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首页> 外文期刊>Current treatment options in gastroenterology >Treatment of Biliary Problems in Inflammatory Bowel Disease.
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Treatment of Biliary Problems in Inflammatory Bowel Disease.

机译：炎症性肠病胆道疾病的治疗。

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The most common biliary problem in patients with inflammatory bowel disease is primary sclerosing cholangitis (PSC). The treatment of this disease is multifaceted and frequently requires a multidisciplinary approach involving internists, nutritionists, gastroenterologists, and surgeons. Unfortunately, other than liver transplantation, no therapy that is currently available has been proven to alter the natural history of PSC or prolong survival. Ursodeoxycholic acid is currently the most promising pharmacologic treatment option for slowing disease progression and should be used in higher than usual doses (20 to 30 mg/kg/d). Treatment of symptoms due to cholestasis, such as pruritis and steatorrhea, is an important aspect of the medical care of patients with PSC. Our preferred treatment of pruritis due to cholestasis is with bile acid binding exchange resins such as cholestyramine or colestipol (which is generally better tolerated than cholestyramine). Endoscopic therapy should be reserved for patients with obstructive jaundice, cholangitis, or symptomatic dominant biliary strictures. We recommend dilation of dominant strictures with graduated or balloon dilators followed by temporary stenting if the postdilation cholangiographic appearance is not improved or adequate biliary drainage cannot be assured. There is indirect evidence that the combination of ursodeoxycholic acid and endoscopic therapy to maintain biliary patency may improve transplant-free survival in patients with PSC, although this remains to be proven. Liver transplantation remains the only effective treatment of advanced PSC, and should be considered in patients with complications of cirrhosis or intractable pruritis or fatigue.
机译：炎症性肠病患者最常见的胆道疾病是原发性硬化性胆管炎（PSC）。这种疾病的治疗是多方面的，并且经常需要采用多学科方法，涉及内科医生，营养学家，肠胃病学家和外科医生。不幸的是，除肝移植外，目前尚无其他疗法能改变PSC的自然病史或延长生存期。熊去氧胆酸是目前最有希望的减缓疾病进展的药物治疗方法，应以高于通常的剂量（20至30 mg / kg / d）使用。由胆汁淤积引起的症状的治疗，例如瘙痒和脂肪泻，是PSC患者医疗保健的重要方面。由于胆汁淤积，我们首选的治疗胆汁炎的方法是使用胆汁酸结合交换树脂，例如胆甾醇胺或胆甾醇（通常比胆甾醇胺耐受性更好）。对于梗阻性黄疸，胆管炎或有症状性胆道狭窄的患者，应保留内镜治疗。如果扩张后的胆管造影外观没有改善或无法确保足够的胆道引流，我们建议先用分级扩张器或球囊扩张器扩张优势狭窄，然后暂时置入支架。有间接证据表明，熊去氧胆酸和内镜治疗相结合以维持胆道通畅可能会改善PSC患者的无移植生存期，尽管这仍有待证明。肝移植仍然是晚期PSC的唯一有效治疗方法，对于有肝硬化，顽固性瘙痒或疲劳的患者应考虑肝移植。

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