Hojo Aya, Kobayashi Taku, Matsubayashi Mao, Morikubo Hiromu, Miyatani Yusuke, Fukuda Tomohiro, Asonuma Kunio, Sagami Shintaro, Nakano Masaru, Matsuda Takahisa, Hibi Toshifumi
Center for Advanced IBD Research and Treatment Kitasato University Kitasato Institute Hospital Tokyo Japan.
Department of Gastroenterology and Hepatology Kitasato University Kitasato Institute Hospital Tokyo Japan.
JGH Open. 2022 Jul 14;6(8):547-553. doi: 10.1002/jgh3.12786. eCollection 2022 Aug.
Crohn's disease (CD) often causes intractable diarrhea after intestinal resection. Anion exchange resins have been reported to be effective in patients with bile acid diarrhea after distal ileectomy; furthermore, bile acid metabolism has been implicated in the pathogenesis of CD. Therefore, we aimed to examine the effectiveness of colestimide in the management of postoperative CD, and to compare its impact between patients with and those without ileocecal resection.
Postoperative CD patients prescribed colestimide for diarrhea between April 2017 and December 2020 were retrospectively evaluated for changes in the total Crohn's disease activity index (CDAI), each CDAI component including diarrhea frequency/week, albumin, and C-reactive protein (CRP) was evaluated before and after the administration of colestimide. Furthermore, comprehensive patient and physician assessments were reviewed from medical records during the first outpatient visit as a global clinical judgment after the initiation of colestimide therapy.
A total of 24 patients were included, of whom 17 had a previous history of ileocecal resection. Significant improvement was noted in CDAI and diarrhea frequency only in the ileocecal resection group (CDAI: 114.5 ± 52.7 and 95.4 ± 34.8, < 0.05; diarrhea frequency/week 23.8 ± 14.1 and 15.4 ± 11.2, < 0.05, respectively). There was no significant improvement in other CDAI components, albumin level, or CRP level in either group. In the global clinical judgment, 13 and 4 patients in the ileocecal and non-ileocecal resection groups, respectively, were judged as "effective," with an overall efficacy rate of 70.8%.
Colestimide is effective for diarrhea in patients with postoperative CD, especially after ileocecal resection.
克罗恩病（CD）在肠道切除术后常导致顽固性腹泻。据报道，阴离子交换树脂对远端回肠切除术后胆汁酸腹泻患者有效；此外，胆汁酸代谢与CD的发病机制有关。因此，我们旨在研究考来替胺在术后CD治疗中的有效性，并比较其在有或无回盲部切除患者中的影响。
回顾性评估2017年4月至2020年12月期间因腹泻而服用考来替胺的术后CD患者，观察其克罗恩病活动指数（CDAI）总分的变化，在服用考来替胺前后评估CDAI的各个组成部分，包括每周腹泻频率、白蛋白和C反应蛋白（CRP）。此外，在首次门诊就诊时，从病历中回顾患者和医生的综合评估，作为考来替胺治疗开始后的整体临床判断。
共纳入24例患者，其中17例有回盲部切除史。仅在回盲部切除组中，CDAI和腹泻频率有显著改善（CDAI：114.5±52.7和95.4±34.8，P<0.05；每周腹泻频率：23.8±14.1和15.4±11.2，P<0.05）。两组的其他CDAI组成部分、白蛋白水平或CRP水平均无显著改善。在整体临床判断中，回盲部切除组和非回盲部切除组分别有13例和4例患者被判定为“有效”，总有效率为70.8%。
考来替胺对术后CD患者的腹泻有效，尤其是在回盲部切除术后。
