Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor.
Department of Medicine, Trinity Health Ann Arbor Hospital, Ypsilanti, Michigan, USA.
Curr Opin Gastroenterol. 2023 Jul 1;39(4):274-286. doi: 10.1097/MOG.0000000000000953. Epub 2023 May 26.
The management of hospitalized patients with inflammatory bowel disease (IBD) is complex. Despite considerable therapeutic advancements in outpatient ulcerative colitis and Crohn's disease management, the in-hospital management continues to lag with suboptimal outcomes. The purpose of this review is to provide a brief overview of our approach to managing patients hospitalized with acute severe ulcerative colitis (ASUC) and Crohn's disease-related complications, followed by a summary of emerging evidence for new management approaches.
ASUC has seen the emergence of well validated prognostic models for colectomy as well as the development of novel treatment strategies such as accelerated infliximab dosing, Janus kinase inhibitor therapy, and sequential therapy, yet the rate of colectomy for steroid-refractory ASUC has not meaningfully improved. Crohn's disease has seen the development of better diagnostic tools, early Crohn's disease-related complication stratification and identification, as well as better surgical techniques, yet the rates of hospitalization and development of Crohn's disease-related complications remain high.
Significant progress has been made in the in-hospital IBD management; however, both the management of ASUC and hospitalized Crohn's disease remain a challenge with suboptimal outcomes. Critical knowledge gaps still exist, and dedicated studies in hospitalized patients with IBD are needed to address them.
综述目的：住院的炎症性肠病（IBD）患者的管理较为复杂。尽管溃疡性结肠炎（UC）和克罗恩病（CD）的门诊治疗有了很大的进展，但住院患者的管理仍相对滞后，治疗效果不理想。本文旨在简要介绍我们管理急性重度溃疡性结肠炎（ASUC）和 CD 相关并发症住院患者的方法，然后综述新管理方法的研究进展。
最新发现：目前已经有了经充分验证的预测 ASUC 患者行结肠切除术的预后模型，以及加速 infliximab 给药、Janus 激酶抑制剂治疗和序贯治疗等新的治疗策略，但类固醇抵抗性 ASUC 患者行结肠切除术的比例并没有明显改善。在 CD 方面，已经开发出了更好的诊断工具、早期 CD 相关并发症的分层和识别方法，以及更好的手术技术，但住院率和 CD 相关并发症的发生率仍然很高。
总结：IBD 的住院管理已经取得了重大进展；然而，ASUC 和住院 CD 的管理仍然是一个挑战，治疗效果不理想。目前仍存在重要的知识空白，需要对住院的 IBD 患者进行专门的研究来解决这些问题。
