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Update on idiopathic colitides

机译：特发性大肠菌素更新

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PURPOSE OF REVIEW: This article summarizes the latest developments for three types of idiopathic colitis: ulcerative colitis, Crohn's disease, and microscopic colitis. RECENT FINDINGS: Crohn's disease and ulcerative colitis are highly related genetically. Colonoscopy remains the gold standard for making a diagnosis. The addition of chromoendoscopy can aid in identification and removal of colonic dysplasia in both disorders. The therapy for ulcerative colitis and Crohn's disease has been transformed with the introduction of anti-TNF treatment. For ulcerative colitis, recent data show that prolonged use of infliximab is effective, well tolerated and that early mucosal healing is associated with decreased risk of colectomy. There is no evidence of a significant increased risk for anti-TNF-induced malignancies. Combination therapy with azathioprine and infliximab for ulcerative colitis has now been shown to be superior to monotherapy. Natalizumab is effective in anti-TNF failures and patients can be risk stratified for progressive multifocal leukoencephalopathy by testing for John Cunningham virus antibodies. Microscopic colitis can often be related to medications, and symptoms may be worsened by coexisting celiac disease. SUMMARY: Combination therapy with an anti-TNF and a thiopurine is currently the most effective treatment for moderate-to-severe Crohn's disease or ulcerative colitis. Stem cell therapy for perianal fistulas in patients with Crohn's disease is a promising new therapy approach.
机译：审查目的：本文总结了三种类型的特发性结肠炎的最新进展：溃疡性结肠炎，克罗恩氏病和镜下性结肠炎。最近的发现：克罗恩氏病和溃疡性结肠炎在遗传上高度相关。结肠镜检查仍然是做出诊断的金标准。内镜检查的增加可以帮助识别和消除两种疾病中的结肠发育不良。溃疡性结肠炎和克罗恩氏病的治疗方法已通过引入抗TNF治疗进行了转化。对于溃疡性结肠炎，最新数据表明，长期使用英夫利昔单抗是有效的，耐受性良好的，早期粘膜愈合与结肠切除术的风险降低相关。没有证据表明抗TNF诱导的恶性肿瘤的风险显着增加。现已证明，硫唑嘌呤和英夫利昔单抗联合治疗溃疡性结肠炎优于单药治疗。纳他珠单抗在抗TNF失败方面有效，并且通过检测约翰·坎宁安病毒抗体，可以使患者发生进行性多灶性白质脑病的风险分层。显微镜下的结肠炎通常与药物有关，并存的腹腔疾病可能会使症状恶化。概述：抗肿瘤​​坏死因子和硫嘌呤的联合治疗目前是中重度克罗恩病或溃疡性结肠炎最有效的治疗方法。克罗恩病患者肛周瘘管的干细胞疗法是一种很有前途的新疗法。

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