Author/Editor     Ferkolj, Ivan
Title     Novosti v zdravljenju kronične vnetne črevesne bolezni
Translated title     What is new in therapy of inflammatory bowel disease
Type     članek
Source     Med Razgl
Vol. and No.     Letnik 40, št. Suppl 1
Publication year     2001
Volume     str. 33-6
Language     slo
Abstract     The goal of treating acute exacerbations of ulcerative colitis is to induce remission. Therapy should begin with an assessment of disease localisation, extent, severity and response to prior treatments. Mild to moderately active disease should be treated with oral mesalazine 3-4.5 g daily; while moderate to severe extensive colitis requires corticosteroid therapy. Distal disease can be treated either with topical mesalazine or topical corticosteroids or a combination of both. Severe to fulminant colitis requires hospitalisation and parenteral administration of corticosteroids. For ulcerative colitis, patients should be given 5-ASA compounds (mesalazin 2-3 g daily), which are very effective in the maintenance of remission. The medications which are used to treat acute exacerbations of Crohn's disease are 5-ASA (3-4.5 g daily), antibiotics (metronidazole and pefloxacine), glucocorticoids and nutritional therapy. An oral controlled-release preparation of budesonide at a dose of 9 mg per day is well-tolerated and effective therapy for active Crohn's disease of the ileum and proximal colon. The development of novel; highly effective forms of therapy such as infliximab, a monoclonal antibody against TNF alpha; has shown dramatic efficacy in the treatment of Crohn's disease. The efficacy of mesalazine or other 5-ASA compounds in maintaining remission or prevention of postoperative recurrence for patients with Crohn's disease is not as effective as in ulcerative colitis.
Summary     Osnovni namen internističnega zdravljenja kronične vnetne črevesne bolezni (KVČB) je prekinitev njenega akutnega zagona in vzpostavitev remisije. Poznati moramo anatomsko lego vnetnih sprememb, razširjenost bolezni; njeno aktivnost in uspešnost morebitnih predhodiuh zdravljenj. Blag in zmerno aktiven ulcerozni kolitis zdravimo z mesalazinom 3-4,5 g dnevno, zmerno in hudo aktivno bolezen pa s kortikosteroidi. Distalno obliko bolezni lahko zdravimo lokalno tudi z mesalazinom, kortikosteroidi ali kombinacijo obeh. Bolniki s težko potekajočim ulceroznim kolitisom potrebujejo hospitalizacijo in kortikosteroide parenteralno. Remisijo ulceroznega kolitisa uspešno vzdržujemo z mesalazinom 2-3 g dnevno: Za zdravljenje akutnega zagona Crohnove bolezni uporabljamo mesalazin 3-4,5 g dnevno, najpogasteje pa kortikosteroide, včasih tudi antibiotike in različne oblike podpornega zdravljenja. Pri zdravljenju ileokolične bolezni je zelo učinkovit tudi novi kortikosteroid budezonid. Med najnovejšimi zdravili največ obeta enkratna kratkotrajna infuzija protiteles proti TNF-alfa (Inf-liximab), ki pri večini bolnikov zelo hitro in učinkovito zmanjša aktivnost bolezni, žal pa se po nekaj mesecih aktivnost zopet povrne. Vzdrževanje remisije pri Crohnovi bolezni ni tako uspešno kot pri ulceroznem kolitisu; uporabljamo pa mesalazin ali azatioprin.
Descriptors     INFLAMMATORY BOWEL DISEASES
COLITIS, ULCERATIVE
CROHN DISEASE
SULFASALAZINE
CYCLOSPORINE
METRONIDAZOLE