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炎症性肠病患者管理中的常见误区

Common Mistakes in Managing Patients with Inflammatory Bowel Disease.

作者信息

Gisbert Javier P, Chaparro María

机构信息

Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain.

出版信息

J Clin Med. 2024 Aug 14;13(16):4795. doi: 10.3390/jcm13164795.

DOI:10.3390/jcm13164795
PMID:39200937
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11355176/
Abstract

Errors are very common in medical practice and in particular, in the healthcare of patients with inflammatory bowel disease (IBD); however, most of these can be prevented. To address common errors in the management of IBD. Our approach to this problem consists in identifying mistakes frequently observed in clinical practice (according to our experience) in the management of patients with IBD, then reviewing the scientific evidence available on the subject, and finally proposing the most appropriate recommendation for each case. The most common mistakes in the management of IBD include those related to diagnosis and differential diagnosis, prevention, nutrition and diet, treatment with different drugs (mainly 5-aminosalicylates, corticosteroids, thiopurines, and anti-TNF agents), extraintestinal manifestations, anemia, elderly patients, pregnancy, and surgery. Despite the availability of guidelines for both disease management and preventive aspects of IBD care, a considerable variation in clinical practice still remains. In this review, we have identified common mistakes in the management of patients with IBD in clinical practice. There is a clear need for a greater dissemination of clinical practice guidelines among gastroenterologists and for the implementation of ongoing training activities supported by scientific societies. Finally, it is desirable to follow IBD patients in specialized units, which would undoubtedly be associated with higher-quality healthcare and a lower likelihood of errors in managing these patients.

摘要

医疗实践中错误非常常见,尤其是在炎症性肠病(IBD)患者的医疗护理中;然而,其中大多数错误是可以预防的。为了解决IBD管理中的常见错误,我们解决这个问题的方法包括识别(根据我们的经验)在IBD患者管理的临床实践中经常观察到的错误,然后回顾关于该主题的现有科学证据,最后针对每个病例提出最合适的建议。IBD管理中最常见的错误包括与诊断和鉴别诊断、预防、营养和饮食、不同药物治疗(主要是5-氨基水杨酸类、皮质类固醇、硫唑嘌呤和抗TNF药物)、肠外表现、贫血、老年患者、妊娠和手术相关的错误。尽管有IBD疾病管理和预防护理方面的指南,但临床实践中仍存在相当大的差异。在本综述中,我们确定了临床实践中IBD患者管理中的常见错误。显然需要在胃肠病学家中更广泛地传播临床实践指南,并开展由科学协会支持的持续培训活动。最后,最好在专科单位对IBD患者进行随访,这无疑将带来更高质量的医疗护理,并降低管理这些患者时出现错误的可能性。

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Common Mistakes in Managing Patients with Inflammatory Bowel Disease.炎症性肠病患者管理中的常见误区
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本文引用的文献

1
ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment.欧洲克罗恩病治疗指南:药物治疗
J Crohns Colitis. 2024 Oct 15;18(10):1531-1555. doi: 10.1093/ecco-jcc/jjae091.
2
Clostridioides difficile infection in inflammatory bowel disease: a clinical review.炎症性肠病中的艰难梭菌感染:一项临床综述
Expert Rev Anti Infect Ther. 2024 May;22(5):297-306. doi: 10.1080/14787210.2024.2347955. Epub 2024 May 2.
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Updates on the management of inflammatory bowel disease from periconception to pregnancy and lactation.从受孕前到妊娠和哺乳期炎症性肠病的管理更新。
Lancet. 2024 Mar 30;403(10433):1291-1303. doi: 10.1016/S0140-6736(24)00052-7. Epub 2024 Mar 5.
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Venous Thromboembolism Prophylaxis in Inflammatory Bowel Disease Inpatients: Systematic Review and Meta-Analysis.炎症性肠病住院患者的静脉血栓栓塞症预防:系统评价和荟萃分析。
Acta Haematol. 2024;147(6):702-715. doi: 10.1159/000538086. Epub 2024 Mar 1.
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AGA Clinical Practice Update on Diet and Nutritional Therapies in Patients With Inflammatory Bowel Disease: Expert Review.AGA 临床实践更新:炎症性肠病患者的饮食和营养治疗:专家综述。
Gastroenterology. 2024 Mar;166(3):521-532. doi: 10.1053/j.gastro.2023.11.303. Epub 2024 Jan 23.
7
Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review.炎症性肠病术后感染并发症的风险与管理:一项系统评价
World J Gastrointest Surg. 2023 Nov 27;15(11):2579-2595. doi: 10.4240/wjgs.v15.i11.2579.
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De-escalation of Biologic Treatment in Inflammatory Bowel Disease: A Comprehensive Review.炎症性肠病生物治疗的降级策略:全面综述。
J Crohns Colitis. 2024 Apr 23;18(4):642-658. doi: 10.1093/ecco-jcc/jjad181.
9
Common Instances of Low-value Care in Inflammatory Bowel Diseases.炎症性肠病中的低价值医疗实例。
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New drugs for the treatment of IBD during conception, pregnancy, and lactation.治疗妊娠、哺乳期炎症性肠病的新药。
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