoing trials using this "tailored" strategy should provide answers on whether this approach allows optimal selection of proven therapies.
患有克罗恩病并接受肠道切除术的患者经常会出现内镜和临床疾病复发。主动吸烟者和患有穿孔性疾病的患者似乎面临更高的这种发展风险。随机对照试验已经证实了许多药物可降低内镜和临床复发的风险，但国际指南目前对于应使用哪种药物存在分歧。由于各种已证实的预防药物的疗效估计值、安全性概况和成本差异很大，因此医生应根据患者的临床复发（低/高）估计概率对个别患者进行个体化管理。这种风险分层可以基于患者的临床特征，无论是否进行早期术后内镜监测。使用这种“量身定制”策略的正在进行的试验应该提供有关这种方法是否允许最佳选择已证实的治疗方法的答案。
