Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Mayo Clin Proc. 2014 Nov;89(11):1553-63. doi: 10.1016/j.mayocp.2014.07.002. Epub 2014 Sep 8.
Ulcerative colitis is a chronic idiopathic inflammatory bowel disease characterized by continuous mucosal inflammation that starts in the rectum and extends proximally. Typical presenting symptoms include bloody diarrhea, abdominal pain, urgency, and tenesmus. In some cases, extraintestinal manifestations may be present as well. In the right clinical setting, the diagnosis of ulcerative colitis is based primarily on endoscopy, which typically reveals evidence of continuous colonic inflammation, with confirmatory biopsy specimens having signs of chronic colitis. The goals of therapy are to induce and maintain remission, decrease the risk of complications, and improve quality of life. Treatment is determined on the basis of the severity of symptoms and is classically a step-up approach. 5-Aminosalycilates are the mainstay of treatment for mild to moderate disease. Patients with failed 5-aminosalycilate therapy or who present with more moderate to severe disease are typically treated with corticosteroids followed by transition to a steroid-sparing agent with a thiopurine, anti-tumor necrosis factor agent, or adhesion molecule inhibitor. Despite medical therapies, approximately 15% of patients still require proctocolectomy. In addition, given the potential risks of complications from the disease itself and the medications used to treat the disease, primary care physicians play a key role in optimizing the preventive care to reduce the risk of complications.
溃疡性结肠炎是一种慢性特发性炎症性肠病，其特征为连续的直肠黏膜炎症，并向近端延伸。典型的表现症状包括血性腹泻、腹痛、急迫感和里急后重。在某些情况下，也可能出现肠道外表现。在适当的临床情况下，溃疡性结肠炎的诊断主要基于内镜检查，其典型表现为连续的结肠炎症，通过确认活检标本显示慢性结肠炎的特征来确诊。治疗的目的是诱导并维持缓解，降低并发症的风险，提高生活质量。治疗方案取决于症状的严重程度，经典的治疗方法是逐步升级。5-氨基水杨酸是治疗轻到中度疾病的主要药物。对于治疗失败或病情更中重度的患者，通常采用皮质类固醇治疗，随后过渡到硫嘌呤、抗肿瘤坏死因子药物或黏附分子抑制剂等类固醇保留药物。尽管有药物治疗，仍有约 15%的患者需要接受直肠结肠切除术。此外，鉴于疾病本身和用于治疗疾病的药物可能带来的并发症风险，初级保健医生在优化预防保健以降低并发症风险方面发挥着关键作用。
