Episode Transcript
Interviewer: 诊断炎症性肠病，即IBD，这是下一期的内容.
Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.
Interviewer: Dr. 约翰·瓦伦丁是治疗肠道炎症性疾病的专家, including inflammatory bowel disease, or IBD as some people know it. 首先，过敏性肠病和炎症性肠病有区别吗?
Dr. Valentine: Those two get confused quite often.
Interviewer: Okay.
Dr. Valentine: So irritable bowel syndrome is quite common. 它不会引起炎症，但会引起腹痛、痉挛、腹泻或便秘. 但炎症性肠病是一种免疫介导的过程，它会引起胃肠道炎症，导致类似的症状, abdominal pain and diarrhea. But because of the inflammation, it can also lead to bleeding in the GI tract, fevers, 还有并发症，比如长期炎症会导致癌症, and the need for surgery.
Interviewer: So it's a little bit more of a nasty character?
Dr. Valentine: Yeah, I agree.
Interviewer: Yeah, okay. 我听说炎症性肠病实际上增加了很多. Can you talk to how much?
Dr. Valentine: 在西方国家和正在西方化的国家，这一比例都在上升. China, India, 南美现在开始出现炎症性肠病的涌入，具体原因尚不清楚. 但是因为病人被诊断的时候很年轻，大发娱乐无法治愈它, we can treat it, these patients are living with it. With the increased rate of new cases, 一些预测模型显示，在未来10年，北美患有炎症性肠病的人数将翻一番.
Interviewer: That doesn't sound very enjoyable for a lot of us, then.
Dr. Valentine: Well, fortunately, we have multiple treatment options. We can treat this, but we can't cure it.
Interviewer: All right. 在另一部分中，大发娱乐将讨论IBD的治疗方案. Because from what I understand, 有相当多的例子，它可能值得自己专门的播客. 请给我介绍一下诊断IBD的过程.
Dr. Valentine: 通常病人会出现慢性症状. An infectious colitis, for example, of Salmonella, Shigella, the common bacterial infections, you may have similar symptoms, but they'll only last three to five days. If somebody comes in having blood in their stool, loose stools, maybe fevers and it's been going on for a couple weeks, then we start thinking about inflammatory bowel disease. 然后大发娱乐需要区分溃疡性结肠炎, which only involves the lining of the colon, and Crohn's disease, which can be anywhere in the GI tract, but tends to like the end of the small intestine, first part of the colon.
Interviewer: Are the symptoms for all those the same? 或者你会用一点不同的诊断方法来明确某人可能在处理什么?
Dr. Valentine: Well, there is a tremendous overlap between the two. Where the inflammation is can make a big difference. 如果你的炎症只发生在小肠的末端, you may not have diarrhea at all. 如果炎症是在直肠和结肠下部，在哪里, 那么腹泻和可见的血将是更常见的特征. So we can get some hints as to which one we think it is, 但大发娱乐需要做更多的诊断测试来解决这个问题.
Interviewer: In addition to symptoms, 你问病人是否有其他的风险因素来大发娱乐确定他们是否确实有这些?
Dr. Valentine: 危险因素并不排除它，但它确实增加了可能性.
Interviewer: Okay.
Dr. Valentine: 所以大发娱乐所知道的患炎症性肠病的最大风险因素是有家庭成员患有这种疾病. That being said, somebody needs to be first. 但家族中通常会有一系列其他免疫介导的疾病, multiple sclerosis, rheumatoid arthritis, lupus or celiac disease. 这些不同的疾病都有共同的基因基础这就是为什么它们倾向于聚集在一起.
Interviewer: 你发现病人在找你的时候自我诊断做得很好吗?
Dr. Valentine: It depends. If they have a family member, especially a brother or sister with it, yeah, they know what the symptoms are and they come in, "I think I sort of have this.“如果他们是家里的老大，他们真的不知道.
Interviewer: Okay. 那么还有哪些其他的诊断方法可以用来确定他们是否患有炎症性肠病呢?
Dr. Valentine: 血性腹泻的首要原因是感染所以你总是需要排除感染. Sometimes, though, the infection can be the trigger. We treat that, but the inflammation won't go away.
Interviewer: Okay.
Dr. Valentine: So we have to rule out infection. The patient's age also can give you some hints.
Interviewer: Okay.
Dr. Valentine: 溃疡性结肠炎和克罗恩病，15到25岁是发病高峰期. It can occur a whole lot younger. It can occur in the 60s. 但是一个25岁的人因为腹泻来了好几周还带血, inflammatory bowel diseases goes to the top of my list.
Interviewer: Are there any tests or screenings that you use?
Dr. Valentine: A colonoscopy would be the primary diagnostic test. You want to be sure you know what you're treating, 特别是因为一些治疗涉及免疫抑制药物. 结肠镜检查，确保你知道是溃疡性结肠炎还是克罗恩病. Make sure the pathology, 病理学家在显微镜下看到的东西符合这个诊断，而不是其他一些奇怪或不太常见的病因.
If the colonoscopy doesn't reveal any problems, then imaging of the small intestine, and there are several ways of doing that. An MRI or a CT scan would be most common. Occasionally, the capsule endoscopy, 但我真的很警惕那些仅仅根据胶囊内窥镜的图像就被诊断出来的人.
Interviewer: Why is that?
Dr. Valentine: Lots of things can cause inflammation in the small intestine. 服用布洛芬和类似的药物可能会引起轻微的断裂. So when they even show these pictures to the experts, 他们很难确定哪些是由布洛芬类药物引起的，哪些是由克罗恩病引起的.
Interviewer: At this point in our conversation, 如果有人在这一点上确信他们有炎症性肠病, 他们会先去看全科医生还是初级保健医生? Or come straight to you at this point?
Dr. Valentine: Well, like I said, need to exclude infection. 所以我认为去初级保健医生那里做粪便检查以排除艰难梭菌感染, Salmonella, Shigella, campylobacter, 第一步是消灭其他能引起结肠炎症的细菌.
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updated: April 17, 2019
originally published: March 15, 2016