[克罗恩病和性结肠炎中严重爆发的治疗]
Andreas Stallmach1, Johannes Stallhofer2, Carsten Schmidt3,4
1Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland. andreas.stallmach@med.uni-jena.de.
Innere Medizin (Heidelberg, Germany)
|January 10, 2025
概括
炎症性肠道疾病 (IBD) 的严重发作需要及时的静脉注射类固醇治疗. 如果无效,可以考虑先进的治疗方法,如生物药物或JAK抑制剂,以及克罗恩病 (CD) 和性结肠炎 (UC) 的手术选择.
科学领域:
- 胃肠道学和免疫学
- 炎症性肠病 (IBD) 研究研究
- 临床治疗学 临床治疗学
背景情况:
- 在IBD中,严重的发作会给患者带来很大的负担和强烈的炎症.
- 治疗的目的是减少症状,预防并发症和长期缓解.
- 粘膜愈合是IBD的关键长期治疗目标.
研究的目的:
- 概述基于证据的诊断和严重克罗恩病 (CD) 和性结肠炎 (UC) 爆发的逐步治疗.
- 预防与IBD爆发相关的严重并发症和死亡率.
- 在经历严重IBD爆发的患者中实现快速缓解.
主要方法:
- 进行了选择性的文献综述.
- 包括德国和欧洲关于严重IBD爆发治疗的指南.
- 审查的重点是诊断和治疗策略.
主要成果:
- 静脉注射类固醇治疗是CD和UC中严重急性发作的初始治疗方法.
- 预计在72小时内会有改善;否则,必须加强治疗.
- 有一系列的先进疗法可用,包括生物药物 (抗TNF-α,抗α4β7,抗IL-12/23,抗IL-23),JAK抑制剂,S1PR调节剂和氨酸抑制剂.
结论:
- 严重IBD爆发的治疗选择取决于患者特定的因素,而不是通用算法.
- 个性化治疗选择考虑药物批准,病史,先前的治疗和风险概况.
- 应考虑在严重IBD爆发的跨学科护理框架内进行手术干预.
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