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  • 1 Csolnoky Ferenc Megyei Kórház I. Belgyógyászati Osztály Veszprém Kórház u. 1. 8200
  • 2 Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest
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A gyulladásos bélbetegségek kezelésének alapszerei az aminoszalicilátok, amelyeket enyhébb betegségben és a fenntartó kezelésben, a szteroidok, amelyeket súlyosabb aktív betegségben, továbbá az immunszuppresszív szerek és az antibiotikumok, amelyeket súlyosabb betegségekben, valamint a szövődmények kezelésére évtizedek óta használunk. A Crohn-betegség kezelése jelentősen változott az elmúlt években. Az újabb nagy klinikai tanulmányok, metaanalízisek tükrében a régóta alkalmazott szerek értékét, indikációját újraértékelték. Az aminoszalicilátok szerepe mindinkább háttérbe szorul az utóbbi években az aktív betegség kezelésében, de különösen a remisszió fenntartásában. Az aktív, mérsékelten súlyos ileocoecalis betegség kezelésében az aminoszalicilátok és hagyományos szteroidok helyett dominálóvá válik a budesonidkezelés. A vastagbél aktív betegségében az aminoszalicilátok szerény szerepe mellett a hagyományos szteroidok megtartották a helyüket. Súlyosabb betegségben és még inkább a fenntartó terápiában ugyanakkor egyre inkább előtérbe kerül az immunszuppresszív szerek, főként az azathioprin korai és mind kiterjedtebb alkalmazása. Más stratégiát igényel a remisszió fenntartása gyógyszeresen és reszekciós műtéttel elért remisszió esetén. Változott a konzervatív és a sebészi kezelés viszonya is. A változás talán legfőbb tényezője, hogy megjelentek a kezelésben az új, ún. biológiai szerek, amelyek egyre hatékonyabbak a korábban gyógyszeres kezelésre rezisztens esetekben, valamint a fistulosus betegség kezelésében.

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