补铁治疗不仅能纠正贫血,还可能影响IBD的病程。今年8月,日本前首相安倍晋三因溃疡性结肠炎复发宣布辞职。一时间,炎症性肠病(IBD)备受关注。IBD是一组累及大小肠,最终导致黏膜溃疡和出血的慢性复发性炎症性疾病,西方化国家发病率较高。IBD本就棘手,有“绿色癌症”之称,如果IBD再遇上这种并发症,更是雪上加霜。病例介绍 患者男性,34岁。一年前无明显诱因出现右下腹阵发性钝痛,伴有腹泻,每天2-3次,无明显脓血粘液。 于当地医院行肠镜:结肠肝曲可见环周多发息肉增生,黏膜桥形成,局部粘膜纠集,浅溃疡形成,周围肿胀充血,管腔狭窄,内镜无法通过。
此外,对于小肠病变/切除的患者,应至少每年测量一次血清维生素B12和叶酸,广泛小肠切除、回肠贮袋手术或广泛回肠受累的患者应进一步增加频率。
▎口服铁剂 贫血是IBD最常见的肠外表现,其主要原因是铁缺乏。虽然强化原发病的管理能防止铁进一步丢失,但仍需铁替代治疗以满足生理功能,疗程结束后必须定时监测贫血复发情况。补铁治疗不仅能纠正贫血,还可能影响IBD的病程。 参考文献: [1]Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390(10114):2769–78. [2]Filmann N, Rey J, Schneeweiss S, Ardizzone S, Bager P, Bergamaschi G, et al. Prevalence of anemia in inflammatory bowel diseases in European countries: a systematic review and individual patient data meta-analysis. Inflamm Bowel Dis. 2014;20(5):936–45. [3]Weiss G. Anemia of chronic disorders: new diagnostic tools and new treatment strategies.Semin Hematol. 2015;52(4):313–20. [4]Evstatiev R, Gasche C. Iron sensing and signalling. Gut. 2012 Jun;61(6):933–52. [5]Dignass AU, Gasche C, Bettenworth D, Birgegard G, Danese S, Gisbert JP, et al.; European Crohn’s and Colitis Organisation [ECCO]. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015;9(3):211–22. [6]World Health Organization, Centers for Disease Control and Prevention. Assessing the iron status of populations. 2nd ed. Geneva, Switzerland; 2007. [7]Cancelo-Hidalgo MJ, Castelo-Branco C, Palacios S, Haya-Palazuelos J, Ciria-Recasens M,Manasanch J, et al. Tolerability of different oral iron supplements: a systematic review. Curr Med Res Opin. 2013 ;29(4):291–303. [8]Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One. 2015;10(2):e0117383. [9]Bonovas S, Fiorino G, Allocca M, Lytras T, Tsantes A, Peyrin-Biroulet L, et al. Intravenous versus oral iron for the treatment of anemia in inflammatory bowel disease: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016;95(2):e2308. [10]Reinisch W, Staun M, Tandon RK, Altorjay I, Thillainayagam AV, Gratzer C, et al. A randomized,open-label, non-inferiority study of intravenous iron isomaltoside 1,000 (Monofer) compared with oral iron for treatment of anemia in IBD (PROCEED). Am J Gastroenterol. 2013;108(12):1877–88. [11]European Medicines Agency: Ema/579491/2013 new recommendations to manage risk of allergic reactions with intravenous iron-containing medicines, 2013, 2018. [12]Stein J, Hartmann F, Dignass AU. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol. 2010;7(11):599–610. [13]Jimenez KM, Gasche C. Management of Iron Deficiency Anaemia in Inflammatory Bowel Disease. Acta Haematol. 2019;142(1):30-36. |
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