Korelitz B I
Department of Medicine, Lenox Hill Hospital, New York, NY.
J Clin Gastroenterol. 1989 Aug;11(4):373-5.
Amebic colitis can mimick Crohn's disease of the colon and ulcerative colitis. Inflammatory bowel disease (IBD) patients can also be carriers of amebae. Since steroids can provoke amebic activity and even cause a fulminating colitis, it is necessary to determine that amebae do or do not exist. Furthermore, amebae can be easily eliminated by drug therapy but it is hard to eradicate IBD. Despite the above, diagnostic modalities for IBD are as effective as those for amebiasis, particularly for Crohn's disease with ileal involvement. Problems in differential diagnosis arise with IBD grossly limited to the colon. In these cases, false negative stool studies are increased by diarrhea and preparation for examinations, and both stool studies and serologies are compromised by steroids. If the clinical course of IBD is downhill, the clinician is justified in starting steroids even if evaluation for amebiasis incomplete. If, however, the index of suspicion is high, concomitant treatment with Metronidazole would be reasonable.
阿米巴性结肠炎可酷似结肠克罗恩病和溃疡性结肠炎。炎症性肠病（IBD）患者也可能是阿米巴携带者。由于类固醇可激发阿米巴活性甚至导致暴发性结肠炎，因此有必要确定是否存在阿米巴。此外，阿米巴可通过药物治疗轻易消除，但IBD却难以根除。尽管如此，IBD的诊断方法与阿米巴病的诊断方法一样有效，尤其是对于累及回肠的克罗恩病。当IBD严重局限于结肠时，鉴别诊断就会出现问题。在这些病例中，腹泻和检查前准备会增加粪便检查假阴性的几率，而类固醇会影响粪便检查和血清学检查结果。如果IBD的临床病程呈恶化趋势，即使对阿米巴病的评估不完整，临床医生也有理由开始使用类固醇。然而，如果怀疑指数较高，同时使用甲硝唑进行治疗将是合理的。
