Hung Alex, Calderbank Tom, Samaan Mark A, Plumb Andrew A, Webster George
Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.
Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Frontline Gastroenterol. 2019 Dec 13;12(1):44-52. doi: 10.1136/flgastro-2019-101204. eCollection 2021.
Ischaemic colitis (IC) is a common condition with rising incidence, and in severe cases a high mortality rate. Its presentation, severity and disease behaviour can vary widely, and there exists significant heterogeneity in treatment strategies and resultant outcomes. In this article we explore practical challenges in the management of IC, and where available make evidence-based recommendations for its management based on a comprehensive review of available literature. An optimal approach to initial management requires early recognition of the diagnosis followed by prompt and appropriate investigation. Ideally, this should involve the input of both gastroenterology and surgery. CT with intravenous contrast is the imaging modality of choice. It can support clinical diagnosis, define the severity and distribution of ischaemia, and has prognostic value. In all but fulminant cases, this should be followed (within 48 hours) by lower gastrointestinal endoscopy to reach the distal-most extent of the disease, providing endoscopic (and histological) confirmation. The mainstay of medical management is conservative/supportive treatment, with bowel rest, fluid resuscitation and antibiotics. Specific laboratory, radiological and endoscopic features are recognised to correlate with more severe disease, higher rates of surgical intervention and ultimately worse outcomes. These factors should be carefully considered when deciding on the need for and timing of surgical intervention.
缺血性结肠炎（IC）是一种发病率不断上升的常见疾病，在严重情况下死亡率很高。其临床表现、严重程度和疾病行为差异很大，治疗策略和最终结果存在显著异质性。在本文中，我们探讨了IC管理中的实际挑战，并在对现有文献进行全面综述的基础上，为其管理提供基于证据的建议。初始管理的最佳方法需要早期识别诊断，随后进行迅速且适当的检查。理想情况下，这应包括胃肠病学和外科的参与。静脉造影CT是首选的成像方式。它可以支持临床诊断，确定缺血的严重程度和分布，并具有预后价值。除暴发型病例外，所有病例均应在48小时内进行下消化道内镜检查，以达到疾病的最远端，提供内镜（和组织学）确认。药物治疗的主要方法是保守/支持性治疗，包括肠道休息、液体复苏和使用抗生素。特定的实验室、影像学和内镜特征与更严重的疾病、更高的手术干预率以及最终更差的结果相关。在决定是否需要手术干预以及手术时机时，应仔细考虑这些因素。
