Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4831-044, Guimarães, Portugal.
Life and Health Sciences Research Institute (ICVS), University of Minho, Campus Gualtar, 4710-057, Braga, Portugal.
Drugs. 2017 Feb;77(2):159-173. doi: 10.1007/s40265-016-0676-y.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by periods of remission and periods of relapse. Patients often present with symptoms such as rectal bleeding, diarrhea and weight loss, and may require hospitalization and even colectomy. Long-term complications of UC include decreased quality of life and productivity and an increased risk of colorectal cancer. Mucosal healing (MH) has gained progressive importance in the management of UC patients. In this article, we review the endoscopic findings that define both mucosal injury and MH, and the strengths and limitations of the scoring systems currently available in clinical practice. The basic mechanisms behind colonic injury and MH are covered, highlighting the pathways through which different drugs exert their effect towards reducing inflammation and promoting epithelial repair. A comprehensive review of the evidence for approved drugs for UC to achieve and maintain MH is provided, including a section on the pharmacokinetics of anti-tumor necrosis factor (TNF)-α drugs. Currently approved drugs with proven efficacy in achieving MH in UC include salicylates, corticosteroids (induction only), calcineurin inhibitors (induction only), thiopurines, vedolizumab and anti-TNFα drugs (infliximab, adalimumab, and golimumab). MH is of crucial relevance in the outcomes of UC, resulting in lower incidences of clinical relapse, the need for hospitalization and surgery, as well as reduced rates of dysplasia and colorectal cancer. Finally, we present recent evidence towards the need for a more strict definition of complete MH as the preferred endpoint for UC patients, using a combination of both endoscopic and histological findings.
溃疡性结肠炎（UC）是一种慢性炎症性肠病，其特征为缓解期和复发期。患者常出现直肠出血、腹泻和体重减轻等症状，可能需要住院治疗，甚至需要结肠切除术。UC 的长期并发症包括生活质量和生产力下降，以及结直肠癌风险增加。黏膜愈合（MH）在 UC 患者的治疗中越来越重要。本文综述了定义黏膜损伤和 MH 的内镜表现，以及目前临床实践中可用的评分系统的优缺点。涵盖了结肠损伤和 MH 的基本机制，强调了不同药物通过不同途径发挥作用，减少炎症和促进上皮修复。全面回顾了用于 UC 实现和维持 MH 的已批准药物的证据，包括抗 TNF-α药物的药代动力学部分。目前已批准的在 UC 中具有 MH 疗效的药物包括柳氮磺胺吡啶、皮质类固醇（仅诱导）、钙调磷酸酶抑制剂（仅诱导）、硫嘌呤、vedolizumab 和抗 TNF-α药物（英夫利昔单抗、阿达木单抗和戈利木单抗）。MH 与 UC 的结局密切相关，可降低临床复发、住院和手术的发生率，以及异型增生和结直肠癌的发生率。最后，我们提出了最近的证据，需要更严格地定义完全 MH，将其作为 UC 患者的首选终点，同时结合内镜和组织学发现。
