cover of episode Real-world Insights into Crohn's, Ulcerative Colitis and other Gastro-Intestinal disorders.

Real-world Insights into Crohn's, Ulcerative Colitis and other Gastro-Intestinal disorders.

2024/9/14
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Aussie Med Ed- Australian Medical Education
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Gavin Diamond
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Jane Andrews
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Gavin Diamond: 我作为一名骨科医生,对炎症性肠病(IBD)和肠易激综合征(IBS)的区别感到困惑,希望Jane Andrews教授能解释清楚IBD和IBS的区别,以及克罗恩病和溃疡性结肠炎的病理特征和症状表现,并探讨IBD的诊断工具、治疗进展以及与IBS和麸质不耐受等相关疾病的关系。 Jane Andrews: IBD和IBS的区别在于,IBD是一种炎症性疾病,伴有炎症和组织损伤;而IBS的症状很多,但没有明显的组织损伤,更像是脑肠功能障碍。IBD主要包括克罗恩病和溃疡性结肠炎两种临床实体。克罗恩病是肠道的全层炎症,会引起狭窄、穿孔和瘘管形成等并发症;溃疡性结肠炎只影响大肠,主要累及肠黏膜层。克罗恩病的特征性病变是非干酪样肉芽肿,而溃疡性结肠炎的病变通常从直肠开始,连续向上扩展。克罗恩病和溃疡性结肠炎的症状表现取决于疾病部位,累及大肠的克罗恩病和溃疡性结肠炎症状相似,常表现为腹痛、大便次数增多、里急后重和便血。克罗恩病常累及回肠,患者可能出现梗阻性症状,如餐后腹痛、腹胀、腹泻等。 鉴别诊断炎症性肠病(IBD)的首要考虑是感染,因为感染更为常见。即使是已知患有克罗恩病或溃疡性结肠炎的患者,每次复发都必须排除感染的可能性。IBD的鉴别诊断还包括肠易激综合征(IBS)和缺血性结肠炎。粪便钙卫蛋白水平升高提示肠道炎症,有助于鉴别IBS和IBD。缺血性结肠炎通常先出现腹痛,然后出现便血和腹泻;而IBD通常先出现腹泻,然后出现便血,腹痛是晚期症状。克罗恩病的发病高峰年龄在29-39岁之间,但10%的患者在18岁以下被诊断,18岁以下诊断的患者往往病情更严重。克罗恩病的发病年龄呈双峰分布,还有一个高峰出现在60-70岁之间,这与发病率的上升和患者寿命的延长有关。克罗恩病患者寿命延长是多因素造成的,包括整体寿命延长和更好的治疗方法。溃疡性结肠炎的治疗取得了重大进展,例如糖皮质激素的应用和单克隆抗体的出现,显著改善了患者预后。随着年龄增长,长期使用硫嘌呤类药物(如硫唑嘌呤)的患者淋巴瘤和皮肤癌风险增加。尽管新型药物价格昂贵,但从成本效益角度来看,它们对患者生活质量的改善是值得的。炎症性肠病(IBD)发病率上升并非基因改变所致,而是多基因疾病,环境因素(暴露组)起重要作用。健康的生活方式,如食用新鲜水果蔬菜、接触自然环境、母乳喂养等,可以降低炎症性肠病(IBD)的风险;而高脂肪、高糖饮食则会增加风险。肠道菌群在炎症性肠病(IBD)的发病中起着重要作用。肠道是内外环境的屏障,富含各种信使物质,肠道黏膜免疫系统与体内环境之间存在复杂的相互作用。炎症性肠病(IBD)的病因尚不清楚,可能是多种因素共同作用的结果,可能与个体因素、环境因素和生活方式选择有关。采取公共卫生措施,对公众进行健康教育,有助于降低炎症性肠病(IBD)的发病风险。 Jane Andrews: 炎症性肠病(IBD)可伴有肠外表现,例如眼部疾病、皮肤病和关节病等。IBD的肠外表现包括虹膜炎、巩膜炎、口腔溃疡、皮肤病(如坏疽性脓皮病和结节性红斑)和关节炎等。坏疽性脓皮病的诊断通常不需要活检,照片即可确诊。结节性红斑是炎症性肠病(IBD)的另一种特征性皮肤表现,表现为小腿前部出现疼痛性结节。炎症性肠病(IBD)的肠外表现通常与肠道炎症活动同步出现。坏疽性脓皮病和结节性红斑是炎症性肠病(IBD)的特征性肠外表现。炎症性肠病(IBD)的诊断评估应根据患者的症状和体征进行,包括粪便钙卫蛋白、血常规、铁代谢指标、肝功能等检查。如果粪便钙卫蛋白和血常规正常,患者症状不明显,则可能为肠易激综合征(IBS),无需进一步检查。如果粪便钙卫蛋白和血常规异常,则需要进一步检查,包括铁代谢指标和肝功能等。肠道超声或磁共振肠道造影检查有助于评估回肠疾病;结肠镜检查有助于获取组织样本进行病理学检查。结肠镜检查是炎症性肠病(IBD)诊断中最常用的检查方法,尤其是在患者出现结肠炎症状或便血时。结肠镜检查可以获取组织样本,以排除其他疾病,如巨细胞病毒感染、艰难梭菌感染或癌症。炎症性肠病(IBD)的治疗目标是诱导缓解并维持缓解,治疗方案取决于疾病类型、部位和严重程度。粪便钙卫蛋白和C反应蛋白水平可以用来监测炎症性肠病(IBD)的治疗效果。溃疡性结肠炎患者在达到缓解后,通常一年进行一次结肠镜检查;如果疾病持续8年以上或伴有原发性硬化性胆管炎,则需要每年进行结肠镜检查以进行癌症筛查。克罗恩病患者通常不需要常规进行胃镜检查,除非有症状;如果结肠受累超过三分之一,则需要进行结直肠癌筛查。炎症性肠病(IBD)的治疗包括基础治疗和高级治疗,基础治疗包括5-氨基水杨酸(5-ASA)制剂和糖皮质激素;高级治疗包括生物制剂和JAK抑制剂。5-氨基水杨酸(5-ASA)制剂局部用药(灌肠、直肠栓剂或泡沫剂)可加速溃疡性结肠炎患者缓解。5-氨基水杨酸(5-ASA)制剂可用于溃疡性结肠炎的诱导缓解和维持缓解,局部用药适用于直肠炎患者。糖皮质激素可用于快速缓解溃疡性结肠炎,但应与其他治疗方案联合使用。随着年龄增长,长期使用硫嘌呤类药物(如硫唑嘌呤)的患者淋巴瘤和皮肤癌风险增加。手术治疗在溃疡性结肠炎和克罗恩病中均可能需要,手术方案取决于疾病的严重程度和部位。

Deep Dive

Chapters
This chapter clarifies the core distinction between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). IBD involves inflammation and tissue damage, while IBS is characterized by symptoms without such damage, suggesting brain-gut dysfunction.
  • IBD is an inflammatory disease with tissue damage.
  • IBS is a syndrome with symptoms but no obvious tissue damage.
  • The difference lies in the presence or absence of inflammation and tissue damage.

Shownotes Transcript

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Ever wondered what really sets Inflammatory Bowel Disease (IBD) apart from Irritable Bowel Syndrome (IBS)? Join Dr Gavin Nimon) ( Orthopaedic Surgeon and host) as he explores this complex topic with expert gastroenterologist, Professor Jane Andrews. You'll gain a deep understanding of the crucial differences between Crohn's disease and ulcerative colitis, including their unique pathological features and symptomatic presentations. Discover why it's essential to distinguish IBD from other conditions like gastroenteritis, and how these insights can lead to better patient care and management.Professor Andrews takes us through the fascinating genetic and pathological nuances of IBD, offering a detailed look at the characteristic non-caseating granulomas of Crohn's disease and the chronic inflammation of ulcerative colitis. We’ll discuss diagnostic tools, the importance of comprehensive clinical evaluation, and the latest advancements in treatment, including the role of biologics, JAK inhibitors, and the ever-evolving field of gut microbiome research. Gain valuable knowledge about the demographic trends in IBD, the impact of diet and lifestyle, and the promising future of patient care.Finally, listen in as we explore the real-world implications of monitoring and treating IBD, from the significance of regular surveillance to the multidisciplinary approach required for managing severe cases. Professor Andrews shares insights on the collaborative efforts between gastroenterologists and colorectal surgeons, and the critical balance needed in using immunosuppressants. We also touch upon related conditions like IBS and gluten intolerance, offering practical advice for patients dealing with these often-misunderstood issues. Whether you are a medical professional or someone affected by these conditions, this episode is packed with essential information and expert guidance.

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