2. 系統的疾患における器質的消化管病変・機能的消化管障害―肝・胆・膵疾患など消化器疾患にみられる消化管病変を含む

The Organic Gastrointestinal Lesions or Functional Bowel Disorders Observed in Systemic Diseases (including Intestinal Lesions that are Provoked by Hepatic, Biliary or Pancreatic Disease)

　消化管の検査に当たりわれわれendoscopistは，その裏に潜んでいるかもしれない系統的疾患を常に理解しそれらを意識しながら観察することが求められている．本稿では系統的疾患によって引き起こされる消化管異常を，器質的消化管病変・機能的消化管障害に分け記述した．なお各論で取り上げられている疾患については詳細な記述を各項にゆずり，取り上げられていないものを中心に述べた．まず器質的消化管病変ではZollinger-Ellison症候群(難治性，易再発性の消化性潰瘍，胃液の大量貯留や，胃の巨大皺襞を認める)，groove pancreatitis(十二指腸下行脚内側に辺縁が比較的平滑，時に不整な粘膜下腫瘍様の隆起性病変あるいは狭窄像を呈することが多い)，膵癌(胃，十二指腸への直接浸潤による狭窄などを来す)，全身性悪性リンパ腫(隆起性病変などを消化管に多発して認める)，成人T細胞性白血病リンパ腫(ATLL ; 全身の諸臓器への浸潤傾向が強く，消化管へも高率に浸潤し様々な消化器症状を呈する)，後天性免疫不全症候群(AIDS ; 各種日和見感染症による消化管病変)，腸管子宮内膜症(直腸Rs～S状結腸の前壁を主体とした片側性隆起や粘膜の顆粒状変化を特徴とする)を取り上げた．次に機能的消化管障害(消化吸収障害，消化管運動障害)では，消化吸収障害として吸収不良症候群と蛋白漏出性胃腸症に関してそれらの症候，原因疾患や診断につき述べ，消化管運動障害として，その診断に際して系統的疾患を含めた他疾患の除外診断が必要となる過敏性腸症候群(IBS)を取り上げた．

　When we observe the gastrointestinal (GI) tract using endoscopy, it is always necessary to consider and understand that potential systemic diseases may be indicated by what we see. The GI abnormalities mentioned in this manuscript are divided into organic GI lesions and functional bowel disorders. Concerning the diseases that were introduced in particular, minute description of each of them, was made, but those that were not introduced in particular were merely mentioned.

　Firstly, we described the following organic GI lesions ; a) Zollinger-Ellison syndrome (refractory and easy-relapsing peptic ulcers, much retention of gastric juice and (or) giant folds in the stomach are observed). b) Groove pancreatitis (elevated or stenotic lesion like a submucosal tumor, which has relatively smooth, or sometimes irregular margin, often exists on the medial wall of the descending portion of the duodenum). c) Pancreatic cancer (stenosis is caused by direct invasion into the stomach or duodenum). d) Systemic malignant lymphoma (multiple elevated lesions etc. are observed in the GI tract). e) Adult T-cell leukemia/lymphoma (ATLL) (organs are easily invaded, the invasion is also observed in the GI tract, and provokes various digestive symptoms). f) Acquired immunodeficiency syndrome (AIDS) (various GI lesions arise from opportunistic infections). g) Intestinal endometriosis (one sided elevation and (or) granularity of the mucosa mainly on the anterior wall of Rs～distal sigmoid colon are characteristic).

　Secondly, functional bowel disorders (digestive and absorptive disorder,GI movement disorder). Their symptoms, original diseases and diagnosis were mentioned as malabsorption syndrome and protein-losing gastroenteropathy. In digestive and absorptive disorder and irritable bowel syndrome (IBS), we described systemic diseases or others which need to be ruled out when diagnosis is made.