《成人克罗恩病管理》内容预览:

    Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problemsas established by interpretation and collation of scientifi cally valid research, derived from extensive review ofpublished literature. When data that will withstand objective scrutiny are not available, a recommendation may bemade based on a consensus of experts.

    Guidelines are intended to apply to the clinical situation for all physicianswithout regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptableapproach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the widerange of choices in any health-care problem, the physician should select the course best suited to the individualpatient and the clinical situation presented.

    These guidelines are developed under the auspices of the AmericanCollege of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outsetfor the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A:Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (desc**tive) controlledtrials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at leastone large well-designed clinical trial with or without randomization, from cohort or case – control analytic studies,or well-designed meta-analysis.

    Evidence based on clinical experience, desc**tive studies, or reports ofexpert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians andothers in related fi elds. The fi nal recommendations are based on the data available at the time of the production ofthe document and may be updated with pertinent scientifi c developments at a later time.disorders with speci c clinical and pathological features characterizedby focal, asymmetric, transmural, and, occasionally,granulomatous in ammation primarily a  ecting the gastrointestinal(GI) tract.

    Despite the relatively lowincidence and prevalence of CD compared with more commonGI disorders, the cost of medical and surgical therapy forpatients with CD is estimated to be up to US $ 2 billion annuallyin the United States and is increasing with the advent ofnewer biological approaches (7,8) . Estimates of hospitalizationrates for CD are di: cult to estimate for the US population. $ emost recent data are from 1998 and have been extrapolatedto US dollars in 2000. $ e total direct and indirect costs forCD in the US were estimated at US $ 826 million and based on84,000 in-patient hospital days and 1.3 million outpatient visits(9) .

    Once patients are started on corticosteroids, up to 38 %of patients will require surgery within 1 year therea> er (10) ,onset, the presence of overlapping features with other in ammatorybowel diseases, and / or the presentation without GIsymptoms (i.e., extraintestinal symptoms), can make thediagnosis of CD di: cult (1) . Characteristic symptoms ofchronic or nocturnal diarrhea and abdominal pain, weightloss, fever, or rectal bleeding re ect the underlying in ammatoryprocess (the absence of rectal bleeding may suggestCD over ulcerative colitis) (18,19) ......

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