2023年小肠疾病诊治进展

Advances in study on the diagnosis and treatment of small intestinal diseases in 2023

2023年,小肠疾病领域取得了多项重要发现和突破。基于数据库的小肠肿瘤全球流行病学研究首次发布。研究显示,2020年全球的小肠癌发病率为0.6/10万,较2010年至2020年的全球平均小肠癌发病率呈上升趋势(不同大洲平均年变化百分比为2.20%~21.67%)。小肠癌的发病负担存在地域差异性,其中北美最高,年龄标化发病率为1.4/10万人。我国男性的小肠癌发病率为0.32/10万人,女性为1.95/10万人。小肠癌发病危险因素(β为0.008~0.198;OR为1.07~10.01)包括较高的人类发展指数、国内生产总值;存在吸烟、饮酒习惯;缺乏运动、肥胖;存在糖尿病、脂代谢紊乱及炎症性肠病病史。在治疗方面,舒林达克和厄洛替尼联合治疗可有效减少家族性腺瘤息肉病患者的息肉负荷。对于小肠克罗恩病,软件方面,人工智能辅助内镜识别被证实可减少漏诊率,提高医疗质量;硬件方面,电动螺旋小肠镜是一把双刃剑,虽然具有更高的全小肠检查率,但在安全性得到充分保障前,仍无法大规模临床推广;药物方面,随着对疾病发病机制的深入了解,针对炎症过程的靶向治疗逐渐成为研究的热点,小分子制剂如乌帕替尼、filgotinib临床数据不断积累;外科方面,最新证据支持新诊断的回肠或回结肠克罗恩病患者接受回结肠切除术作为一线治疗的疗效不劣于肿瘤坏死因子α单抗治疗。小肠出血的诊治也在不断进步,沙利度胺作为突破性药物用于治疗毛细血管畸形所致小肠出血,为广大患者带去福音。此外,小肠梗阻的外科治疗理念逐步更新,通过评分体系,可预测小肠梗阻患者适宜接受外科手术切除或接受内科保守治疗。未来随着医疗技术、理念和人工智能的不断发展和创新,小肠疾病的诊治将会更加精准和高效。

In 2023,multiple important discoveries and breakthroughs have been made in the field of small intestine diseases,and database-based global epidemiological study on small intestinal cancer was first released.It showed that the global incidence rate of small intestinal cancer in 2020 was 0.6/100000,which was on an upward trend compared with the average incidence rate from 2010 to 2020(average annual change percentage in different continents,2.20%to 21.67%).The burden of small intestinal cancer was geographic disparity,and age-standardized incidence rate(1.4/100000)was high-est in North America.The incidence rate of small intestinal cancer in China was 0.32/100000 for men and 1.95/100000 for women.Risk factors for small bowel cancer(β=0.008 to 0.198;OR=1.07 to 10.01)included higher human develop-ment index and gross domestic product;smoking and drinking habits;lack of exercise,obesity,diabetes,and lipid metabo-lism disorders;history of inflammatory bowel diseases.Therapeutically,the combined use of sulindac and erlotinib has been effective in reducing the polyp burden in patients with familial adenomatous polyposis.For Crohn’s disease in the small intestine,in terms of software,AI-assisted endoscopic recognition has been proven to reduce misdiagnosis,improving medical quality.In terms of hardware,the electric spiral enteroscopy is a double-edged sword.Although it has a higher rate of completing entire small intestine examination,it cannot be widely used in clinical practice until its safety is fully guaran-teed.In terms of drugs,with the in-depth understanding of the pathogenesis of the disease,targeted therapy for the inflam-matory process has gradually become a research hotspot.Clinical data on small-molecule agents such as upadacitinib and filgotinib are continuously accumulating.In terms of surgery,the latest evidence supports that surgery may become a first-line treatment for specific Crohn’s disease.The diagnosis and treatment of small intestine bleeding are also continuously improving.Thalidomide,as a drug used to treat small intestine bleeding caused by capillary malformations,has brought good news to a large number of patients.In addition,the surgical treatment for small intestine obstruction is gradually being updated,and there are now more accurate prediction models for treatment decisions in patients with small intestine obstruction.Looking ahead,with the continuous development and innovation of medical technology,and artificial intelligence,the diagnosis and treatment of small intestinal diseases will become more precise and efficient.