Trikudanathan G等【1】对EIMs的诊断和治疗进行了综述。结直肠癌(CRC)是IBD患者严重的并发症，Peyrin-Biroulet L等【2】报道了一组大样本的CRC队列研究(19451例)，发现IBD相关的CRC患者其临床表现与其它CRC患者类似，但预后相对更差。IBD诊出过晚可能是CRC发生的危险因素【3】。另一方面，IBS的症状同样可存在于IBD患者【4】，显微镜下结肠炎患者【5】中，也有报道IBS患者可能伴发膀胱过度活动症(overactive bladder, OAB)【6】，不宁腿综合征【7】等症状。Stabell N【8】等认为IBS患者可能伴有躯体痛觉敏感。

炎症性肠病肠外表现的诊疗管理

     在炎症性肠病（IBD）患者中经常会发现肠外表现，这些肠外表现可能在诊断出IBD之前、之时或之后发现。IBD的肠外表现可以根据它们与IBD活动的关系而分类。第一组肠外表现与肠道疾病的活动具有直接关系，包括少关节性关节炎、口腔溃疡、结节性红斑和巩膜外层炎。第二组肠外表现似乎是独立于潜在的肠道疾病发生的，包括强直性脊柱炎和葡萄膜炎。第三组包括那些可能与肠炎有关系或无关系的肠外表现，例如坏疽性脓皮病，有可能是原发性硬化性胆管炎（PSC）。结肠、结肠外器官共有的遗传易感性、异常的自我识别、 免疫器官特异性细胞抗原的自身抗体可能跟这些肠外表现的发病机理和发展有联系。在IBD医疗设备中使用生物制剂扩大了对一些致残性肠外表现的治疗选择，并且这些生物制剂形成了管理大多数致残性肠外表现的基础。原发性硬化性胆管炎（PSC）是最常见的与IBD相关的肝胆临床表现，除了内镜治疗和肝脏移植外，还没有明确的治疗方法。未来需要以发病机理、早期诊断和对这些肠外表现的治疗为目标的研究。

Diagnosis and therapeutic management of extra-intestinal manifestations of inflammatory bowel disease.

Extra-intestinal manifestations (EIMs) are reported frequently in patients with inflammatory bowel disease (IBD) and may be diagnosed before, concurrently or after the diagnosis of IBD. EIMs in IBD may be classified based on their association with IBD disease activity. The first group has a direct relationship with the activity of the bowel disease and includes pauciarticular arthritis, oral aphthous ulcers, erythema nodosum and episcleritis. The second group of EIMs appears to follow an independent course from the underlying bowel disease activity and include ankylosing spondylitis and uveitis.

The third group includes EIMs that may or may not be related to intestinal inflammation, such as pyoderma gangrenosum and probably primary sclerosing cholangitis (PSC). Genetic susceptibility, aberrant self-recognition and immunopathogenic autoantibodies against organ-specific cellular antigens shared by the colon and extra-colonic organs may contribute to the pathogenesis and development of these EIMs. The use of biological agents in the IBD armamentarium has expanded the treatment options for some of the disabling EIMs and these agents form the cornerstone in managing most of the disabling EIMs. PSC is one of the most common hepatobiliary manifestations associated with IBD in which no clear treatment options exist other than endoscopic therapy and liver transplantation. Future research targeting the pathogenesis, early diagnosis and treatment of these EIMs is required.

显微镜下结肠炎和肠易激综合征之间的症状重叠：一份前瞻研究

背景：显微镜下结肠炎和肠易激综合征（IBS）是水样腹泻、腹部不适和其它胃肠症状的普遍原因。之前的回顾性资料和一项随机对照试验信息的事后分析表明， 在显微镜下结肠炎患者的症状以及IBS诊断标准中的主要症状之间，有着相当大的重叠。我们力求在前瞻性群组研究中研究这种相似性。

方法：给在我们这里就医的患有活检证实的显微镜下结肠炎的患者的随机分发症状问卷。基于他们的回复，我们确定了IBS各种不同临床表现的患者比例。符合IBS标准的患者，我们将他们的临床特征与不符合IBS标准的患者进行了比较。

结果：在120名患者中有38%至58%的患者符合IBS的诊断标准。与不符合IBS诊断标准的患者相比，这些患者都更年轻，并且似乎女性更多。

结论：患有显微镜下结肠炎的患者经常符合IBS的诊断标准。因此说明这些标准不够明确，不能排除显微镜下结肠炎。在患有水样腹泻的患者中，如果使用止泻药物不能控制则需要进行结肠镜下粘膜活检。

 Symptomatic Overlap Between Microscopic Colitis and Irritable Bowel Syndrome: A Prospective Study.

 BACKGROUND: Microscopic colitis and irritable bowel syndrome (IBS) are the common causes of watery diarrhea, abdominal discomfort, and other gastrointestinal symptoms. Previous retrospective data and post hoc analysis of information from a randomized controlled trial have suggested that there is considerable overlap between the symptoms seen in patients with microscopic colitis and the symptom-based criteria for IBS. We sought to study this overlap in a prospective cohort.

METHODS: A random cohort of patients with biopsy-proven microscopic colitis seen at our institution were administered a symptom questionnaire. Based on their responses, the proportion of patients who met various definitions for IBS was determined. Clinical characteristics of those meeting IBS criteria were compared with those who did not.

RESULTS: In the 120 patients who were included, 38% to 58% met the diagnostic criteria for IBS. These patients tended to be younger and more likely female than those who did not meet IBS criteria.

CONCLUSIONS: Patients with microscopic colitis frequently meet the diagnostic criteria for IBS. Therefore, these criteria are not specific enough to exclude the presence of microscopic colitis. In patients with watery diarrhea, colonoscopy with mucosal biopsies should be performed if symptoms are not controlled by antidiarrheal medications.

Ref：

1.Trikudanathan G, Venkatesh PG, Navaneethan U. Drugs. 2012 Dec 24;72(18):2333-49. doi: 10.2165/11638120-000000000-00000.

2.Peyrin-Biroulet L, Lepage C, Jooste V, et al. Colorectal cancer in inflammatory bowel diseases: a population-based study (1976-2008). Inflamm Bowel Dis. 2012 Dec;18(12):2247-51. doi: 10.1002/ibd.22935. Epub 2012 Mar 29.

3.Baars JE, Kuipers EJ, van Haastert M, et al. Age at diagnosis of inflammatory bowel disease influences early development of colorectal cancer in inflammatory bowel disease patients: a nationwide, long-term survey. J Gastroenterol. 2012 Dec;47(12):1308-22. doi: 10.1007/s00535-012-0603-2. Epub 2012 May 25.

4.Halpin SJ, Ford AC. Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2012 Oct;107(10):1474-82. doi: 10.1038/ajg.2012.260. Epub 2012 Aug 28.

5.Abboud R, Pardi DS, Tremaine WJ, et al. Inflamm Bowel Dis. 2013 Feb 1. Epub ahead of print.

6.Matsumoto S, Hashizume K, Wada N, et al. Relationship between overactive bladder and irritable bowel syndrome: a large-scale internet survey in Japan using the overactive bladder symptom score and Rome III criteria. BJU Int. 2012 Oct 26. doi: 10.1111/j.1464-410X.2012.11591.x. Epub ahead of print.

7.Borji R, Fereshtehnejad SM, Taba Taba Vakili S, et al. Association between irritable bowel syndrome and restless legs syndrome: a comparative study with control group. J Neurogastroenterol Motil.2012Oct;18(4):426-33. doi：10.5056/jnm.2012.18.4.426. Epub 2012 Oct 9. 8.Stabell N, Stubhaug A, Fl?gstad T, et al. Pain. 2012 Dec 5. pii: S0304-3959(12)00625-2.