Rogler G, Andus T, Schölmerich J
Klinik und Poliklinik für Innere Medizin I, Universität Regensburg.
Zentralbl Chir. 1998;123(4):316-24.
Improvement and standardization of the conservative therapy of inflammatory bowel disease has lead to a better prognosis for the patients. During the acute flare of Crohn's disease steroids are still the standard therapy, whereas 5-aminosalicylic acid (5-ASA) preparations are used for maintenance therapy during remission. In contrast ulcerative colitis may be treated with 5-ASA also for acute exacerbations. The development of new drugs as for example the topical steroids helps to improve life quality of the patients by reducing adverse side effects. Potent immunosuppressants as azathioprine and methotrexate are useful in chronic active and refractory disease. Cyclosporin A plays a role in severe steroid refractory colitis. In the future immunomodulation by application of antiinflammatory cytokines or antibodies to inflammatory cytokines may have its place in the treatment of IBD patients. In some cases, however, the conservative therapy reaches its limits. Mistakes in the therapy are made, when these limits are not recognized and complications are not discovered in time.
炎症性肠病保守治疗方法的改进与标准化已使患者的预后得到改善。在克罗恩病急性发作期，类固醇仍然是标准治疗药物，而在缓解期，5-氨基水杨酸（5-ASA）制剂则用于维持治疗。相比之下，溃疡性结肠炎急性加重期也可用5-ASA治疗。新型药物的研发，如局部用类固醇，通过减少不良反应有助于提高患者的生活质量。强效免疫抑制剂，如硫唑嘌呤和甲氨蝶呤，对慢性活动期和难治性疾病有效。环孢素A在严重的类固醇难治性结肠炎中发挥作用。未来，应用抗炎细胞因子或针对炎性细胞因子的抗体进行免疫调节可能在炎症性肠病患者的治疗中占有一席之地。然而，在某些情况下，保守治疗会达到其极限。当未认识到这些极限且未及时发现并发症时，就会出现治疗失误。
