PDF(Pubmed)
Abstract：
Background/Objectives: The treatment of patients with mild-to-moderate ulcerative colitis (UC) is challenging. Although there are commonly used guidelines, therapy optimization is not standardized. We conducted a survey to investigate the management and treatment of patients with mild-to-moderate UC. Methods: Physicians with experience in treating inflammatory bowel diseases (IBD) were invited to participate in an anonymous, multiple-choice survey between June and July 2023. The survey addressed various issues of patient care such as patient monitoring, treatment optimization, follow-up, treatment decision making, and therapy de-escalation. Results: The survey included 222 physicians (59.9% men; mean age = 50.4 years) from 66 countries worldwide. Gastroenterologists were the most represented specialists (89.6%), followed by surgeons (3.2%), and internal medicine doctors (2.7%). Two-thirds of the participants (66.7%) had >10 years of experience in the field of IBD. The combination of oral (≥4 g/day) and rectal 5-aminosalicylic acid (5-ASA) was the preferred choice when optimizing therapy. Budesonide MMX (41.8%) and systemic steroids (39.9%) were preferred in patients who failed 5-ASA. Treatment decisions were predominantly based on endoscopic (99.0%) or clinical (59.8%) activity. A significant percentage of clinicians did not optimize therapy in the case of increased fecal calprotectin alone (45.1%) or radiological/ultrasound activity (39.8%) alone. Conclusions: The guidelines for the management of mild-to-moderate UC are well accepted in clinical practice. Endoscopic remission remains the main therapeutic target, followed by clinical remission. Fecal calprotectin and intestinal ultrasound still elicit complaints from physicians.
摘要：
背景/目标：轻度至中度溃疡性结肠炎（UC）患者的治疗具有挑战性。虽然有常用的指导方针，治疗优化不规范。我们进行了一项调查，以调查轻中度UC患者的管理和治疗。方法：邀请有治疗炎症性肠病（IBD）经验的医生参加匿名，2023年6月至7月的多项选择调查。该调查解决了患者护理的各种问题，例如患者监测，治疗优化，后续行动,治疗决策，和治疗降级。结果：调查包括来自全球66个国家的222名医生（59.9％的男性；平均年龄=50.4岁）。胃肠病学家是代表最多的专家(89.6%)，其次是外科医生(3.2%)，和内科医生(百分之二点七)。三分之二的参与者(66.7%)在IBD领域有>10年的经验。优化治疗时，口服（≥4g/天）和直肠5-氨基水杨酸（5-ASA）的组合是首选。布地奈德MMX（41.8％）和全身性类固醇（39.9％）在5-ASA失败的患者中是首选。治疗决定主要基于内窥镜（99.0％）或临床（59.8％）活性。在单独增加粪便钙卫蛋白（45.1％）或单独增加放射学/超声活动（39.8％）的情况下，相当比例的临床医生没有优化治疗。结论：轻中度UC的治疗指南在临床实践中被广泛接受。内镜缓解仍是主要的治疗靶点,其次是临床缓解。粪便钙卫蛋白和肠道超声仍然引起医生的抱怨。
