A “multidimensional” diagnostic mindset and individualized therapeutic armamentarium for inflammatory bowel disease

CHEN Dongfeng; QIU Zhuqing

doi:10.16016/j.2097-0927.202605034

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A “multidimensional” diagnostic mindset and individualized therapeutic armamentarium for inflammatory bowel disease

Expert Review | 更新时间：2026-07-15

- A “multidimensional” diagnostic mindset and individualized therapeutic armamentarium for inflammatory bowel disease
- Journal of Army Medical University Vol. 48, Issue 13, Pages: 1801-1808(2026)
- 作者机构：
  
  陆军军医大学（第三军医大学）大坪医院消化内科，重庆
- 作者简介：
  
  CHEN Dongfeng， E-mail： chendf1981@126.com
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(82170594)
- DOI：10.16016/j.2097-0927.202605034
  CLC： R574
- Received：13 May 2026，
  
  Revised：2026-05-20，
  
  Accepted：03 June 2026，
  
  Published：15 July 2026
- 稿件说明：
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陈东风，邱竹箐.炎症性肠病的“多维”诊断思维与个体化治疗武器［J］.陆军军医大学学报，2026，48（13）：1801-1808.DOI：10.16016/j.2097-0927.202605034.

CHEN D F，QIU Z Q.A “multidimensional” diagnostic mindset and individualized therapeutic armamentarium for inflammatory bowel disease［J］.J Army Med Univ，2026，48（13）：1801-1808.DOI：10.16016/j.2097-0927.202605034.
陈东风，邱竹箐.炎症性肠病的“多维”诊断思维与个体化治疗武器［J］.陆军军医大学学报，2026，48（13）：1801-1808.DOI：10.16016/j.2097-0927.202605034. DOI：

CHEN D F，QIU Z Q.A “multidimensional” diagnostic mindset and individualized therapeutic armamentarium for inflammatory bowel disease［J］.J Army Med Univ，2026，48（13）：1801-1808.DOI：10.16016/j.2097-0927.202605034. DOI：

摘要

炎症性肠病（inflammatory bowel disease，IBD）病因复杂、临床表现异质性强，早期鉴别诊断困难，内镜与影像评估标准未完全统一，生物标志物敏感性与特异性不足，治疗反应预测体系不完善，患者依从性差，给临床精准诊断与个体化治疗带来显著挑战。近年来IBD发病率在全球及我国持续上升，且诊断延迟普遍存在，亟需系统性的诊治策略。其诊断的关键环节：①筛查高危人群（15~35岁及60~75岁发病、一级亲属史、持续腹泻便血、肛周病变等），尽早启动结肠镜及影像评估；②梳理腹泻、腹痛、消耗三大核心临床表现，识别肠外表现［关节炎、结节性红斑、原发性硬化性胆管炎（primary sclerosing cholangitis，PSC）等］及特殊表现（肛瘘、阑尾切除术后不缓解等）；③影像学评估应从肠管、系膜缘血管、系膜淋巴结3个维度建立逻辑思维链条，CT小肠造影与肠道超声各具优势；④鉴别诊断需系统排除肠结核、缺血性肠病、药物性肠病及罕见免疫遗传性疾病，整合流行病学、血清标志物、内镜动态演变及精准病理等多方面信息。治疗层面：①强调“达标治疗”理念，治疗目标从症状缓解转向黏膜愈合乃至组织学愈合。药物选择需综合疾病表型、生物标志物、内镜活动度及患者特征实现个体化。美沙拉嗪为轻中度溃疡性结肠炎（ulcerative colitis， UC）一线用药；糖皮质激素仅作急性期“桥梁”；生物制剂（抗TNF-α、抗整合素、抗IL-12/23）针对中重度患者；JAK抑制剂与鞘氨醇-1-磷酸受体（sphingosine-1-phosphate receptor，S1PR）调节剂为小分子精准选择。特殊人群管理需精准平衡疗效与风险，妊娠期优选维得利珠单抗，老年患者慎用激素及JAK抑制剂，合并乙肝或结核潜伏感染需前置抗病毒或抗结核治疗。②对疑难及困难型IBD的治疗，提出了从表型驱动到多组学分子分型的范式革新，AI辅助胶囊内镜、血浆游离DNA（cell-free DNA，cfDNA）甲基化谱等动态无创监测技术，以及多学科协作综合管理模式。IBD本质是系统性免疫紊乱，诊治需把握临床线索、影像学三维度（肠管、系膜缘血管、系膜淋巴结）研判，诊治应贯彻早诊断、个体化、精准化及全疾病周期管理的理念，从缓解症状逐渐转向黏膜愈合与组织学愈合，提升患者的生活质量。

Abstract

Inflammatory bowel disease (IBD) is characterized by complex etiology and highly heterogeneous manifestations

which poses significant challenges to precise diagnosis and individualized therapy due to difficulties in early differential diagnosis

incomplete standardization of endoscopic and imaging criteria

insufficient sensitivity and specificity of biomarkers

imperfect predictive systems for treatment response

and poor patient adherence. In recent years

the incidence of IBD has continued to rise both globally and in China

with diagnostic delay being common

necessitating the urgent development of systematic diagnostic and therapeutic strategies. The critical steps in diagnosis are as follows: ① screening high-risk populations (age at onset of 15 to 35 years or 60 to 75 years

family history in first-degree relatives

persistent diarrhea with hematochezia

perianal lesions

etc.

)

and initiating colonoscopy and imaging assessment as early as possible; ② elucidating the three core manifestations—diarrhea

abdominal pain

and wasting

—while recognizing extraintestinal manifestations [arthritis

erythema nodosum

primary sclerosing cholangitis (PSC)

etc.

]

and special presentations (anal fistulas

failure to improve after appendectomy

etc.

); ③ establishing a logical chain of imaging assessment from 3 dimensions: the bowel wall

mesenteric marginal vessels

and mesenteric lymph nodes

with computed tomography enterography (CTE) and intestinal ultrasound each offering distinct advantages; ④ systematically excluding intestinal tuberculosis

ischemic bowel disease

drug-induced enteropathy

and rare inherited immune disorders in differential diagnosis

integrating information from epidemiology

serum biomarkers

dynamic endoscopic evolution

and precise histopathology. In terms of treatment: ① emphasizing the “treat-to-target” paradigm

with therapeutic goals shifting from symptom relief to mucosal healing and even to histological healing. Drug selection should be individualized based on disease phenotype

biomarkers

endoscopic activity

and patient characteristics. Mesalazine serves as first-line therapy for mild-to-moderate UC; corticosteroids are used only as a “bridge” in the acute phase; biologics (anti-TNF-α

anti-integrin

anti-IL-12/23) are indicated for moderate-to-severe patients; JAK inhibitors and sphingosine-1-phosphate receptor (S1PR) modulators represent small-molecule precision options. Management of special populations requires a precise balance between efficacy and risk

with vedolizumab preferred during pregnancy

cautious use of corticosteroids and JAK inhibitors in elderly patients

and prerequisite antiviral or anti-tuberculosis therapy for patients with concurrent hepatitis B or latent tuberculosis infection. ② For difficult-to-treat and refractory IBD

a paradigm shift from phenotype-driven to multi-omics molecular subtyping is proposed

along with dynamic non-invasive monitoring technologies such as AI-assisted capsule endoscopy and plasma cell-free DNA (cfDNA) methylation profiling

and integrated manag

ement model of multidisciplinary team (MDT). IBD is essentially a systemic immune disorder; diagnosis and treatment require grasping clinical clues and evaluating the 3 imaging dimensions (bowel wall

mesenteric vessels and lymph nodes). The principles of “early diagnosis”

“individualized precision therapy”

and “whole-disease-cycle management” should be implemented in diagnosis and treatment of IBD

gradually shifting from symptom relief toward mucosal and histological healing

thereby improving patients’ quality of life.

关键词

Keywords

references

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