大腸病変と酷似する胃病変を伴った潰瘍性大腸炎の1例

Gastric Lesions in Ulcerative Colitis, Report of a Case

要旨　患者は43歳男性で，下痢と心窩部痛を主訴とした．胃X線検査では胃角部から前庭部にかけてびまん性に微小潰瘍を認め，辺縁像ではカラーボタンサインを呈した．胃内視鏡検査では同部に小潰瘍の多発を認めた．病理組織学的には上皮のびらんと粘膜固有層へ高度のびまん性炎症細胞浸潤を認め，多数の腺窩内膿瘍を伴っていた．また活動期の潰瘍性大腸炎と原発性硬化性胆管炎の合併を認め，潰瘍性大腸炎の緩解に伴って胃病変も軽快した．本例の胃粘膜病変は，潰瘍性大腸炎の大腸粘膜病変と酷似しており，潰瘍性大腸炎の胃病変と考えられた．

　A 43-year-old man who had suffered from ulcerative colitis since 6 month before was admitted to the hospital because of epigastric pain and diffuse hemorrhagic erosions of the stomach. Laboratory results were significant for a C-reactive protein level of 3.54 mg/dl, leukocytosis of 11,800/μl, and an erythrocyte sedimentation rate of 62 mm/hr. Furthermore, elevation in alkaline phosphatase (1,553 IU/l), gamma-glutamyl transpeptidase (847 IU/l), aspartic aminotransferase (59 IU/l), and alanine aminotransferase (94 IU/l) were pointed out. Antinuclear antibody and IgG antibodies for Helicobacter pylori were positive. Barium studies demonstrated numerous diffuse erosions with color-button sign at the gastric antrum. Gastric-biopsy specimens showed diffuse infiltration of inflammatory cells and many gland abscesses. Colonic examinations revealed ulcerative colitis in the active phase. Liver biopsy demonstrated thick concentric fibrosis around the bile ducts, which compatible with is primary sclerosing cholangitis. The patient was treated with 5-ASA, H2-RA, and PSL, after which he became asymptomatic. We propose that diffuse ulcerative gastritis should be considered one of the gastrointestinal complications of ulcerative colitis.