2)天疱瘡，類天疱瘡

Pemphigus, Pemphigoid

　水疱症の代表的疾患である天疱瘡，類天疱瘡は皮膚や口腔粘膜に水疱やびらんを形成する自己免疫疾患である．本症における消化管病変は炎症性病変と腫瘍性病変に大別される．炎症性病変は食道に高率に認められ，その内視鏡所見は皮膚病変と類似した水疱やびらん形成が主体であり，時に食道粘膜剝離を伴うのが特徴的であった．一方，本症に特徴的な胃・腸病変の報告はなかったが，潰瘍性大腸炎の併発が報告されており，両者に何らかの因果関係が存在する可能性が示唆される．本症と悪性腫瘍との関連性については一定の見解は得られていないが，消化器癌の合併頻度が比較的高いとの報告が多く，積極的な消化管スクリーニング検査が必要であると考えられた．

　Digestive lesions in patients with pemphigus and pemphigoid, which are kinds of bullous disorders, were reviewed. Inflammatory changes due to pemphigus or pemphigoid were mainly observed in the esophagus. Typical endoscopic findings of the inflammatory changes were bullae and/or erosions. Sometimes, exfoliation of esophageal mucosa was revealed by endoscopy. There is no report about the characteristic findings of endoscopy in the stomach and intestine in patients with bullous disorders. However, bullous disorders were occasionally detected in patients with ulcerative colitis, suggesting the pathogenesis of bullous disorders may be associated with that of ulcerative colitis.

　The relationship between bullous disorders and neoplasms is still unknown. However, the incidence of gastrointestinal malignancies in patients with bullous disorders is higher than that in healthy populations. Therefore, it is necessary to perform endoscopy on patients with bullous disorders in order to detect neoplasms in the gastrointestinal tract.