VA Ann Arbor Health Services Research & Development Center for Clinical Management Research, Ann Arbor, MI, United States; Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.
Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.
J Crohns Colitis. 2014 Jan;8(1):80-4. doi: 10.1016/j.crohns.2013.07.003. Epub 2013 Aug 12.
A 26 year-old man with a history of mild, left-sided ulcerative colitis presents to your clinic for a routine follow-up appointment. He initially presented approximately 5 years ago with intermittent rectal bleeding and diarrhea, which led to a diagnostic colonoscopy. His symptoms resolved in 1–2 weeks with a combination of oral and rectal mesalamine, and you have seen him annually since that time. At today’s visit, he readily admits that he fails to take his medication on a regular basis, opting instead to use oral mesalamine as needed in response to symptoms. He estimates that he uses the medication for several weeks at a time, once or twice a year. Currently, he is having 1–2 formed bowel movements a day, with no blood and no nocturnal symptoms. His laboratory studies, including inflammatory markers and complete blood count, are normal. Upon questioning, you learn that he sees little benefit in taking a daily medication. His symptoms flare infrequently and improve quickly with initiation of mesalamine. He asks you if continuous, long-term mesalamine use confers any advantage or disadvantage over intermittent use based on symptoms, as he is currently doing.
一位 26 岁男性，有轻度左侧溃疡性结肠炎病史，因常规随访就诊于您的诊所。他最初在大约 5 年前出现间歇性直肠出血和腹泻，导致进行了诊断性结肠镜检查。他的症状在 1-2 周内通过口服和直肠美沙拉嗪联合治疗得到缓解，此后他每年都来就诊。在今天的就诊中，他坦率地承认自己没有规律地服用药物，而是在出现症状时按需使用口服美沙拉嗪。他估计他每年会有一次或两次连续使用药物数周的情况。目前，他每天有 1-2 次成型的排便，没有血液且夜间无症状。他的实验室研究包括炎症标志物和全血细胞计数均正常。经询问，他认为每天服用药物益处不大。他的症状很少发作，且在开始使用美沙拉嗪后很快缓解。他想知道，像他目前这样间歇性使用美沙拉嗪，与持续长期使用相比，基于症状，是否有任何优势或劣势。
