Gastroenterology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, United Kingdom.
Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds LS9 7TF, United Kingdom.
World J Gastroenterol. 2020 Jul 14;26(26):3712-3719. doi: 10.3748/wjg.v26.i26.3712.
Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease (IBD). There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing, rather than clinical remission alone. Consequently, the treatment of refractory "functional" gastrointestinal symptoms, often attributed as the aftermath of previous inflammation, has recently become more prominent in quiescent disease. With further expected advances in anti-inflammatory treatments on the horizon, the burden of such symptoms in quiescent disease, which have been relatively neglected, is set to become an even bigger problem. In this article, we highlight the current state of research and understanding in this field, including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms, such as irritable bowel syndrome and functional anorectal and pelvic floor disorders, in patients with quiescent IBD. These disorders are not only highly prevalent in these patients, they are often misdiagnosed, and are difficult to treat, with very few evidence-based therapies. Moreover, they are associated with substantial impairment in quality-of-life, considerable morbidity, and psychological distress. There is therefore an urgent need for a change in emphasis towards earlier recognition, positive diagnosis, and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active IBD. This article also highlights the need for further research to develop much needed evidence-based therapies.
生物疗法的最新进展彻底改变和重新定义了炎症性肠病（IBD）的治疗靶点。现在更加强调实现更严格的粘膜和组织学愈合治疗目标，而不仅仅是临床缓解。因此，在疾病静止期，经常归因于先前炎症的难治性“功能性”胃肠道症状的治疗最近变得更加突出。随着抗炎治疗的进一步预期进展，静止期此类症状的负担（相对被忽视）预计将成为一个更大的问题。在本文中，我们强调了该领域当前的研究和理解状况，包括最近关于诊断和管理静止期 IBD 患者功能性胃肠道症状（如肠易激综合征和功能性肛门直肠和盆底障碍）的临床实践指南和研究进展。这些疾病不仅在这些患者中非常普遍，而且经常被误诊，并且难以治疗，几乎没有基于证据的治疗方法。此外，它们与生活质量显著受损、相当大的发病率和心理困扰有关。因此，迫切需要改变重点，对于没有活动性 IBD 的持续存在功能性胃肠道症状的患者，应更早识别、积极诊断和进行针对性治疗。本文还强调了需要进一步研究，以开发急需的基于证据的治疗方法。
