克隆氏小冊放網頁用

Size: px

Start display at page:

Download "克隆氏小冊放網頁用"

案詹
5 years ago
Views:

1 Crohn s Disease

2 Table of Contents

3 (Crohn s disease) (Inflammatory bowel disease) (incidence rate) (Crohn s disease) (Inflammatory bowel disease) 3 4

4 % * * (heterogeneous) / 6

5 (ileocolonoscopy) (segmental lesions) (anorectal lesions) (longitudinal ulcers) (aphthous ulcers) (cobblestone appearance) (Intestinal Tuberculosis) (acid-fast staining) (PCR) 7. fecal calprotectin 8. (CT) (MRI) (Luminal distension)

6 CDAI (Crohn's disease activity index) Healthy Site of disease = 1= 2= 3= ( -21) = 1= 2= 3= 4= ( -28) = 2= = 9 1 X2 X X7 X2 X3 X1

7 hematocrit ( 47%, 42%) ( 1%=1 ) ( 1%=1 ) X6 X1 1 (Erythema nodosum) (Pyoderma gangrenosum) (Aphthous ulcers) 38. (longitudinal ulcers) CDAI 6 <1 >22 >

appearance) A2-17-4 years A3-Over 4 years L2-Colon B2-Stricturing L3-Ileocolon

8 (aphthous ulcers) Montreal (Montreal classification) Age at Diagnosis Location Behaviour A1-16 years or younger L1-Terminal ileum B1-Nonstricturing, nonpenetrating (cobblestone appearance) A years A3-Over 4 years L2-Colon B2-Stricturing L3-Ileocolon B3-Penetrating L4-Upper GI P-Perianal disease modifier Montreal L-category L1 L2 L3 L4 L4+L

9 Montreal B-category B1 B2 B3 B3p Baumgart DC, et al. Crohn s Disease. The Lancet 212;38(983): B (HBsAg) B (anti-hbsab) B (anti-hbcab) HBsAg anti-hbcab HBV DNA HBV DNA B 4. X (Interferon-gamma release assayigra) (Tuberculin skin testtst) X ( IGRA ) P (induction) (maintenance) 1 16

10 Mesalazine (-ASA) 2.2 -ASA budesonide mg/kg 6 mg 28 Methotrexate (MTX) thiopurines MTX Thiopurines ( azathioprine[aza] 6-mercaptopurine [6-MP]) MTX 4.2 (AZA 6-MP MTX)..1.2

11 Mild (CDAI: 1-22) Moderate (CDAI: 22-4) Severe (CDAI: > 4) Induction therapy Oral -ASA (for colonic disease) Budesonide or conventional steroids Systemic steroids.-1.mg/kg (max: 6 mg/day), duration(max: 28 days) Hospitalization, intensive care, IV steroid, parenteral nutrition, surgical consultation antibiotic if needed exclude CMV and C. difficile infection no MTX SC or IM 2 mg/week Response no Response Response Response no Response yes yes yes yes no yes no Biologics no no Response after 3- days yes no Surgery exclude stenosis, abscess, fistula Maintenance therapy Biologics ± Oral -ASA Immunomodulators* Immunomodulators* Immunomodulators* Immunomodulators* Biologics ± Immunomodulators* Induction of remission therapy Recommended treatment pathway Maintenance therapy Alternative treatment pathway for consideration Please note: This algorithm may contain medications/indications currently not approved by TFDA. *MTX maintenance dosage: 1-1 mg/wk 19 2

12 (mucosal healing) (CBC) C-reactive protein (CRP) Erythrocyte sedimentation rate (ESR) (Fecal calprotectin) C-reactive protein (CT) (MRI)

13 MTX -ASA AZA MTX cyclosporine (moderate-to-severe active luminal) (exclusive enteral nutrition) *

14 2.2 * prednisolone 1 mg/kg4 mg/ 1. mg/kg 6 mg/ (active perianal fistula) anti-tnf PCDAI (Pediatric Crohn s disease activity index) 1 = = = / 1 1 = = = = -1 = 2 2- =

15 HCT < 1 ( / ) ( ) 2. = > 33% = 28-32% = < 28% ( ) = 34% = 29-33% = < 29% ESR = < 2 mm/hr = 2- mm/hr = > mm/hr Albumin 1 = 3. g/dl = g/dl = 3. g/dl = 3% = 3-34% = < 3% 1-19 ( ) = 37% = 32-36% = < 32% = / = 1%-9% 1 = 1% (Height at Diagnosis) 1 = < 1 (channel) = 1, < 2 (channel) = >2 (channel) (Height at Follow-Up) 1 1 = -1 = -1~ -2 = -2 = = = 27 28

16 (Perirectal Disease) 1 = None = 1 = 2 CDAI 11 < = ( ) = = (Extraintestinal Manifestations) 38. C 3 (definite arthritis) (uveitis) (Erythema nodosum)(pyoderma gangrenosum) 1. (adenocarcinoma) ( ) thiopurines (lymphoma) (Non-Melanoma Skin Cancer; NMSC) 1. (Fistula)

17 1.2 (AZA/6-MP infliximab adalimumab) 1 2. (stenosis) (symptomatic short fibrotic strictures) (Endoscopic balloon dilation) (stricture-plasty) (intestinal resection) ICD-1-CM/PCS K.-K.919 X 7 (Gastrointestinal drugs) Mesalazine balsalazide 8 (Immunologic agents) Adalimumab Adalimumab 31 32

18 1) -aminosalicylic acid (sulfasalazine, mesalamine, balsalazide) / (azathioprine, 6-mercaptopurine, methotrexate) CDAI 3) 2) -aminosalicylic acid (sulfasalazine, mesalamine, balsalazide) (azathioprine, 6-mercaptopurine, methotrexate) CDAI 1 3) -aminosalicylic acid (sulfasalazine, mesalamine, balsalazide) (azathioprine, 6-mercaptopurine, methotrexate) ( ) CDAI 1 1) adalimumab 8 ( 4 ) I. CDAI 1 II. CDAI 1 2) 16 ( 8 ) CDAI 16 ( 8 ) 3) 6 ( 28 ) 3. (1)(2)(3) (1/1/1) 33 34

19 16mg 8mg4mg 4mg 6 ( 28 ) 1) 2) (active infection) 3) ( ) 4) (pre-malignancy) ( 1) ) 6) (multiple sclerosis) 1) 2) I. II. ( ) III. ( ) IV. ( ) adalimumab CDAI (Crohn s disease activity index) 3 36

20 Adalimumab 1) (azathioprine, 6-mercaptopurine, methotrexate) (PCDAI>3) 2) (height velocity Z Score -1 to -2.) 3) (height velocity Z Score -1 to -2.) 1) adalimumab 8 3 (PCDAI >=1) 2) ( 8 ) 3) 6 ( 28 ) 3. (1)(2)(3) 1) >=4 16mg 8mg 4mg 4mg 37 38

21 2) <4 8mg 4mg 2mg 2mg 1) (active infection) 2) ( ) 3) (pre-malignancy) 4) ) (multiple sclerosis) 1) 2) I. II. ( ) III. adalimumab PCDAI (Pediatric Crohn s disease activity index) 39 4

22 -ASA () Mesalazine mg (PENTASA prolonged-released tablet) 1 g 2 g (PENTASA Sachet, Prolonged-Release Granules) 4mg (Asacol tablets) 8mg (Asacol gastro-resistant tablets) 12 mg (Mezavant XL tablets) 1 g (PENTASA Suppository) mg (Asacol Suppository) 1 g/ 1 ml (PENTASA Enema) 2 mg/ ml (COLASA Enema) 4 mg/ ml (COLASA Enema) Sulfasalazine mg (Salazopyrin EN-tabs) mg (Salazine enteric coated tablets) 41 42

23 Azathioprine Mercaptopurine (6-MP) Methotrexate / Cyclosporine / Adalimumab ( Humira ) Infliximab 43 44

24 Management of Crohn s disease in Taiwan: consensus guidelines of the Taiwan Society of Inflammatory Bowel Disease. Intest Res 217; 1(3). Epub ahead of print. ECCO guidelines on IBD Management of Crohn s Disease in Adults (ACG) The Asia Pacific Consensus Statements on Crohn's Disease Part 1: definition, diagnosis and epidemiology Asia-Pacific consensus statements on Crohn's disease. Part 2: Management Elsevier Inflammatory Bowel Disease Resource Center 4

25 217 27

WGO Practice Guidelines style template

WGO Practice Guidelines style template 世界胃肠组织全球指南炎症性肠病 : 全球观点杜颖译戴宁审校浙江大学医学院附属邵逸夫医院消化科 (310016) 2009 年 6 月评阅组 Dr. Charles N. Bernstein ( 主席, 加拿大 ) Prof. Michael Fried ( 瑞士 ) Drs. J.H. Krabshuis