Hirschfeld S, Clearfield H R
Hahnemann University School of Medicine, Philadelphia, Pennsylvania, USA.
Am Fam Physician. 1995 Jun;51(8):1971-5.
The pharmacologic management of ulcerative colitis and Crohn's disease is usually carried out in a stepwise fashion. Initially, oral sulfasalazine or 5-aminosalicylic acid (5-ASA) products are given and, for patients with rectal disease, treatment may include topical therapy with either 5-ASA enemas or hydrocortisone suppositories. Patients with more active inflammatory disorders may also require oral corticosteroid therapy. Patients with fulminant disease may require intravenous steroids and antibiotic therapy. If frequent relapses prevent discontinuation or significant reduction of prednisone therapy, azathioprine or 6-mercaptopurine may offer benefit as steroid-sparing agents. Also, intravenous cyclosporine has proved useful in patients with fulminant inflammatory bowel disease that is unresponsive to other therapy. Metronidazole has value in the treatment of perianal disease secondary to Crohn's disease. Balancing the risks and benefits of single or combination therapy is an ongoing challenge in patients with inflammatory bowel disease.
溃疡性结肠炎和克罗恩病的药物治疗通常按逐步方式进行。最初，给予口服柳氮磺胺吡啶或5-氨基水杨酸（5-ASA）产品，对于直肠疾病患者，治疗可能包括使用5-ASA灌肠剂或氢化可的松栓剂进行局部治疗。炎症更活跃的患者可能还需要口服皮质类固醇治疗。暴发性疾病患者可能需要静脉注射类固醇和抗生素治疗。如果频繁复发导致无法停用泼尼松治疗或显著减少其用量，硫唑嘌呤或6-巯基嘌呤作为类固醇节省剂可能有益。此外，静脉注射环孢素已被证明对其他治疗无反应的暴发性炎症性肠病患者有用。甲硝唑在治疗克罗恩病继发的肛周疾病方面有价值。在炎症性肠病患者中，平衡单一治疗或联合治疗的风险和益处是一项持续的挑战。
