Shomron Ben-Horin, Ofir Har-Noy, Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat-Gan 52621, Israel.
World J Gastroenterol. 2017 Apr 28;23(16):2995-3002. doi: 10.3748/wjg.v23.i16.2995.
To examine treatment decisions of gastroenterologists regarding the choice of prescribing 5-aminosalycilates (5ASA) with corticosteroids (CS) versus corticosteroids alone for patients with active ulcerative colitis (UC).
A cross-sectional questionnaire exploring physicians' attitude toward 5ASA + CS combination therapy CS alone was developed and validated. The questionnaire was distributed to gastroenterology experts in twelve countries in five continents. Respondents' agreement with stated treatment choices were assessed by standardized Likert scale. Background professional characteristics of respondents were analyzed for correlation with responses.
Six hundred and sixty-four questionnaires were distributed and 349 received (52.6% response rate). Of 340 eligible respondents, 221 (65%) would continue 5ASA in a patient hospitalized for intravenous CS treatment due to a moderate-severe UC flare, while 108 (32%) would stop the 5ASA ( < 0.001), and 11 (3%) are undecided. Similarly, 62% would continue 5ASA in an out-patient starting oral CS. However, only 140/340 (41%) would proactively start 5ASA in a hospitalized patient not receiving 5ASA before admission. Most (94%) physicians consider the safety profile of 5ASA as very good. Only 52% consider them inexpensive, 35% perceive them to be expensive and 12% are undecided. On multi-variable analysis, less years of practice and perception of a plausible additive mechanistic effect of 5ASA + CS were positively associated with the decision to continue 5ASA with CS.
Despite the absence of data supporting its benefit, most gastroenterologists endorse combination of 5ASA + CS for patients with active moderate-to-severe UC. Randomized controlled trials are needed to assess if 5ASA confer any benefit for these patients.
研究胃肠病学家在为活动期溃疡性结肠炎（UC）患者选择 5-氨基水杨酸（5ASA）联合皮质类固醇（CS）与单独使用 CS 治疗时的治疗决策。
开发并验证了一种调查医生对 5ASA+CS 联合治疗与 CS 单独治疗的态度的横断面问卷。该问卷分发给来自五大洲 12 个国家的胃肠病学专家。通过标准化李克特量表评估受访者对规定治疗选择的认同程度。分析受访者的背景专业特征与回答之间的相关性。
共发放 664 份问卷，收到 349 份（52.6%的回复率）。在 340 名符合条件的受访者中，221 名（65%）会在因中度至重度 UC 发作而住院接受静脉 CS 治疗的患者中继续使用 5ASA，而 108 名（32%）会停止使用 5ASA（<0.001），11 名（3%）犹豫不决。同样，62%的人会在开始口服 CS 的门诊患者中继续使用 5ASA。然而，只有 140/340（41%）会在未入院前未使用 5ASA 的住院患者中主动开始使用 5ASA。大多数（94%）医生认为 5ASA 的安全性非常好。只有 52%的人认为它们价格低廉，35%的人认为它们昂贵，12%的人犹豫不决。多变量分析显示，从业年限较短和认为 5ASA+CS 具有合理的附加机制作用与继续使用 5ASA+CS 的决定呈正相关。
尽管缺乏支持其获益的证据，但大多数胃肠病学家支持在活动期中重度 UC 患者中联合使用 5ASA+CS。需要进行随机对照试验来评估这些患者使用 5ASA 是否有获益。
