Evidence-Based Treatment for a Patient with Ulcerative Colitis_Chinese Journal of Evidence-Based Medicine

Authors：

WU ZongYing , WANG YiPing

Department of Digestic Medicine of West China Hospital; Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Ulcerative colitis; 5-aminosalicyclic acid enemas; Evidence-based treatment; Side-effects

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目的　针对近期收治的1例常规治疗疗效不理想的溃疡性结肠炎患者,我们进行了证据检索和评价,以期找到更有效的治疗方法.
方法　计算机检索MEDLINE(1978～2004)、CBMdisc(1978～2004)及Cochrane图书馆(2004年第3期),查找 5-氨基水杨酸(5-ASA)灌肠液治疗溃疡性结肠炎及与病情缓解有关的系统评价、临床随机对照试验等,并对所获证据进行评价.
结果　高质量的临床证据表明,5-ASA灌肠液治疗溃疡性结肠炎及帮助病情缓解均优于口服5-ASA及柳氮磺胺嘧啶局部灌肠治疗.据此临床证据,结合医生经验及病人意愿,对该例患者实施5-ASA 1g+生理盐水100 ml qd,睡前保留灌肠治疗.1周后,患者临床症状明显缓解,腹泻基本停止,每天解黄色黏液便1～2次.肠镜复查,炎症较前明显减轻.出院后继续用上述方案维持治疗,每周2次.门诊随访1年,患者未再复发,也无明显副作用发生.
结论　5-ASA灌肠液是控制溃疡性结肠炎活动期间病情及帮助缓解、减少复发的有效药物.

Citation： WU ZongYing,WANG YiPing. Evidence-Based Treatment for a Patient with Ulcerative Colitis. Chinese Journal of Evidence-Based Medicine, 2005, 05(7): 571-573. doi: Copy

1.	Lloyd RS, Francois M, Scott G, Malcolm R, Norton G, Fred S, Thomas M, Joseph S, Ed Prokipchuk, Lowell B. 5-aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis and proctitis[J]. Gastroenterology, 1987; 92(35): 1894-1898.
2.	Cobden I, al-Mardini H, Zaitoun A, Record CO. Is topical therapy necessary in acute distal colitis? Double-bind comparison of high-dose oral mesalazine versus steroid enemas in the treatment of active distal ulcerative colitis[J]. Aliment Pharmacol Ther, 1991; 5(5): 513-522.
3.	Lori K, Hartley C, Cornelius D, Peter R, John Orchard. A comparison of mesalamine suspention enema and oral sulfasalazine for treatment of active distal ulcerative colitis in adults[J]. The American Journal of Gastroenterology, 1995; 90(5): 736-739.
4.	Bianchi PG, Ardizzone S, Petrillo M, Fasoli A, Molteni P, Imbesi V. Low pentasa dosage versus hydrocortisone in the topical treatment of active ulcerative colitis: a randomized, double-blind study[J]. The American Journal of Gastroenterology, 1995; 90(5): 736-739.
5.	Campieri M, Lanfranchi GA, Bazzocchi G, Brignola C, Sarti F, Franzin G, Battocchia A, Labo G, Dal MontePR. Treatment of ulcerative colitis with high-dose 5-aminosalicyclic acid enemas[J]. Lancet, 1981; 45(8): 270-271.
6.	Mulder CJ, Tytgat GN, Wiltink EH, Houthoff HJ. Comparison of 5-aminosalicyclic acids and prednisolone phosphate sodium enema in the treatment of distal ulcerative colitis. A prosective, randomized, double-blind trial[J]. Scandinavian Journal of Gastroenterology, 1988; 23(8): 1005-1008.
7.	Gionhetti P, Ardizzine S, Benvenuti ME. A new mesalazine gel enema in the treatment of left-sided ulcerative colitis: a randomized controlled multicenter trial[J]. Aliment Phamacol Ther, 1999; 13(3): 381-388.
8.	Danish 5-ASA Group. Topical 5-aminoalicyclic acid versus prednisolone in ulcerative proctosigmoiditis. A randomized double blind multicenter trial[J]. Dig Dis Sci, 1987; 32(6): 598-602.
9.	Campieri M, Gionchetti P, Benizzi A, Brigola C, Tampieri M, Lannone P, Miglioli M, Barbara L. Optimun dosage of 5-aminoalicyclic acid as rectal enemas in patient with active ulcerative colitis[J]. Gut,1991;32(8):929-931.
10.	Sutherland L, Macdonald JK. Oral 5-aminoalicyclic acid for induction of remission in ulcerative colitis(Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
11.	Russell DC, Douglas MW, Ronald AT, Thisted, Stephen B, Hanauer. A meta analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis[J]. The American Journal of Gastroenterology, 2000; 95(5): 1263-1276.
12.	Gerassimos JM, Athanassions H, Kalliopi P, Charis S, Georgios T. Intermittent therapy with high-dose 5-aminosalicyclic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis[J]. Dis Colon Rectum, 1994; 37(23): 58-62.
13.	Andreoli A, Spinena S, Levenstein S, Prantera C. 5-aminoalicyclic acid enema versus oral sulphasazine in maintaining remission in ulcerative colitis[J]. Italian Journal of Gastroenterology, 1994; 26(3): 121-125.
14.	Biddle WL, Greenberger NJ, Swan JT, Mcphee MS, Miner PB. 5-aminoalicyclic acid enemas: effective agent in maintaining remission in left-sided ulcerative colitis[J]. Gastroenterology, 1988; 94(4): 1075-1079.
15.	Albasio G, Pacini F, Camarri E, Messori A, Trauori G, Bonanomi AG, Bardazzi G, Milla M, Ferrero S, Biaginim, Quaranta S, Amorosi A. Combined therapy with 5-aminoalicyclic acid tablets and enemas for maintaining remission in ulcerative colitis: a randomized double-blind study[J]. American Journal of Gastroenterology, 1997; 92(7): 11143-11147.
16.	Sutherland L, Roth D, Beck P, Makiyama K. Role of 5-aminoalicyclic acid for maintenance of remission in ulcerative colitis(Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
17.	Gisbert JP, Gomollon F, Pajares JM. Role of 5-aminoalicyclic acid(5-ASA) in the treatment of inflammatory bowel disease: a systematic review[J]. Digestive Disease and Science, 2002; 47(3): 471-488.

1. Lloyd RS, Francois M, Scott G, Malcolm R, Norton G, Fred S, Thomas M, Joseph S, Ed Prokipchuk, Lowell B. 5-aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis and proctitis[J]. Gastroenterology, 1987; 92(35): 1894-1898.
2. Cobden I, al-Mardini H, Zaitoun A, Record CO. Is topical therapy necessary in acute distal colitis? Double-bind comparison of high-dose oral mesalazine versus steroid enemas in the treatment of active distal ulcerative colitis[J]. Aliment Pharmacol Ther, 1991; 5(5): 513-522.
3. Lori K, Hartley C, Cornelius D, Peter R, John Orchard. A comparison of mesalamine suspention enema and oral sulfasalazine for treatment of active distal ulcerative colitis in adults[J]. The American Journal of Gastroenterology, 1995; 90(5): 736-739.
4. Bianchi PG, Ardizzone S, Petrillo M, Fasoli A, Molteni P, Imbesi V. Low pentasa dosage versus hydrocortisone in the topical treatment of active ulcerative colitis: a randomized, double-blind study[J]. The American Journal of Gastroenterology, 1995; 90(5): 736-739.
5. Campieri M, Lanfranchi GA, Bazzocchi G, Brignola C, Sarti F, Franzin G, Battocchia A, Labo G, Dal MontePR. Treatment of ulcerative colitis with high-dose 5-aminosalicyclic acid enemas[J]. Lancet, 1981; 45(8): 270-271.
6. Mulder CJ, Tytgat GN, Wiltink EH, Houthoff HJ. Comparison of 5-aminosalicyclic acids and prednisolone phosphate sodium enema in the treatment of distal ulcerative colitis. A prosective, randomized, double-blind trial[J]. Scandinavian Journal of Gastroenterology, 1988; 23(8): 1005-1008.
7. Gionhetti P, Ardizzine S, Benvenuti ME. A new mesalazine gel enema in the treatment of left-sided ulcerative colitis: a randomized controlled multicenter trial[J]. Aliment Phamacol Ther, 1999; 13(3): 381-388.
8. Danish 5-ASA Group. Topical 5-aminoalicyclic acid versus prednisolone in ulcerative proctosigmoiditis. A randomized double blind multicenter trial[J]. Dig Dis Sci, 1987; 32(6): 598-602.
9. Campieri M, Gionchetti P, Benizzi A, Brigola C, Tampieri M, Lannone P, Miglioli M, Barbara L. Optimun dosage of 5-aminoalicyclic acid as rectal enemas in patient with active ulcerative colitis[J]. Gut,1991;32(8):929-931.
10. Sutherland L, Macdonald JK. Oral 5-aminoalicyclic acid for induction of remission in ulcerative colitis(Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
11. Russell DC, Douglas MW, Ronald AT, Thisted, Stephen B, Hanauer. A meta analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis[J]. The American Journal of Gastroenterology, 2000; 95(5): 1263-1276.
12. Gerassimos JM, Athanassions H, Kalliopi P, Charis S, Georgios T. Intermittent therapy with high-dose 5-aminosalicyclic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis[J]. Dis Colon Rectum, 1994; 37(23): 58-62.
13. Andreoli A, Spinena S, Levenstein S, Prantera C. 5-aminoalicyclic acid enema versus oral sulphasazine in maintaining remission in ulcerative colitis[J]. Italian Journal of Gastroenterology, 1994; 26(3): 121-125.
14. Biddle WL, Greenberger NJ, Swan JT, Mcphee MS, Miner PB. 5-aminoalicyclic acid enemas: effective agent in maintaining remission in left-sided ulcerative colitis[J]. Gastroenterology, 1988; 94(4): 1075-1079.
15. Albasio G, Pacini F, Camarri E, Messori A, Trauori G, Bonanomi AG, Bardazzi G, Milla M, Ferrero S, Biaginim, Quaranta S, Amorosi A. Combined therapy with 5-aminoalicyclic acid tablets and enemas for maintaining remission in ulcerative colitis: a randomized double-blind study[J]. American Journal of Gastroenterology, 1997; 92(7): 11143-11147.
16. Sutherland L, Roth D, Beck P, Makiyama K. Role of 5-aminoalicyclic acid for maintenance of remission in ulcerative colitis(Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
17. Gisbert JP, Gomollon F, Pajares JM. Role of 5-aminoalicyclic acid(5-ASA) in the treatment of inflammatory bowel disease: a systematic review[J]. Digestive Disease and Science, 2002; 47(3): 471-488.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment for a Patient with Ulcerative Colitis

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