炎症性肠病面临的问题与挑战

炎症性肠病：面临的问题与挑战,Increasing cumulative number of ulcerative colitis and Crohns disease patients in Japan during a 17-year period according to the national registry maintained by the Ministry of Health, Labor and Welfare of the Japanese government,Yao T, Matsui T, et al. Dis Colon Rectum 2000;,Age- and sex-adjusted annual incidence ofCD and UC in the Songpa-Kangdongdistrict, Seoul, 19862005.,Yang SK, et al. Inflamm Bowel Dis 2008,New Cases （香港）,Leong Inflamm Bowel Dis 2004,0,5,10,15,20,25,30,35,85,86-89,90-92,93-95,96-98,99-01,Year,New Cases,Ulcerative colitisn= 121,Crohns diseasen = 80,Annual Incidence of IBD in Hong Kong,0,0.2,0.4,0.6,0.8,1,1.2,1.4,0.05Endoscopic healing 26.9 2.9 0.05Side effect(%) 1.9 10.8 0.05Effect(%) 47.0 63.3No effect(%) 14.0 23.4 Adverse event(%) 20.0 33.3 0.05Effect(%) 35.1 32.6No effect(%) 15.8 23.3 Adverse event(%) 8.8 30.2 0.05* at week 8,Treatment of CD,Analysis of 515 CD patients - Aminsalicylates: 57.67% - Corticosteroids: 28.74% - Immunopressants: 4.66% - Antibiotics: 45.63% - Chinese medicine: 14.25% - Surgical treatment: 33.2%,J Gastroenterol Hepatol 2006; 21:1009,治疗 UC：5-ASA、皮质激素、免疫调节剂疗程、适应症、疗效、副反应 CD： 生物制剂的应用黏膜愈合作为新的疗效标准？上阶梯疗法与下阶梯疗法 维持治疗的方法？长期维持或过度到免疫抑制剂？ 长期治疗的担心：肿瘤发生率是否升高？,IBD 面临的问题与挑战,中外有关IBD的共识意见,中国炎症性肠病协作组. 对我国炎症性肠病诊断治疗规范的共识意见(2007)Carter M J，et al. Guidelines for the management of inflammatory bowel disease in adults. Gut,2004,53(9):V1-16(英国)Travis S P L, et al. European evidence based consensus on the diagnosis and management of Crohns disease: current managementJ. Gut,2006,55(suppe 1):i16-i35(欧洲)Lichtenstein G R, et al. American Gastroenterological Association Institute Medical Position Statement on Corticosteroids, Immunomodulators,and Infliximab in Inflammatory Bowel Disease. Gastroenterol, 2006, 130(3):935-939；940-987(美国),最新的共识意见,Management of Crohn s Disease in Adults P