medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-26-7-14medalphabet-3959Research ArticleПРАКТИЧЕСКАЯ ГАСТРОЭНТЕРОЛОГИЯPRACTICAL GASTROENTEROLOGYВедение пациентов с болезнью Крона – от истории до современных подходовManagement of patients with Crohn's disease – from history to modern approacheshttps://orcid.org/0000-0001-9252-9152БикбавоваГ. Р.BikbavovaG. R.

Бикбавова Галия Равильевна - к.м.н., доцент, кафедры госпитальной терапии, эндокринологии

г. Омск

Bikbavova Galiya R. - PhD Med, associate professor at Dept of Hospital Therapy, Endocrinology

Omsk

galiya1976@mail.ruhttps://orcid.org/0000-0002-7603-8481АхмедовВ. А.AkhmedovV. A.

Ахмедов Вадим Адильевич - д.м.н., проф., зав. кафедрой медицинской реабилитации дополнительного профессионального образования

г. Омск

Akhmedov Vadim A. - DM Sci (habil.), professor, head of Dept of Medical Rehabilitation of Additional Professional Education

Omsk

v_akhmedov@mail.ruhttps://orcid.org/0000-0002-2663-0102ТретьяковаТ. В.TretyakovaT. V.

Третьякова Татьяна Валентиновна - врач-гастроэнтеролог, зав. гастроэнтерологическим отделением

г. Омск

Tretyakova Tatyana V. - gastroenterologist, head of Gastroenterology Dept

Omsk

strekozaomsk@mail.ruПирожковаА. М.PirozhkovaA. M.

Пирожкова Алина Михайловна - студентка 5-го курса лечебного факультета

г. Омск

Pirozhkova Alina M. - 5th-year student at Faculty of Medicine

Omsk

alinulya16@gmail.comФГБОУ ВО «Омский государственный медицинский университет» МинздраваРоссияRegional Clinical HospitalRussian FederationФГБОУ ВО «Омский государственный медицинский университет» Минздрава РоссииРоссияOmsk State Medical UniversityRussian FederationБУЗ Омской области «Областная клиническая больница»РоссияRegional Clinical HospitalRussian Federation202409112024026«Практическая гастроэнтерология» (2)714Copyright © Бикбавова Г.Р., Ахмедов В.А., Третьякова Т.В., Пирожкова А.М., 20242024Бикбавова Г.Р., Ахмедов В.А., Третьякова Т.В., Пирожкова А.М.Bikbavova G.R., Akhmedov V.A., Tretyakova T.V., Pirozhkova A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3959

С момента выделения болезни Крона в качестве отдельной нозологии до настоящего времени достигнут существенный прогресс как в диагностике заболевания, так и к подходам к лечению пациентов с данной патологией. Активное внедрение в клиническую практику биологических препаратов и подхода top-down у пациентов с факторами негативного прогноза привело к значительному улучшению результатов лечения и прогноза у пациентов. Применение максимально эффективной противовоспалительной терапии в период «терапевтического окна возможностей» до 18 месяцев служит залогом достижения ремиссии либо минимальной активности болезни Крона путем подавления воспаления и предотвращения необратимых структурных повреждений стенки кишки и, как следствие, развития осложнений. В статье представлен еще далекий до своего завершения экскурс в историю открытия этого заболевания. Освещены подходы к лечению пациентов с данной патологией с объяснением современной позиции, основанной на данных метаанализов и систематических обзоров. Представлена демонстрация пациентки с пенетрирующим фенотипом болезни Крона в виде перианального поражения и отягощенным онкопатологией анамнезом. Терапия устекинумабом может рассматриваться как оптимальная стратегия ведения пациентов с болезнью Крона с факторами неблагоприятного прогноза.

Since the isolation of Crohn's disease as a separate pathology, significant progress has been made both in the diagnosis of the disease and in approaches to the treatment of patients with this pathology. The active introduction of biologics and the top-down approach into clinical practice in patients with negative prognosis factors has led to a significant improvement in treatment results and prognosis in patients. The use of the most effective anti-inflammatory therapy during the «therapeutic window of opportunity» – up to 18 months – is the key to achieving remission, or minimal activity of Crohn's disease by suppressing inflammation and preventing irreversible structural damage to the intestinal wall and, as a result, the development of complications. The article presents an excursion into the history of the discovery of this disease, which is still far from its completion. The approaches to the treatment of patients with this pathology are highlighted with an explanation of the current position based on data from meta-analyses and systematic reviews. A demonstration of a patient with a penetrating phenotype of Crohn's disease in the form of a perianal lesion and a history of oncopathology is presented. Ustekinumab therapy can be considered as an optimal management strategy for patients with Crohn's disease with unfavorable prognosis factors.

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The authors declare that there are no conflicts of interest present.