小腸炎症性疾患の臨床像と画像所見

Clinical Features and Imaging Characteristics of Inflammatory Disorders of the Small Intestine

要旨●近年，CT/MR enterographyやカプセル・バルーン内視鏡の普及により，小腸病変の評価が容易となった．小腸炎症性疾患は，①炎症性腸疾患（Crohn病，潰瘍性大腸炎関連），②感染性腸炎（腸結核，CMV腸炎，Whipple病など），③薬剤性腸炎（NSAIDs起因性腸症，ARB関連腸症），④血管炎症候群（IgA血管炎，EGPAなど），⑤自己免疫・自己炎症性疾患（Behçet病，SLE，MEFV遺伝子関連腸炎，アミロイドーシスなど），⑥虚血・放射線性小腸炎，⑦その他（CEAS）に大別される．診断には，腫瘍性病変を除外したうえで①病変の分布・局在，②粘膜病変の形態・配列，③介在粘膜の性状，④経時的変化や薬剤反応性を臨床経過・全身所見と統合して判断することが重要である．

　In recent years, advances in CT/MR enterography along in conjunction with capsule and balloon endoscopy have enhanced the evaluation of small-intestinal lesions.

　Inflammatory disorders afflicting the small intestine can be broadly classified into inflammatory bowel disease−related enteritis ; infectious enteritis ; drug-induced enteropathy ; vasculitic enteritis ; autoimmune and autoinflammatory diseases ; ischemic or radiation-induced enteritis ; and hereditary enteropathies. After excluding neoplastic lesions, it is essential to integrate radiologic, endoscopic, and histopathologic findings with the clinical course and systemic manifestations for accurate diagnosis. The distribution and localization of lesions, morphology and configuration of the ulcer, characteristics of the intervening mucosa, and temporal changes or responsiveness to therapy require special attention. A comprehensive, multimodal assessment is imperative for distinguishing between the diverse etiologies of small-intestinal inflammation.