Metode de tratament ale bolii Crohn

BC usoara pana la moderata pacienti in ambulator capabili de a tolera dieta orala fara deshidratare, toxicitate, moliciune, masa sau obstructie abdominala; BC moderata pana la severa pacienti care nu au mai raspuns la forma de tratament de mai sus sau pacienti cu simptome predominante, cum sunt febra, scaderea ponderala, durere si moliciune abdominala, greata si voma intermitente, sau anemie; BC severa-fulminanta pacienti cu simptome persistente in ciuda tratamentului cu steroizi sau pacienti care prezinta febra, voma persistenta, obstructie intestinala, moliciune, rebound, casexie au un abces; Remisie pacienti care sunt asimptomatici, fie spontan, fie dupa tratamentul medical sau chirurgical.

Pacientii care necesita steroizi pentru a ramanea asimptomatici nu sunt considerati a fi in stadiul de remisie.

Datorita heterogenitatii bolii si optiunilor terapiei combinate, este putin probabil ca trialurile controlate sa devina vreodata ghid pentru tratamentul uneia dintre circumstantele clinice. In plus, costul terapiei, complianta pacientului si susceptibilitatea individuala la toxicitatea medicamentelor, sunt factori, in mod egal relevanti, pentru luarea deciziilor la patul bolnavului.

Intrucat etiopatogenia BC nu este pe deplin elucidata, se considera ca scopul principal al tratamentului il constituie controlul bolii, cu urmatoarele obiective: Ameliorarea simptomelor si inducerea remisiunii; Mentinerea unei stari de nutritie corespunzatoare; Diminuarea leziunilor inflamatorii intestinale; Prevenirea recidivelor si complicatiilor.

Tratamentul rational trebuie sa urmeze secventa factorilor patogenici, care se succeda in evolutia afectiunii (Fig. 1. ). Ierarhizarea diferitelor metode de tratament este oarecum diferita in functie de principalele entitati clinice si de diversitatea formelor clinico-evolutive [50] (Fig. 1). Infectii, toxine Profilaxie?! AINS Bacterii din lumen - Antibiotice: orale, parenterale, nonabsorbabile Ph-PS, f MLP, LPS - Repaos intestinal: dieta, nutritie parenterala Superantigeni - Spalatura intestinala Antigeni alimentari - Fixarea sau degradarea Pg-PS, fMPL, LPS - Transplant fecal ANOMALII DE IMUNOREGLARE Cresterea IL-1 Th1 vs Th2; HLA-DR Prezentarea Ag INFLAMATIE Macrofage, Tx, LT - Corticoterapie: parenteral, local PAF, O2, NO - Imunosupresie IFN-I?, THF-I? - Inhibitori de lipooxigenaza: ulei de peste, Zileuton - Antioxidante - Imunomodulatoare SIMPTOMATOLOGIE Diaree, sangerare, durere - Terapie nutritionala Scadere ponderala - Antidiareice Fig. 1. Mecanisme etiopatogenice si tratamentul rational III. TRATAMENTUL MEDICAMENTOS 1. DERIVATII ACIDULUI SALICILIC Tratamentul primar al afectiunilor inflamatorii cronice a inceput cu un compus salicilic, salazopirina (SZP) sau azulfidina [50]. Din momentul in care s-a dovedit ca partea activa a SZP este acidul 5-aminosalicilic (5-AS), cu denumirea comuna internationala mesalamina sau mesalazina, s-au descoperit numerosi derivati salicilici noi, grupati in ...

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