背景:尽管直肠中存在神经节细胞,一些患者的症状与先天性巨结肠相似。关于这些疾病的术语尚未达成共识。我们将这组疾病定义为“先天性巨结肠病的相关疾病”,并编制了这些指南,以促进临床医生的准确诊断并为每种疾病提供适当的治疗策略。
方法:这些指南是使用医学信息网络分发系统(MINDS)中的方法制定的。在七种相关疾病中,孤立性神经节减少症;巨细胞-微结肠-肠蠕动综合征;和慢性特发性肠假性梗阻被选择为临床问题(CQ)的目标。在对PubMed和Ichu-ShiWeb上的日语和英语文章的全面搜索中,从288篇文章中提取了836条与CQ相关的证据;这些证据在证据表中进行了总结。
结果:我们在此概述了新建立的日本Hirschsprung病相关疾病的临床实践指南。鉴于目标疾病是罕见且棘手的,大多数证据来自病例报告和病例系列。在CQ中,诊断,药物,营养支持,手术治疗,并给出每种疾病的预后。我们强调全层肠活检标本对肠神经节组织病理学评估的重要性。考虑到准则的实用性,每个CQ的建议都是通过专家之间的长时间讨论而制定的。
结论:每个CQ都给出了Hirschprung病相关疾病的临床实践建议,以及对当前证据的评估。我们希望这些信息将有助于日常实践和未来的研究。
BACKGROUND: Despite the presence of ganglion cells in the rectum, some patients have symptoms similar to those of Hirschsprung\'s disease. A
consensus has yet to be established regarding the terminology for these diseases. We defined this group of diseases as \"allied disorders of Hirschsprung\'s disease\" and compiled these
guidelines to facilitate accurate clinician diagnosis and provide appropriate treatment strategies for each disease.
METHODS: These
guidelines were developed using the methodologies in the Medical Information Network Distribution System (MINDS). Of seven allied disorders, isolated hypoganglionosis; megacystis-microcolon-intestinal hypoperistalsis syndrome; and chronic idiopathic intestinal pseudo-obstruction were selected as targets of clinical questions (CQ). In a comprehensive search of the Japanese- and English-language articles in PubMed and Ichu-Shi Web, 836 pieces of evidence related to the CQ were extracted from 288 articles; these pieces of evidence were summarized in an evidence table.
RESULTS: We herein outline the newly established Japanese clinical practice
guidelines for allied disorders of Hirschsprung\'s disease. Given that the target diseases are rare and intractable, most evidence was drawn from case reports and case series. In the CQ, the diagnosis, medication, nutritional support, surgical therapy, and prognosis for each disease are given. We emphasize the importance of full-thickness intestinal biopsy specimens for the histopathological evaluation of enteric ganglia. Considering the practicality of the
guidelines, the recommendations for each CQ were created with protracted discussions among specialists.
CONCLUSIONS: Clinical practice recommendations for allied disorders of Hirschprung\'s disease are given for each CQ, along with an assessment of the current evidence. We hope that the information will be helpful in daily practice and future studies.