Bibliomed – Dossiers thématiques à propos de …
!!
!!!!!!
Les$maladies$chroniques$intestinales$
$ $
Bibliomed$4$Une$information$dédiée$Médecine$Générale,$synthèse$entièrement$indépendante$des$
données$les$plus$récentes$selon$les$principes$de$la$médecine$centrée$patient.$
"#$%&'()'*+!,'*!-.)/0,012'*!3/#0(2%&'*!2()'*)2(.,'*!'()#.2('()!&(!/.(423.-!
50(3)20((',! 6.7'&#! ')! &(! #')'()2**'6'()! 26-0#).()! *&#! ,.! %&.,2)$! 4'! 82'9!
:'&#! (.)&#'! '*)! 306-,';'+! 6&,)25.3)0#2',,'+! ,.! *<6-)06.)0,012'! ')!
,=$80,&)20(!*0()!8.#2.>,'*!')!2,!';2*)'!&('!1#.(4'!2(3'#)2)&4'!30(3'#(.()!,'*!
,262)'*!')!.**032.)20(*!'()#'!)#0&>,'*!50(3)20((',*!2()'*)2(.&;+!*<(4#06'!4&!
30,0(! 2##2).>,'! ')! -.)/0,012'*! 2(5,.66.)02#'*! 2()'*)2(.,'*?! 6.,.42'! 4'!
@#0/(+! #'3)030,2)'! /$60##.12%&'+! 6.,.42'! 3A,2.%&'! 0&! 2()0,$#.(3'! .&!
1,&)'(9!!
:.!-#$8.,'(3'!4&!*<(4#06'!4&!30,0(!2##2).>,'!'*)!'*)26$'!'()#'!BC!')!DCE+!
,'!-,&*!*0&8'()!4'*!.4&,)'*!7'&('*9!:.!6.70#2)$!4'*!30(*&,).)20(*!*'!50()!'(!
6$4'32('! 4'! -#'62'#! #'30&#*?! FFE! 8'#*&*! GHE! '(! 1.*)#0I'()$#0,012'! :.!
-#$8.,'(3'! 4=&('! .55'3)20(! 0#1.(2%&'! *0&*I7.3'()'! '*)! 5.2>,'+! -.*! -,&*!
$,'8$'!%&'!4.(*!,.!-0-&,.)20(!1$($#.,'+!')!,'*!#'3066.(4.)20(*!.3)&',,'*!
('! -#$30(2*'()! -.*! ,.! -#.)2%&'! *<*)$6.)2%&'! 4=';.6'(*! 306-,$6'().2#'*!
'(! 4'/0#*! 4'! *21('*! $803.)'&#*! 4'! -.)/0,012'! 0#1.(2%&'9! J('! 4$6.#3/'!
$4&3.)28'! '*)! ,'! -2,2'#! 3'()#.,! 4'! ,.! -#2*'! '(! 3/.#1'! K! 82*$'! -&#'6'()!
*<6-)06.)2%&'! -0&#! &(! 30()#L,'! 4&#.>,'! 4'*! )#0&>,'*! 50(3)20((',*! ')! ,'!
6.2()2'(!4'!,.!%&.,2)$!4'!82'9!!
M&.(4!#'3/'#3/'#!&('!6.,.42'!2(5,.66.)02#'!40()!,.!-#$8.,'(3'!.&16'()'!
#$1&,2N#'6'()!'(! "#.(3'! 4'!BC! (0&8'.&;!3.*O! .(!-0&#! BCC!CCC! /.>2).()*9!
M&',,'*!-'&8'()!P)#'!,'*!3.&*'*Q!M&',*!)'*)*!42*-0(2>,'*!-0&#!30(52#6'#!,'!
42.1(0*)23Q! M&',,'*! -0**2>2,2)$*! 4'! -#2*'! '(! 3/.#1'! '(! ,=.>*'(3'! 4=&(!
)#.2)'6'()!3&#.)25!.3)&',,'6'()!)0&70&#*!4&!406.2('!4'!,.!#'3/'#3/'Q!
:.! >20-*2'! 2()'*)2(.,'! '*)I',,'! )0&70&#*! ($3'**.2#'! -0&#! 30(52#6'#! ,'!
42.1(0*)23!4'!6.,.42'!3A,2.%&'!5.3'!K!&(!).>,'.&!3,2(2%&'!3.#.3)$#2*)2%&'Q!
M&',,'!'*)!,.!8.,'&#!-#$423)28'!4'*!)'*)*!*$#0,012%&'*Q!:=$823)20(!4&!1,&)'(!
'*)I',,'!K!82'Q!!
R'! (06>#'&*'*! $)&4'*! ')! #'3066.(4.)20(*! )'()'()! 4=.--0#)'#! 4'*!
$,$6'()*!4'!#$-0(*'9!@2(%!-#'62'#*!S2>,206'4!'(!50()!&('!*<()/N*'9!!!!!
!
T'-)'6>#'!!DCBU!
CB!
Sommaire$
!!"
!T<(4#06'! 4'! ,=2()'*)2(!
2##2).>,'! VTWWX?! &('! .--#03/'!
3,2(2%&'!
!
!!#
!T<(4#06'! 4'! ,=2()'*)2(!
2##2).>,'?!%&'!-#0-0*'#!K!(0*!
-.)2'()*Q!
!
!#$
!Y.,.42'*!2(5,.66.)02#'*!
3/#0(2%&'*! 4'! ,=2()'*)2(!
VYW@WX?! %&',*! #'-N#'*! '(!
DCBUQ!
!
!"%
!Y.,.42'! 3A,2.%&'?!
6.,.42'!-$42.)#2%&'!Z#.#'[Q!
!
!"#
!Y.,.42'! 3A,2.%&'?! ,.!
>20-*2'! '*)I',,'! )0&70&#*!
($3'**.2#'!
!
&'()*+,-.)-./01(2-321(.1**1245/-.6&778.
!
J('!.--#03/'!3,2(2%&'$$V\]FF^!4&!B_!6.#*!DCBUX$
!
9+(2-:2-.;..
:.!-#$8.,'(3'!4&!*<(4#06'!4'!,=2()'*)2(!2##2).>,'!VTWWX!'*)!'*)26$'!'()#'!BC!')!DCE!30(3'#(.()!,'!-,&*!*0&8'()!
4'*!.4&,)'*!'()#'!DC!')!HC!.(*+!D!502*!-,&*!*0&8'()!,'*!5'66'*!%&'!,'*!/066'*B9!W,!-'&)!.55'3)'#!1#.8'6'()!,.!
%&.,2)$!4'!82'9!`&;!JT`!2,!'*)!#'*-0(*.>,'!4'!-,&*!4'!H!62,,20(*!4'!30(*&,).)20(*!.6>&,.)02#'*!.((&',,'*!')!U+_!
62,,20(*!4'!-#'*3#2-)20(*!-0&#!&(!30a)!)0).,! 4'!DC!62,,2.#4*!4'!40,,.#*9!:.!*<6-)06.)0,012'!'*)! $62('66'()!
8.#2.>,'! ')+! 306-.#.)28'6'()! .&! -,.3'>0+! ,='5523.32)$! 4'! ,.! -,&-.#)! 4'*! )#.2)'6'()*! #'*)'! 6.#12(.,'9! J('!
#$3'()'!62*'!K!70&#!4'!#'3066.(4.)20(*B+D+!&('!#'8&'!*<*)$6.)2%&'H!!')!&('!6$).!.(.,<*'!.--0#)'()!%&',%&'*!
$,$6'()*!4'!306-#$/'(*20(9!
.
<+((=-3.)-./4./122=*42>*-..
"#$!%&'()*'+)*,*-.$!/+0.
é
$!
:.!-#'62N#'!425523&,)$!'*)!4=$).>,2#!,'!-#052,!*<6-)06.)2%&'!4&! -.)2'()9!:'! TWW! ('! 30##'*-0(4!-.*!K!&('!'()2)$!
>2'(!4$52(2'!6.2*!K!&(!'(*'6>,'!4'!3.&*'*!428'#*'*!?!.,)$#.)20(!4'!,.!5,0#'+!4'!,.!60)#232)$!')!4'!,.!-'#6$.>2,2)$!
2()'*)2(.,'*+! 6042523.)20(*! 4'*! 4$5'(*'*! 266&(2).2#'*+!2()'#.3)20(*! ('&#0I8$1$).)28'*+! <! 306-#2*! ,'!*).)&)!
-*<3/0I*032.,H9!:'!42.1(0*)23!'*)!$80%&$!4'8.()!,=';2*)'(3'!4=&(!,.#1'!$8'().2,!4'!*<6-)L6'*+!4&#.()!4'-&2*!.&!
602(*!^!602*9!@'#).2(*!*<6-)L6'*!*0()!3.#.3)$#2*)2%&'*?!*',,'*!60,,'*!5#$%&'()'*!0&O')!30(*)2-.)20(+!40&,'&#!
0&! 2(30(50#)! .>4062(.,+! >.,,0(('6'()+!-#0803.)20(! -.#! ,=2(1'*)20(! 4'! (0&##2)&#'! 0&! 4=.,26'()*!*-$3252%&'*+!
8.#2.>2,2)$!4.(*!,'!)'6-*!V,03.,2*.)20(!4'!,.!40&,'&#+!.*-'3)!4'*!*',,'*X9!R=.&)#'*!*<6-)L6'*!)',*!%&'!,$)/.#12'+!
(.&*$'*+! 40&,'&#*! 40#*.,'*+! 40&,'&#*!8$*23.,'*+! *0()! 5#$%&'()*! ')! -'&8'()! 30()#2>&'#! K! $).<'#!,'! 42.1(0*)239!
T'&,'6'()!DCE!4'*!-.)2'()*!-.#,'#0()!4=2(30()2('(3'!*-/2(3)$#2'(('!*2!,.!%&'*)20(!(='*)!-.*!-0*$'B9!
!
1$%!20.)
è
0$%!3$!4*'$!555!
W,*!*0()!.3)&',,'6'()!-#0-0*$*!3066'!3#2)N#'*!4'!#$5$#'(3'?!40&,'&#!0&!2(30(50#)!.&!602(*!H!70&#*!-.#!602*!
4&#.()! ,'*! H! 4'#(2'#*! 602*! ')! 4$>&)! b! ^! 602*! c! .6$,20#.)20(!-.#! ,.! 4$5$3.)20(! ')O0&! 6042523.)20(! 4'! ,.!
5#$%&'(3'!')O0&!4'!,.!30(*2*).(3'!4'*!*',,'*9!W,*!4$52(2**'()!H!*0&*I1#0&-'*!306-)'!)'(&!4'!,=.*-'3)!4'*!*',,'*!
62'&;!30##$,$!%&'!,'&#!5#$%&'(3'!K!,=$8.,&.)20(!4&!)#.(*2)!?!TTW!.8'3!42.##/$'!VTTWIR!d!*',,'*!4$5.2)'*!b!DUE!4&!
)'6-*!')!*',,'*!4&#'*!e!DUE!4&!)'6-*+X!-,&*!5#$%&'()!3/'f!,=/066'+!.8'3!30(*)2-.)20(!VTTWI@!d!*',,'*!4&#'*!b!
DUE!')!*',,'*!60,,'*!e!DUEX+!-,&*!5#$%&'()!3/'f!,.!5'66'!0&!62;)'!VTTWIY!d!*',,'*!60,,'*!')!*',,'*!4&#'*!b!DUEX9!
!
6.-#$%!3
+,$0)$!3$!(+)7*,*-.$!*0-+#.89$!
`1'bUC!.(*+!.11#.8.)20(!-#01#'**28'!4'*!*<6-)L6'*+!.6.21#2**'6'()!2(';-,2%&$+!42.##/$'!(03)&#('+!6',.'(.!
0&! #'3)0##.12'*+! -'#3'-)20(! 4=&('! 6.**'! .>4062(.,'! 0&!#'3).,'+! .()$3$4'()*! 5.62,2.&;! 4'! 3.(3'#*! 0&!
-.)/0,012'!30,2%&'!0&!2()'*)2(.,'!0&!4'!6.,.42'!3A,2.%&'+!.($62'!5'##2-#28'!2(';-,2%&$'9!
!
:0.-.#$!.+)0*-
è
#$!
I `,26'().2#'!?!3.,32&6+!6.1($*2&6+!*0(!4'!>,$!
I Y$423.6'()'&*'?! .()2/2*).62(2%&'*+! `W\T+! .()2>20)2%&'*+!.()24$-#'**'&#*+! .()2-.#g2(*0(2'(*+!
.()2-*<3/0)2%&'*+!2(/2>2)'&#*!3.,32%&'*+!6')50#62('+!42&#$)2%&'*+!0-20h4'*+!*<6-.)/230626$)2%&'*9!
!
;<+'$#%!2*'(,
é
'$#)+.0$%!=!
W,! ';2*)'! &('! 1#.(4'! 2(3'#)2)&4'! 30(3'#(.()! ,'*! ,262)'*! ')!.**032.)20(*! '()#'! TWW! ')! 6.,.42'! 2(5,.66.)02#'!
2()'*)2(.,'9!
9+/+3?+@1-.?!&('!$)&4'!3.*!30()#L,'!VG^^!-.)2'()*!*&*-'3)*!4'!TWW!')!GUB!)$602(*!'(!>0(('!*.()$X!.!60()#$!&('!
-#$8.,'(3'!4'!,$*20(*!2(5,.66.)02#'*!623#0*30-2%&'*!4'!B+UE!VFOG^^X!4.(*!,'!1#0&-'!TWW!')!D+HE!4.(*!,'!1#0&-'!
)$602(!i! GU!.(*!?!&('! 30,0*30-2'!4'!#0&)2('! (='*)!40(3!-.*!7&*)252$'!3/'f!4'*!-.)2'()*!-#$*'().()!4'*!*21('*!
3.#.3)$#2*)2%&'*!4'!TWW!*.(*!.&)#'!*21('!4=.--',9!
94/@*+2-?21(-!A=?4/-. -2. 9BC!?! .&!8&! 4'*!4255$#'()'*!$)&4'*! .<.()! $8.,&$!,=.--0#)!4'!3'*!)'*)*!*.(1&2(*!')O0&!
';.6'(*!4'!*',,'*HIU+!2,!(=<!.!.&3&('!-#'&8'!4'!,'&#!2()$#P)9!W,*!('!*0()!40(3!-.*!#'3066.(4$*!'(!#0&)2('!3/'f!
4'*!-.)2'()*!-#$*'().()!4'*!*21('*!3.#.3)$#2*)2%&'*!4'!TTW!'(!4'/0#*!4'!*21('*!4=.,.#6'!$803.)'&#*!4'!6.,.42'!
2(5,.66.)02#'! ?! #2*%&'! 4'! 6.,.42'! 2(5,.66.)02#'! 2()'*)2(.,'!eBE! *2! 3.,-#0)'3)2('! 5$3.,'! V/0#*! (06'(3,.)&#'X!
eGCj1O1!0&!@kl!eC+U!61O4,!G9!
!
!
M&'!-#0-0*'#!K!(0*!-.)2'()*!Q.V\]!FFm!4&!C_!`8#2,!DCBUX.
!
9+(2-:2-..
:'! 42.1(0*)23! 4&! *<(4#06'! 4'! ,=2()'*)2(! 2##2).>,'! VTWWX! '*)! '**'()2',,'6'()! 3,2(2%&'9! :.! -#2*'! '(! 3/.#1'! 4'*!
)#0&>,'*! 50(3)20((',*! 1.*)#0! 2()'*)2(.&;! '*)! ,262)$'! ')! -&#'6'()! *<6-)06.)2%&'! VS2>,206'4!FF^X9! :='5523.32)$!
)#N*! #',.)28'! 4'*! 4255$#'()*! )#.2)'6'()*! 306-.#.)28'6'()! .&! -,.3'>0! ')! ,'*! (06>#'&;! 3#2)N#'*! 4=$8.,&.)20(!
-0**2>,'*!#'(4'()!2(3'#).2('*!,'*!30(3,&*20(*!4'*! '**.2*!3,2(2%&'*9!:.!-,&-.#)!4'*! #'3066.(4.)20(*!#'-0*'()!
-,&*!*&#!4'*!';-$#2'(3'*!3,2(2%&'*!%&'!*&#!4'*!'**.2*!#.(4062*$*+!)$6021(.()!4'!>'.&30&-!4=2(30((&'*B9!
.
<+((=-3.)-./4./122=*42>*-...
>
+?*03!9#$! 3
é
'+027$!
é
392+)./$
?! *='(%&$#2#! 4&! 604'! 4'! 82'! 4&! -.)2'()! V.,26'().)20(+! *$4'().#2)$X! ')!
2(50#6'#!*&#!,.!(.)&#'!4'*!)#0&>,'*!')!,'&#!>$(21(2)$!')!,.!82*$'!*<6-)06.)2%&'!4'*!)#.2)'6'()*!42*-0(2>,'*B9!
!
@*#%$.,%!3.
é
)
é
).89$%
?!-#'(4#'!,'!)'6-*!4'!6.(1'#!n!$82)'#!4'!*.&)'#!4'*!#'-.*!n!>02#'!.&!602(*!m!8'##'*!4'!
,2%&24'O70&#!?! '.&+! >02**0(*! (0(! 3.5$2($'*+! )2*.('*! n!,262)'#! 3.5$+! )/$! VH! ).**'*O70&#X+!.,300,! ')! >02**0(*!
1.f'&*'*!n!,262)'#!,$1&62('&*'*+!6.h*+!-066'*!4'!)'##'!2(*&552*.66'()!3&2)'*+!>.(.('+!-.2(!V(0(!421$#$*!4.(*!
,=2()'*)2(! 1#P,'X+! 5#&2)*! VH! -0#)20(*! 4='(82#0(! mC1O70&#! op#.4'! @qX!n! 3$#$.,'*! 4=.802('! ,'! 6.)2(! 0&! B! 3&2,,'#! K!
*0&-'O70&#!4'!1#.2('*!4'!,2(!'(!3.*!4'!>.,,0(('6'()*n!$82)'#!,'!*0#>2)0,!V>02**0(*+!5#2.(42*'*!')!-#04&2)*!*.(*!
*&3#'X!'(!3.*!4'!42.##/$'!-#$4062(.()'B9!!
D15*-3!?! 4.(*! BF! $)&4'*! VBH^H! -.)2'()*X+! ,'*! 52>#'*! 2(*0,&>,'*! V*0(! 4'! >,$! ')! 6.h*X! 0()! ,'! 6P6'! '55')! %&'! ,'!
-,.3'>0! ')! -'&8'()! .11#.8'#! ,'*! *<6-)L6'*9! :'&#! 30(*066.)20(! 402)! P)#'! .4.-)$'!n! '(! 3.*! 4'! 30(*)2-.)20(!
-#$4062(.()'+!-#282,$12'#!,'*!52>#'*!*0,&>,'*!V-0&4#'!4'!*-.1/&,.!0&!5,030(*!4=.802('X!Vp#.4'!@XBI^9!!
C*+51+21E>-3.?!&('!$)&4'!0>*'#8.)20((',,'!*&#!F^!-.)2'()*!30(*066.()!D! <.0&#)*O70&#+!'(#23/2*!VGH!-.)2'()*X!
0&!(0(!VHHX!'(!-#0>20)2%&'*!(=.!-.*!60()#$+!K!G!*'6.2('*+!4'!4255$#'(3'!*21(2523.)28'!'()#'!,'*!4'&;!1#0&-'*+!
.3)25!')!-,.3'>0!VUFE!8*!UHE!n!-!d!C+FBXF9!
F(.*=G1,-.)0-:?/>31+(!('!*'#.!'(82*.1$+!*2!,'*!*<6-)L6'*!-'#*2*)'()+!%&=.-#N*!.82*!42$)$)2%&'!*-$32.,2*$9!J('!
.,,'#12'!'*)!#.#'!6.2*!&('!2()0,$#.(3'!'*)!5#$%&'()'+!-.#!';'6-,'!.&;!52>#'*!2(*0,&>,'*9!
!
A2)./.)
é
!(7&%.89$B!R.(*!&('!$)&4'!3/'f!H_!-.)2'()*!V60<'(('!4=r1'!GU!.(*X!*&282*!U+D!.(*+!-.**'#!4'!H+D!K!U+D!
/O*'6.2('!4=.3)282)$!-/<*2%&'!.6$,20#.2)!,'!*30#'!4'!*$8$#2)$!4&!TWW!VDBm!8*!DF^!n!-dC+CCBX+!,.!%&.,2)$!4'!82'+!,.!
5.)21&'+!,.!4$-#'**20(+!')!,=.(;2$)$m9!
!
C0+.)$'$#)%!(7+0'+2*,*-.89$%9!:='55')!-,.3'>0!'*)!26-0#).()!V-#N*!4'!GFEX!4.(*!,'*!'**.2*!#.(4062*$*9!
H(213@43,+)1E>-3.4(21?I+/1(-*G1E>-3.+>.,>3?>/+2*+@-3!?! &('! 6$).! .(.,<*'! VU^! $)&4'*! ')! HFDU! -.)2'()*X_!.!
60()#$!%&=2,*!*0()! *21(2523.)28'6'()!-,&*! '5523.3'*!%&'!,'!-,.3'>0!*&#!,'*!40&,'&#*!.>4062(.,'*! Vkk!B+HD!n! W@!
_UE!B+BD!s!B+UU!n!-eC+CCB!n!\\t!d!FX+!,'!>2'(!P)#'!1,0>.,!VB+G_!n!B+DUIB+FF!n!-eC+CCCB!n!\\t!d!UX!')!,'!*30#'!4'!
*$8$#2)$!VB+m^!n!B+D^!s!D+F^!n!-eC+CB!n!\\tdHX9!
H(21)=@*-33->*3.?!,.!6P6'!6$).!.(.,<*'!.!60()#$!&(!>$($523'!*21(2523.)25!4'*!.()24$-#'**'&#*!*&#!,'*!40&,'&#*!
.>4062(.,'*!Vkk!B+G_!n!B+CUID+BD!n!-!d!C+CH!n!\\t!d!UX+!,'!>2'(!P)#'!1,0>.,!VB+UF!n!B+DHID+CC!n!-!e!C+CCB!n!\\t!d!GX+!
,'!*30#'!4'!*$8$#2)$!VB+__!n!B+HDID+__n!-!d!C+CCBn!\\t!d!GX9!:'*!WkTT!$).2'()!-,&*!'5523.3'*!*&#!,'!>2'(!P)#'!1,0>.,+!
,'*!)#23<3,2%&'*!*&#!,'*!40&,'&#*!.>4062(.,'*!')!,'!*30#'!4'!*$8$#2)$9!
J+)1A1?42->*3.)>.2*4(312.?! ,.;.)25*! V*.&5! ,.3)&,0*'X! 0&! #.,'()2**'&#*! V,0-$#.624'X+! *',0(! ,.! -#$4062(.(3'! 4'!
30(*)2-.)20(!0&!4'!42.##/$'+!'(!.7&*).()!,.!40*'!K!,.!#$-0(*'!3,2(2%&'B9!
!
5#)$0/$#).*#%!(%&27*D2*'(*0)$'$#)+,$%
?!&('!#'8&'!4'!DU!$)&4'*!(=.!-.*!60()#$!4'!4255$#'(3'!!*21(2523.)28'!
'()#'!-*<3/0)/$#.-2'*+!t@@!0&!#',.;.)20(!8*!1#0&-'*!)$602(*^9!@'*!)/$#.-2'*!-'&8'()!P)#'!'(82*.1$'*!'(!3.*!4'!
TWW!-'#*2*).()!.-#N*!BD!602*!4'!-#2*'!'(!3/.#1'!42$)$)2%&'!')!-/.#6.30,012%&'B9!R.(*!G!$)&4'*!VBGF!-.)2'()*X!4'!
5.2>,'!%&.,2)$+!,=/<-(0)/$#.-2'!(='*)!-.*!-,&*!'5523.3'!%&'!,.!-*<3/0)/$#.-2'!0&!,'!-,.3'>0B9!
!
A9)0$%!)0+.)$'$#)%9! R.(*! U! $)&4'*! 4'! 5.2>,'! %&.,2)$+! ,=.3&-&(3)&#'! (=$).2)! -.*! -,&*! '5523.3'! %&'! ,'! S2524&*!
VB+CF!n!C+_CIB+DFX!*&#!BmB!-.)2'()*!0&!%&'!,.!-*<3/0)/$#.-2'!VB+CU!n!C+mF!s!B+D^X!*&#!BCC!-.)2'()*F9!
R.(*!UB!'**.2*!306-.#.()!4255$#'()*!-#0)030,'*!/06$0-.)/2%&'*!.&!)#.2)'6'()!30(8'()20((',+!DD!60()#.2'()!
&(!>$($523'!')!D_!.&3&('!4255$#'(3'9$ $
Mots%clés%:$syndrome$du$colon$irritable$–diagnostic$–$traitement$[IBS$diagnosis$–$treatment]$
J4/4)1-3.1(A/4,,42+1*-3.?I*+(1E>-3.)-./01(2-321(.6J7978K.
!
M&',*!#'-N#'*!'(!DCBU!Q!V\°!FmG!4&!CG!u&2(!DCBUX9.
!
9+(2-:2-..
:'*!6.,.42'*!2(5,.66.)02#'*!3/#0(2%&'*!4'!,=2()'*)2(!VYW@WX!#'1#0&-'()!,.!6.,.42'!4'!@#0/(!VY@X!')!,.!#'3)0I
30,2)'!/$60##.12%&'! Vk@vX+!3.#.3)$#2*$'*!)0&)'*! 4'&;!-.#!&('! 2(5,.66.)20(!4'! ,.! -.#02!4=&('! -.#)2'! 4&!)&>'!
421'*)259!w,,'*!'()#.x('()!&(!/.(423.-!50(3)20((',!6.7'&#!')!&(!#')'()2**'6'()!26-0#).()!*&#!,.!%&.,2)$!4'!82'9!
:'&#! 3.&*'! #'*)'! 2(30((&'+! 6&,)25.3)0#2',,'+! ,'&#! $80,&)20(! 8.#2.>,'+! -.#502*! .3306-.1($'! 4'! 306-,23.)20(*!
*$8N#'*+!*.(*!)#.2)'6'()!3&#.)25!.3)&',9!R'*!*<()/N*'*!')!$)&4'*!.--0#)'()!4'*!$,$6'()*!4'!306-#$/'(*20(BDI
Bm9!
!
<+((=-3.)-./4./122=*42>*-...
"#$!0
é
(+0).).*#!)0
è
%!7
é
)
é
0*-
è
#$!
:'*! YW@W! -'&8'()! *'! #$8$,'#! K! )0&)! r1'+! ,'! -,&*! *0&8'()! '()#'! DC! ')! HC! .(*9! l,&*! 5#$%&'()'*! 4.(*! ,'*! -.<*!
4$8',0--$*! ,=2(324'(3'! ')! ,.! -#$8.,'(3'! .&16'()'()! #$1&,2N#'6'()!?! BC! (0&8'.&;! 3.*! '(! "#.(3'OBCC! CCC!
/.>O.(B+!BUE!3/'f!4'*!'(5.()*9!:'*!40(($'*!4&!#'12*)#'!wlWY`RBH!*&#!UFB!-.)2'()*!4&!\0#4!4'!,.!"#.(3'!0()!
60()#$!*&#!U!.(*!&('!-#01#'**20(!4'!,=2(324'(3'!1,0>.,'!4'!F+H!K!_+^OBCC!CCC!/.>2).()*!*02)!&('!.&16'().)20(!
4'!BDCE!')!BFCE!#'*-'3)28'6'()!-0&#!,.!Y@!')!,.!k@v9!@/'f!4'*!621#.()*!,'!#2*%&'!4'!YW@W!#'702()!3',&2!4'!,.!
-0-&,.)20(! 4=.33&'2,+! 4=0y! &(! #L,'! -0**2>,'! 4'! 5.3)'&#*! '(82#0(('6'().&;?! -0,,&)20(+! /<12N('+! .,26'().)20(+!
.()2>20)2%&'*+!.--'(423'3)062'*+!).>.3+!*.(*!%&=.&3&('!$)&4'!('!-'#6'))'!4'!,'!30(52#6'#BD+BG9!!
E,9%.$90%!20.)
è
0$%!3.+-#*%).89$%!
9/1(1E>-3.?!40&,'&#*!.>4062(.,'*!')!42.##/$'!-.#502*!*.(1,.()'*!-#$4062(.()'*+!52**&#'*!0&!52*)&,'*!4'!,.!#$120(!
.(.,'+!-.#502*!.**032$'*!K!4'!,.!52N8#'+!4'*!*21('*!3&).($*+!.#)23&,.2#'*+!/$-.)2%&'*!0&!03&,.2#'*9!R.(*!DCE!4'*!
3.*+!,=2()'(*2)$!4'*!)#0&>,'*!-'&)!26-0*'#!&(!.##P)!4'!,=.,26'().)20(!')!&('!/0*-2).,2*.)20(9!`&!30&#*!4'!,=$80I
,&)20(!-'&8'()!*&#8'(2#!4'*!*)$(0*'*+!.>3N*+!52*)&,'*!0&!033,&*20(*!2()'*)2(.,'*9!:'!#2*%&'!4'!3.(3'#!4&!3L,0(!'*)!
40&>,$!.-#N*!BC!.(*!4=$80,&)20(BD9!
L1+/+G1E>-3.?!,.!3.,-#0)'3)2('!5$3.,'+!/0#*!(06'(3,.)&#'! Vv\X+! '(!-#$*'(3'!4'!*21('*!3,2(2%&'*!')! >20,012%&'*!
$803.)'&#*! 4=2(5,.66.)20(! V.($62'+! @kl+! ,'&303<)0*'+! >2,.(! /$-.)2%&'+! 3#$.)2(2('+! $).)! (&)#2)20((',X+! '*)+! .&!
*'&2,!4'!UCz1O1+!&(!$,$6'()!4255$#'()2',!4=&(!*<(4#06'!50(3)20((',!4&!30,0(!2##2).>,'9!R.(*!&('!6$).I.(.,<*'!
4'!BH!$)&4'*!V^FC!.4&,)'*!')!HFB!'(5.()*X!*'(*2>2,2)$!')!*-$325232)$!$).2'()!#'*-'3)28'6'()!4'!C+_H!VC+mUIC+_FX!')!
C+_^! VC+F_IC+__X+! .8'3! &('! *-$325232)$! 602(4#'! 3/'f! ,='(5.()! ')! ,=.40,'*3'()!?! C+F^!VC+^DIC+m^!n! -dC+CGmX9! :'!
40*.1'!4'!,.!3.,-#0)'3)2('!.!-'#62*!4'!#$4&2#'!4'!^FE!,'!(06>#'!4='(40*30-2'*!.8'3!^E!4'!5.&;!($1.)25*+!3/'f!
,=.4&,)'!')!_E!3/'f!,='(5.()BU9!!!
:=$)&4'! *26&,).($'! 4'*! `T@`! V.3! .()2IT.33/.#06<3'*! 3'#'82*2{+! v\X! ')! -`\@`! V.3! .()2('&)#0-/2,'*!
3<)0-,.*62%&'*!-$#2(&3,$.2#'*X!.24'!K!4255$#'(32'#!k@v!')!Y@B^+BF9!
M()+3?+@1-!?!&('!2,$0I30,0*30-2'!')!&('!A*01.*)#0*30-2'!.8'3!>20-*2'*!-'#6'))'()!4'!3.#.3)$#2*'#!,'*!,$*20(*!?!
42*30()2(&'*!K!-#$4062(.(3'!2,$.,'!')!*)$(0*'*!5#$%&'()'*!4.(*!,.!Y@!n!30()2(&'*!*.(*!.))'2()'!2,$.,'!')!#.#'*!
*)$(0*'*!4.(*!,.!k@v9!!
7,4G-*1-!?!'()$#0I*3.(('#+!'()$#0IWkY+!824$0!3.-*&,'!'(40*30-2%&'!-'&8'()!.24'#!4.(*!4'*!3.*!!4255232,'*B^+BF9!
5,!#
&!+!(+%!3$!)0+.)$'$#)!290+).F!3$%!G5@5!
:.!)/$#.-'&)2%&'!.!-0&#!0>7'3)25!&(!30()#L,'!4&#.>,'!4'!,.!-.)/0,012'!')!,'!6.2()2'(!4'!,.!%&.,2)$!4'!82'9!!
N*412-,-(2.)-.?*13-9!!Amino&salycilates!VUI`T`X!'(!BN#'!2()'()20(9!:'*!'55')*!2(4$*2#.>,'*!VBC!K!GUEX!*0()!40*'!
4$-'(4.()*!V(.&*$'*+!$-21.*)#.,12'*+!42.##/$'+!-.(3#$.)2)'*+!T)'8'(*!u0/(*0(XBG9!
.&Corticostéroïdes,&'(!3.*!4=$3/'3!4'*!UI`T`+!.8'3!UCE!4'!#2*%&'*!4='55')*!*<*)$62%&'*!-.#502*!*$8N#'*!4.(*!4'*!
)#.2)'6'()*! 4$-.**.()! BD! *'6.2('*! ?! 0*)$0-0#0*'+! 0*)$0($3#0*'! 4'! ,.! )P)'! 5$60#.,'+! 6<0-.)/2'*+!
3.).#.3)'BD+BG9!!!
N*412-,-(2. )-. A+()9! Immunomodulateurs!'5523.3'*! 4.(*! ,'! 6.2()2'(! 4'*! #$62**20(*! VY@! ')! k@vX9! T&#! mH!
-.)2'()*!.-#N*!H+U!.(*!4'!)#.2)'6'()!-.#!.f.)/20-#2('!V`|`X!')!-0&#*&2)'!-'(4.()!Bm!602*!4'!,=`|`!8*!-,.3'>0+!
,'*!).&;!4'!#'3/&)'*!$).2'()!#'*-'3)28'6'()!4'!DB!')!mE!V-dC+CB_UXBG9!!
.& Biothérapies& anti& TNF.
α
!4.(*! ,'*! 50#6'*! *$8N#'*! ')! #$*2*).()'*! ?! 2(5,2;26.>! 0&! .4.,26&6.>! -0&#! ,.! Y@+!
2(5,2;26.>!*'&,'6'()!4.(*!,.!k@vBD+B^+BF9!W,!(=<!.!-.*!4'!30(*'(*&*!*&#!,.!4&#$'!4&!)#.2)'6'()+!.4.-)$!.&!3.*!-.#!
3.*+!(2!*&#!,'!6.2()2'(!4'!,='5523.32)$!K!,0(1!)'#6'Bm9!
.&L’alimentation!(=2(5,&'!-.*!*&#!,'!30&#*!4'!,.!6.,.42'9!R'*!*&--,$6'().)20(*!V5'#+!.324'!50,2%&'+!f2(3X!802#'!&('!
.,26'().)20(!-.#'()$#.,'!-'&8'()!P)#'!($3'**.2#'*!K!,.!4'6.(4'B^+BF9!
.&Chirurgie9!w(!4'/0#*!4'!30()';)'*!4=&#1'(3'+!&('!3/2#&#12'!$,'3)28'!*',0(!,=$)'(4&'!')!,.!428'#*2)$!4'*!,$*20(*!
'*)!#$*'#8$'!.&;!6.,.4'*!#$*2*).()!K!&(!)#.2)'6'()!6$423.,!>2'(!30(4&2)9!
!
Mots%clés%:$maladie$inflammatoire$de$l’intestin$–diagnostic$$traitement$[inflammatory$bowel$disease$–
diagnosis$–$treatment]$
J4/4)1-.?O/14E>-..
!
J('!6.,.42'!-$42.)#2%&'!Z!#.#'![!Q!V\°!F^C!4&!BH!\08'6>#'!DCBGX!
!
!
.
9+(2-:2-..
:.!-#'62N#'!4'*3#2-)20(!3,2(2%&'!30((&'!4'! 3'))'!42.##/$'!3/#0(2%&'! '*)! 3',,'! 4=`#').'&*+! 6$4'32(! !1#'3!! 4&!
D(4!!*2N3,'!!.-#N*!!u@9!W,!!'(!!*0&-}0(('!,=0#212('!.,26'().2#'!')!*0&,21('!%&=',,'!!.55'3)'!,='(5.()!3066'!,=.4&,)'+!
-,&*! *0&8'()! ,'*! ! 5'66'*9! :.! 6.,.42'! 3A,2.%&'! VY@X! '*)! #'4$3#2)'! K! ,.! 52(! 4&! B_N6'! *2N3,'! -.#! &(! -$42.)#'!
.(1,.2*! ')! 30(*24$#$'! K! -.#)2#! 4'! 3'! 606'()! 3066'! &('! 6.,.42'! -$42.)#2%&'! #.#'9! ~'#*! B_UC+! &(! -$42.)#'!
/0,,.(4.2*!4$60()#'! ,'!#L,'!4$3,'(3/.()!4&!1,&)'(! 2**&!4&!>,$+!4&! *'21,'!')!4'! ,=0#1'!?!,'!#$126'!*.(*!1,&)'(!
-'#6')!4'-&2*!,.!1&$#2*0(!4'*! -.)2'()*9!Y.2*!,'!#L,'!#'*-'3)25!4'*!5.3)'&#*! '(82#0(('6'().&;+!1$($)2%&'*!')!
266&(0,012%&'*!'*)!'(30#'!6.,!306-#2*9!:'*!$)&4'*!#$3'()'*!*&11N#'()!&('!.&16'().)20(!4'!-#$8.,'(3'!4.(*!
,'*!-.<*!4$8',0--$*+!K!4'*!r1'*!)#N*!428'#*!4'!,.!82'+!*.(*!';-,23.)20(!$824'()'B_IDD9!!
!
.
<+((=-3.)-./4./122=*42>*-!
H9$,,$!$%)!,+!(0
é
/+,$#2$!3$!,+!G@!=!
R.(*! ,'*! -.<*! 03324'().&;+! ',,'! '*)! '(! -0-&,.)20(! 1$($#.,'! 4'! C+F! K! DE+! 6.2*!-,&*! $,'8$'! 4.(*! 3'#).2('*!
-0-&,.)20(*!Z!K!#2*%&'![!-0&#!428'#*'*!#.2*0(*!?!H!K!^E!3/'f!,'*!42.>$)2%&'*!4'!)<-'!B+!BC!K!DCE!3/'f!,'*!.-I!
-.#'()$*!4&!B'#!4'1#$!4=&(!*&7')!3A,2.%&'+!H!K!BUE!3/'f!,'*!*&7')*!.<.()!&('!.($62'!5'##2-#28'+!B!K!HE!'(!3.*!
4=0*)$0-0#0*'9!T&#)0&)+!,.!6.70#2)$!4'*!Y@!*0()!.)<-2%&'*+!40(3!*0&8'()!6$30((&'*!?!-0&#!3/.%&'!3.*!4'!Y@!
42.1(0*)2%&$'+!2,!';2*)'#.2)!H!K!F!3.*!(0(!42.1(0*)2%&$*DC9!•(!#')#0&8'!&('!2(324'(3'!-#03/'!!4'!3',,'*!4=w&#0-'!
0&!4'*!JT`!'(!`5#2%&'!4&!\0#4+!.&!Y0<'(I•#2'()!0&!'(!W(4'!n!'(!#'8.(3/'+!',,'!'*)!%&.*26'()!(&,,'!'(!`*2'!4&!
T&4!w*)!')!'(!`5#2%&'!(02#'9!:=2(324'(3'!'*)!-.**$'!4'!DIH!K!_+!802#'!BH+!(0&8'.&;!3.*!-0&#!BCC!CCC!/.>2).()*!')!
-.#! .(! 4&#.()! 3'*! HC! 4'#(2N#'*! .(($'*+! -#0>.>,'6'()! 4&! 5.2)! 4'! ,.! 6'2,,'&#'! 30((.2**.(3'! 4'*! 50#6'*!
.)<-2%&'*!')! *2,'(32'&*'*! 1#r3'! .&;! )'*)*! *$#0,012%&'*9! R'*! 4255$#'(3'*! 4'! -#$8.,'(3'! 4'! 1N('*! 4'!
-#$42*-0*2)20(! ')! 4'*! 604.,2)$*! 4'! ,.! 428'#*2523.)20(! .,26'().2#'! -0&##.2'()! .&**2! ';-,2%&'#! 3'*! 8.#2.)20(*!
1$01#.-/2%&'*!')!4.(*!,'!)'6-*9!
!
G+#.F$%)+).*#%!
à
!2*90)!$)!,*#-!)$0'$!
Y.,1#$! *0(! .(32'((')$+! ,.! 30(5$#'(3'! 4'! 30(*'(*&*! 4&! \Wv! .6$#23.2(! #'*)'! &('! #$5$#'(3'! 4'! )#N*! 1#.(4'!
%&.,2)$+!-0*.()!4'*!%&'*)20(*!)0&70&#*!4=.3)&.,2)$DB9!
:.! 50#6'! )<-2%&'! 4'! ,.! Y@! 3/'f! ,'! 7'&('! '(5.()! .**032'! 4N*! ,'! 4$>&)! 4'! ,=2(1'*)20(! 4&! 1,&)'(! ?! #').#4! 4'!
3#02**.(3'+! 42.##/$'! 3/#0(2%&'+! 42*)'(*20(! ! .>4062(.,'+! 50()'! ')! /<-0)0(2'! 6&*3&,.2#'+! .(0#';2'+! )#2*)'**'+!
.8'3! 4'! 1#.(4'*! 8.#2.)20(*! *',0(! ,'*! -.<*9! Y.2*! 2,! ';2*)'! 4'*! 50#6'*! .)<-2%&'*! ')! 6P6'! *2,'(32'&*'*+!
-#$42*-0*.()!K!4'*!Y@!)<-2%&'*!4'!,=.4&,)'DB9!
@/'f! ,€.4&,)'+! ,.! Y@! -'&)! P)#'! Z! 3,.**2%&'! [! V42.##/$'! -#$4062(.()'X! 0&! *2,'(32'&*'! V*<6-)L6'*! 1.*)#0I!
2()'*)2(.&;! -'&! 26-0#).()*X+! -#$*'().()! 4=.&)#'*! 6.(25'*).)20(*! V.($62'! 0&! 0*)$0-0#0*'X+! .**032$'! K! 4'*!
6.,.42'*!.&)0I266&('*!V42.>N)'!4'!)<-'!B+!)/<#0h42)'*+!('&#0-.)/2'!-$#2-/$#2%&'X+!0&!4'*!)&6'&#*!6.,21('*9!
:.!%&'*)20(! 4&!#L,'! -0**2>,'!4€&(! )#.2)'6'()!-#$303'!4'*! Y@!*&#! ,'!4$8',0--'6'()! 4'*!306-,23.)20(*! .&)0I
266&('*!5.2)!)0&70&#*!4$>.)9!
!
H9.!F+930+.)D.,!3
é
(.%)$0I!$)!2*''$#)!=!
:'!1,&)'(!(='*)!)0;2%&'!%&'!3/'f!4'*!*&7')*!1$($)2%&'6'()!-#$42*-0*$*+!>2'(!%&'!4'*!5.3)'&#*!(0(!1$($)2%&'*!
2()'#82'(('()!$1.,'6'()9! T0(! .##P)! .! &(! 26-.3)! -0*2)25! *&#! ,=.--$)2)+! ,€$).)! (&)#2)20((',+! ,.! 4'(*2)$! 62($#.,'!
0**'&*'!')!,'*!5#.3)&#'*!3/'f!,'*!!*&7')*!*<6-)06.)2%&'*9!k2'(!('!-'#6')!4'!30(3,&#'!K!,=2()$#P)!-#$8'()25!4=&(!
)',! #$126'! -0&#! ,'! #2*%&'! &,)$#2'&#! 4'! -.)/0,012'*! .**032$'*+! 4'! 6.,.42'*! .&)0! 266&('*! 0&! 4'! 3.(3'#*+!
(0).66'()!4.(*!,'*!50#6'*!.*<6-)06.)2%&'*!4'!Y@9!:.!%&'*)20(!%&2!*'!-0*'!'*)!40(3!3',,'!4&!42.1(0*)23!3/'f!
4'*!*&7')*!*<6-)06.)2%&'*!V0&!.*<6-)06.)2%&'*!-.#'()*!.&!B'#!4'1#$!4=&(!*&7')!.))'2()X+!-0&#!6'))#'!'(*&2)'!
'(!-,.3'!&(!#$126'!*.(*!1,&)'(+!-,&)L)!%&'!3',,'!4&!4$-2*).1'+!(0(!7&*)252$!'(!-0-&,.)20(!1$($#.,'9!:=$8.,&.)20(!
DCCF! 4'! ,.! v`T! #'*)'! 4=.3)&.,2)$DD!?! ,.! -0*2)282)$! 4'*! .()230#-*! .()2! '(406<*2&6! ')! .()2!)#.(*1,&).62(.*'!
30(52#6'! ,.! *&*-2320(! 3,2(2%&'! n! 4'*! >20-*2'*! 4'! ,=2()'*)2(! 1#P,'! *0()! .,0#*! 2(42%&$'*+! ',,'*! *'&,'*! .552#6.()! ,'!
42.1(0*)23!4'!Y@!2(42%&.()!&(!#$126'!*.(*!1,&)'(9!
.
.
.
1 / 8 100%
La catégorie de ce document est-elle correcte?
Merci pour votre participation!

Faire une suggestion

Avez-vous trouvé des erreurs dans linterface ou les textes ? Ou savez-vous comment améliorer linterface utilisateur de StudyLib ? Nhésitez pas à envoyer vos suggestions. Cest très important pour nous !