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Российский журнал гастроэнтерологии, гепатологии, колопроктологии

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Европейские рекомендации по IgG4-ассоциированным заболеваниям в гастроэнтерологии — рекомендации UEG и SGF, основанные на доказательствах

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Аннотация

Общая цель данного руководства — обеспечить научно обоснованные рекомендации по диагностике и лечению иммуноглобулин G4 (IgG4)-ассоциированных гастроэнтерологических заболеваний у взрослых и детей. IgG4-ассоциированные гастроэнтерологические заболевания могут быть диагностированы только после комплексного обследования, включающего гистологическое исследование, оценку морфологии органов посредством визуализирующих исследований, серологические исследования, оценку поражения других органов и ответ на терапию глюкокортикоидами. Лечение проводится у пациентов с наличием симптомов (обструктивная желтуха, боль в животе, боль, связанная с хвостовой частью поджелудочной железы, и поражение органов пищеварительной системы, помимо поджелудочной железы, включая IgG4-ассоциированный холангит). Доза глюкокортикоидов при терапии зависит от массы тела пациента; начинают с дозы 0,6-0,8 мг/кг/сут внутрь (типичная начальная доза 30-40 мг/сут эквивалента преднизолона) в течение 1 месяца, чтобы вызвать ремиссию, после чего дозу на протяжении еще двух месяцев снижают. Ответ на первоначальную терапию следует оценивать через 2-4 недели по клиническим, биохимическим и морфологическим маркерам. При полиорганном заболевании или наличии рецидивов в анамнезе рекомендуется поддерживающая терапия глюкокортикоидами. Если активность заболевания и выраженность симптомов через 3 месяца не снизились, следует заново переоценить диагноз. При рецидиве заболевания в ходе 3 месяцев терапии следует добавить иммуносупрессивные препараты.

Об авторах

Й-М. Лёр
Отделение заболеваний верхних отделов ЖКТ, Клиника Каролинского университета; Отделение клинической медицины, вмешательств и технологий (CLINTEC), Каролинский институт
Швеция

Стокгольм.



У. Бойерс
Отделение гастроэнтерологии и гепатологии, Медицинский центр Амстердамского университета
Нидерланды

Амстердам.



М. Вуясинович
Отделение заболеваний верхних отделов ЖКТ, Клиника Каролинского университета; Отделение медицины Худдинге, Каролинский институт
Швеция

Стокгольм.



Д. Альваро
Отделение трансляционной и индивидуализированной медицины, Университет Сапиенца в Риме
Италия

Рим.



Й. Б. Фрекьер
Отделение радиологии, клиника университета Ольборга
Дания

Ольборг.



Ф. Ботгрид
Отделение ревматологии и клинической иммунологии, Медицинский университет Шарите Берлина
Германия

Берлин.



Г. Капурсо
Отделение панкреатобилиарной эндоскопии и эндосонографии, Центр трансляционных и клинических исследований поджелудочной железы, Научный институт IRCCS Сан-Рафаэль
Италия

Милан.



Э. Л. Калвер
Отделение трансляционной гастроэнтерологии, больница Джона Рэдклиффа и медицинское отделение Наффилда, Оксфордский университет
Великобритания

Оксфорд.



Э. Де Мадария
Отделение гастроэнтерологии, клиника общего профиля университета Аликанте, ISABIAL
Испания

Аликанте.



Э. Делла-Торре
Школа медицины, университет Вита-Салюте Сан-Рафаэль; Отделение иммунологии, ревматологии, аллергии и редких болезней (UnIRAR), Научный институт IRCCS Сан-Рафаэль
Италия

Милан.



З. Дефлетсен
Отделение патологии, Панкреатологический центр Оденсе (OPAC), Клиника университета Оденсе
Дания

Оденсе.



Э. Домингес-Муньос
Отделение гастроэнтерологии и гепатологии, университетская клиника Сантьяго-де-Компостела
Исландия

Сантьяго-де-Компостела.



П. Чубковски
Отделение гастроэнтерологии, гепатологии, нарушений питания и педиатрии, Мемориальный институт детского здоровья
Польша

Варшава.



Н. Эвальд
Институт эндокринологии, диабетологии и метаболизма, клиника университета Иоханнеса Вестлинга; Гиссенский университет имени Юстуса Либиха
Германия

Гиссен.



Л. Фруллони
Отделение медицины, Институт поджелудочной железы, университет Вероны
Италия

Верона.



Н. Губергриц
Кафедра внутренних болезней, Донецкий национальный медицинский университет
Украина

Лиман.



Д. Г. Думан
Кафедра гастроэнтерологии, медицинский факультет, университет Мармара
Турция

Стамбул.



Т. Хакерт
Кафедра общей хирургии, хирургии брюшной полости и трансплантации, университет Гейдельберга
Германия

Гейдельберг.



Х. Иглесиас-Гарсия
Отделение гастроэнтерологии и гепатологии, университетская клиника Сантьяго-де-Компостела
Испания

Сантьяго-де-Компостела.



Н. Карталис
Отделение лучевой диагностики брюшной полости, Клиника Каролинского университета
Швеция

Стокгольм.



А. Лаги
Кафедра хирургии и клинической медицины и трансляционной медицины, университет Сапиенца в Риме, Больница Св. Андрея
Италия

Рим.



Ф. Ламмерт
Отделение медицины II, Медицинский центр Саарландского университета
Германия

Хомбург.



Ф. Линдгрен
Отделение детской гастроэнтерологии, гепатологии и питания, Клиника Каролинского университета
Швеция

Стокгольм.



А. Охлобыстин
Первый Московский государственный университет им. И.М. Сеченова (Сеченовский Университет)
Россия

Москва.



Г. Орачж
Отделение гастроэнтерологии, гепатологии, нарушений питания и педиатрии, Мемориальный институт детского здоровья
Польша

Варшава.



А. Парнички
Институт трансляционной медицины, Исследовательский центр им. Сентаготаи, Медицинская школа университета Печа; Национальный институт педиатрии им. Пала Хейма
Венгрия

Печ; Будапешт.



Р. М. П. Муцелли
Отделение лучевой диагностики брюшной полости, Клиника Каролинского университета
Швеция

Стокгольм.



В. Ребур
Отделение панкреатологии, больница Божон, Клиши, Парижский университет
Франция

Париж.



Й. Розендаль
Кафедра внутренних болезней I, университет им. Мартина Лютера
Германия

Галле.



Н. Шлейниц
Отделение внутренних болезней Timone, Государственная больница Марселя, университет Экс-Марсель
Франция

Марсель.



А. Шнайдер
Отделение гастроэнтерологии и гепатологии, клиника Бад-Херсфельда
Германия

Бад-Херсфельд.



Э. ФХ ван Боммель
Отделение внутренних болезней, Голландский национальный экспертный центр по ретроперитонеальному фиброзу, больница им. Альберта Швейцера
Нидерланды

Дордрехт.



К. С. Вербеке
Отделение патологии, Клиника университета Осло, и университет Осло
Норвегия

Осло.



М. П. Вульерма
Отделение радиологии, больница Божон
Франция

Клиши.



Х. Витт
Центр диетологии Эльзы Кронер Фрезениус, отделение детской диетологии, Технический университет Мюнхена
Германия

Фрайзинг.



рабочая группа UEG по разработке рекомендаций



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Для цитирования:


Лёр Й., Бойерс У., Вуясинович М., Альваро Д., Фрекьер Й.Б., Ботгрид Ф., Капурсо Г., Калвер Э.Л., Де Мадария Э., Делла-Торре Э., Дефлетсен З., Домингес-Муньос Э., Чубковски П., Эвальд Н., Фруллони Л., Губергриц Н., Думан Д.Г., Хакерт Т., Иглесиас-Гарсия Х., Карталис Н., Лаги А., Ламмерт Ф., Линдгрен Ф., Охлобыстин А., Орачж Г., Парнички А., Муцелли Р.М., Ребур В., Розендаль Й., Шлейниц Н., Шнайдер А., Боммель Э.Ф., Вербеке К.С., Вульерма М.П., Витт Х., по разработке рекомендаций р.U. Европейские рекомендации по IgG4-ассоциированным заболеваниям в гастроэнтерологии — рекомендации UEG и SGF, основанные на доказательствах. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2021;31(1):80-114.

For citation:


Lohr J., Beuers U., Vujasinovic M., Alvaro D., Frøkjær J.B., Buttgereit F., Capurso G., Culver E.L., de-Madaria E., Della-Torre E., Detlefsen S., Dominguez-Munoz E., Czubkowski P., Ewald N., Frulloni L., Gubergrits N., Duman D.G., Hackert T., Iglesias-Garcia J., Kartalis N., Laghi A., Lammert F., Lindgren F., Okhlobystin A., Oracz G., Parniczky A., Mucelli R.M., Rebours V., Rosendahl J., Schleinitz N., Schneider A., Bommel E.F., Verbeke C.S., Vullierme M.P., Witt H., working group t.g. European Guideline on IgG4-related Digestive Disease — UEG and SGF Evidence-based Recommendations. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021;31(1):80-114. (In Russ.)

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