University of Tennessee College of Medicine, Chattanooga, TN 37403, USA.
Am Fam Physician. 2013 May 15;87(10):699-705.
Ulcerative colitis is a chronic inflammatory disease of the colon. The etiology is unknown. Risk factors include a history of recent infection with Salmonella or Campylobacter, living in Western industrialized nations and at higher latitudes, and a family history of the disease. The incidence peaks in early adulthood, but patients can develop the disorder from early childhood through adulthood. Ulcerative colitis often presents with abdominal pain, diarrhea, and hematochezia. It is important to exclude infectious etiologies. Anemia and an elevated erythrocyte sedimentation rate or C-reactive protein level may suggest inflammatory bowel disease, but the absence of laboratory abnormalities does not rule out ulcerative colitis. The diagnosis is suspected clinically and confirmed through endoscopic biopsy. First-line treatment is therapy with 5-aminosalicylic acid. Corticosteroids may be added if 5-aminosalicylic acid therapy is ineffective. Infliximab can be added to induce and sustain remission. Patients with severe or nonresponsive ulcerative colitis should be hospitalized, and intravenous corticosteroids should be given. If medical management has been ineffective, surgical intervention is indicated for severe disease. Patients with ulcerative colitis have an increased risk of colon cancer and should have periodic colonoscopy beginning eight to 10 years after diagnosis.
溃疡性结肠炎是一种结肠的慢性炎症性疾病。病因不明。危险因素包括近期感染沙门氏菌或弯曲杆菌、居住在西方国家和高纬度地区、以及家族病史。发病高峰在成年早期，但患者可从儿童期到成年期发病。溃疡性结肠炎常表现为腹痛、腹泻和血便。重要的是要排除感染性病因。贫血和红细胞沉降率或 C 反应蛋白水平升高可能提示炎症性肠病，但实验室异常的缺乏并不排除溃疡性结肠炎。诊断是基于临床怀疑并通过内镜活检来确认。一线治疗是使用 5-氨基水杨酸治疗。如果 5-氨基水杨酸治疗无效，可以添加皮质类固醇。英夫利昔单抗可用于诱导和维持缓解。患有严重或无反应性溃疡性结肠炎的患者应住院，并给予静脉皮质类固醇。如果药物治疗无效，则应进行手术干预严重疾病。溃疡性结肠炎患者患结肠癌的风险增加，应在诊断后 8 至 10 年内定期进行结肠镜检查。
