Tom 10, Nr 1 (2018)
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Opublikowany online: 2018-08-13
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Czy można przewidzieć przebieg choroby Leśniowskiego-Crohna? Jak reagować?
Gastroenterologia Kliniczna 2018;10(1):32-38.
Streszczenie
Przebieg kliniczny choroby Leśniowskiego-Crohna (ChLC) jest bardzo zróżnicowany. U dużej części chorych schorzenie ma bardzo ciężki, agresywny przebieg, prowadzący do znacznego uszkodzenia przewodu pokarmowego — wskutek zwężeń, przetok i następstw koniecznych zabiegów operacyjnych. Chorzy ci wymagają od początku intensywnego leczenia w tym leków biologicznych i/lub immunosupresyjnych do indukowania i podtrzymania remisji i zapobieżenia w/w zmianom destrukcyjnym. U około 40% pacjentów przebieg jest jednak łagodny z długimi okresami remisji u około 10–20% niewymagającymi nawet leczenia podtrzymującego. W grupie tej stosowanie leków biologicznych i/ lub immunosupresyjnych nie jest uzasadnione. Taka terapia niepotrzebnie naraża ich na poważne niekiedy objawy niepożądane i łączy się z bardzo wysokimi kosztami. Określenie czynników predykcyjnych ciężkiego przebiegu ChLC pozwala na stratyfikację pacjentów i wybór odpowiedniego postępowania leczniczego. Czynnikami wskazującymi na możliwość agresywnego przebiegu choroby są między innymi: wiek poniżej 40 lat w momencie rozpoznania, konieczność stosowania glikokortykosteroidów już przy pierwszym zaostrzeniu, zmiany okołoodbytowe, lokalizacja w jelicie cienkim i górnym odcinku przewodu pokarmowego, ciężkie zmiany endoskopowe i palenie tytoniu. Znaczenie predykcyjne mają także: mutacje w genie NOD2/Card15 oraz obecność przeciwciał przeciwko antygenom bakteryjnym takich jak ASCA (anti- Saccharomycescerevisiae).
Słowa kluczowe: choroba Leśniowskiego-Crohnaprzebieg klinicznyczynniki predykcyjne
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