Inserm U954, Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France; Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
Clin Gastroenterol Hepatol. 2020 Jan;18(1):14-23. doi: 10.1016/j.cgh.2019.07.005. Epub 2019 Jul 10.
It is unclear whether ulcerative colitis (UC) is a progressive disease similar to Crohn's disease (CD). Patients with UC often are undertreated because of the possibility of curative colectomy and the perception that the disease burden is lower than that of CD. We discuss findings from studies that aimed to determine whether UC and CD have the same disease burden and should be treated in the same intensive way. We discuss the similarities between CD and UC, including effects on quality of life, long-term complications, strictures, increased risk of cancer, pseudopolyps, functional abnormalities, and anorectal dysfunction. Contrary to the generally accepted idea, surgery cannot cure UC. Postoperative complications, especially pouchitis and fecal incontinence, affect more than one third of patients. CD and UC each pose substantial economic burdens. Monitoring, treatments, and goals of therapy are similar for all inflammatory bowel diseases. Earlier initiation of disease-modifying drugs might reduce the progression of UC and reduce its burden after surgery, although UC might not cause the irreversible damage observed in patients with CD.
溃疡性结肠炎（UC）是否为一种类似于克罗恩病（CD）的进展性疾病尚不清楚。由于可能需要进行治愈性结肠切除术，且人们认为该病的疾病负担低于 CD，因此 UC 患者往往治疗不足。我们将讨论旨在确定 UC 和 CD 是否具有相同疾病负担且应采用相同强化方式治疗的研究结果。我们讨论了 CD 和 UC 之间的相似之处，包括对生活质量、长期并发症、狭窄、癌症风险增加、假性息肉、功能异常和肛肠功能障碍的影响。与普遍接受的观点相反，手术不能治愈 UC。术后并发症，尤其是袋炎和粪便失禁，影响超过三分之一的患者。CD 和 UC 各自都带来了巨大的经济负担。监测、治疗和治疗目标对于所有炎症性肠病都是相似的。早期使用疾病修饰药物可能会减缓 UC 的进展，并降低术后的疾病负担，尽管 UC 可能不会引起 CD 患者观察到的不可逆转的损伤。
