什么知道左侧d Ulcerative Colitis
UC的亚型，这种疾病会导致疼痛和永久性损坏而没有适当的治疗。这是如何继续前进。
编辑注意事项：这个故事是新系列的一部分，健康中大学称为“获得你的博士学位！”，这朝着那些让他们的条件基础知识的人来说，想要提升他们的专业知识。谁准备好了？！
If you’re familiar with the irritable bowel disease known as ulcerative colitis (UC), you probably know that it’s characterized by chronic inflammation of the rectum and large intestine (colon). People with UC are battling a number of unpleasant symptoms, including rectal bleeding, diarrhea, abdominal pain, and an urgent need to go to the bathroom. Fun times! But despite what you may think, UC doesn’t always affect the entire colon. In certain cases, it can be restricted to specific areas.
这些亚型UC中的一种称为左侧溃疡性结肠炎。它从冒号的颠倒“u”形状中获得了名字。在腹部的右侧是被称为上升的结肠，因为消化的食物从小肠道升高。然后，横跨倒立的u，从右到左，是中间结肠（也称为横向冒号）。一旦到达身体的左侧，结肠就会向下弯曲 - 脾弯曲。当它向腹部左侧行驶到你的直肠上时，它被称为下降结肠。
“溃疡性结肠炎开始于直肠。If it goes beyond that—but not beyond the splenic flexure—that’s left-sided colitis,” says Berkeley Limketkai, M.D, Ph.D., an associate clinical professor at the David Geffen School of Medicine at the University of California, Los Angeles.
你可能永远不会听说过它，但“左侧溃疡性结肠炎不是罕见的，”利马妥凯博士说。“约34％的溃疡性结肠炎患者患有左侧结肠炎 - 这不是一个少数人。”有些研究表明，在生活中发展的人（通常是60岁或以上）更有可能与年轻人相比具有左侧结肠炎。虽然它与更通用的UC（也称为牡蛎或广泛的结肠炎）人群共同普遍，但左侧结肠炎可以拥有自己的（有趣！）副作用和症状。让我们仔细看看。
Left-Sided Colitis and Poop
如果没有首先谈论大便，你就无法谈论任何类型的肠道问题。腹泻通常被认为是UC的最典型的症状之一，根据Limketkai博士，“大约90％的UC，包括左侧，腹泻。但结肠炎可以改变肠习惯，也可以有便秘也是便秘的。“
有些人有左侧UC可以体验便秘;当他们确实需要去洗手间时，他们可能会花很长时间在厕所排便，或者他们可能必须在一天内多次去，因为凳子堆积在他们的结肠中。
How Serious Is Left-Sided Colitis?
It’s logical to reason that if your UC is restricted to just the left side, it’s probably not as severe as UC that affects your entire colon. Not true. It all depends on the degree of inflammation—not where the inflammation is located—as well as how well a person responds to medication.
“If a patient has refractory[unmanageable]left-sided colitis, they can be quite ill, with debilitating bloody diarrhea leading to anemia, malnutrition, and weight loss,” says Jeffry A. Katz, M.D., a professor of medicine at Case Western Reserve University School of Medicine in Cleveland, OH.
诊断左侧结肠炎
As with other forms of ulcerative colitis, left-sided colitis is most likely diagnosed by a colonoscopy. During this procedure, a thin, fiber-optic camera is inserted into the anus and threaded into the rectum and colon to capture images of the lining. “When performing a colonoscopy, sometimes it’s like someone drew a sharp line in the colon and the disease stops at that line and doesn't cross,” says Dr. Katz. In the case of left-sided colitis, the inflammation with redness and other irregularities in the gut’s lining are visible up to the splenic flexure (that “bend in the road”), but these signs disappear once the scope goes beyond that point. (If the inflammation in your colon continues after the splenic flexure, your doctor will make a diagnosis of pancolitis.)
不清楚为什么UC以这种方式工作。“它可能是遗传或免疫介导的，或与肠道细菌或肠道血液供应或其他东西有关，”Katz博士说。
Unfortunately, just because your left-sided colitis is contained to one area right now doesn’t mean things will stay this way. Left-sided colitis can progress to pancolitis, particularly if it’s not properly treated. “One of the biggest factors of progression is whether it was adequately controlled with medication,” says Dr. Limketkai, “If left-sided colitis is adequately controlled, then progression is less common.”
好消息：约有70％的人有左侧结肠炎保持这种方式。KATZ博士说，超过约10年的治疗期，12％的患者将归因于直肠或乙液的UC，（连接到直肠的部分结肠）。另有17％的人将继续发展致鼠炎。
左侧结肠炎的治疗
一般来说，对左侧溃疡性结肠炎的治疗与其他形式的溃疡性结肠炎的治疗与少量例外情况不同。选择的初始治疗是5-ASA，一种减少炎症的药物类别。
“与用口服5-处理相比，局部（灌肠剂或直肠栓剂）和口服5-氨基水杨酸酯的组合，患有轻度至中等的左侧结肠炎的患者的良好数据可以更好地使用局部（灌肠或直肠栓剂）和口服5-氨基水溶液（5-ASA）。独自的ASA或局部5-ASA，“Katz博士说。“这可能是左侧结肠炎患者的一个治疗差异与具有更广泛或更有限的结肠炎的患者相比。”
如果栓剂或灌肠不能达到结肠的其他区域，则左侧结肠炎的接近使得它更容易（但不太尴尬），以便用可以注射或插入的局部药物治疗。这是一个优势，因为通过以这种方式施用药物，可以直接递送到发芽的组织中，以潜在更有效的结果。当然，挑战是遵守性：许多患者害羞地远离局部方案，涉及定期使用灌肠或直肠栓剂，因为它们发现它繁琐和令人尴尬。
In other ways, treatment for left-sided UC, especially severe cases, is similar to those with severe pancolitis or extensive UC. If the case is moderate to severe, the big guns are used early and aggressively to get the inflammation under control, says Dr. Limketkai. These medications are referred to as biologics, drugs that target specific proteins in the body that are causing inflammation. Therapies include:
Entyvio (vedolizumab)
鬣狗（Adalimumab）
Remicade(英夫利昔单抗)
Stelara（Ustekinumab）
Another drug that may be used is Xeljanz (tofactinib), which acts differently by inhibiting an enzyme that activates the body’s immune response. “We don’t do this aggressive treatment for mild to moderate cases because it can be too much, says Dr. Limketkai.
“你可以为药物发育抗体，[使药物无效。]You don’t want to burn your bridge.” Still, between this option and a growing list of other therapies that have shown success, you’re bound to find a treatment that works for your left-sided UC.
老年人的左侧结肠炎：治疗实践。（2019）。“老年人溃疡性结肠炎的管理。”link.springer.com/article/10.1007/s40266-018-0611-x
治疗方案：Gut。（2019）。“British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.”ePrints.gla.ac.uk/198140/1/198140.pdf.
治疗方案：BMJ.。（2019）。“Management of ulcerative colitis: summary of updated NICE guidance.”bmj.com/content/367/bmj.l5897
左侧UC有多常见：Clinical Gastroenterology and Hepatology。（2018）。“基于人口群体成人溃疡性结肠炎的自然历史：系统审查。”pubmed.ncbi.nlm.nih.gov/28625817/
