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Stomach and Intestine(Tokyo) Volume 42, Issue 4 （April 2007）

胃と腸 42巻4号（2007年4月発行）

Japanese English

今月の主題炎症性腸疾患（IBD）の上部消化管病変

主題

Crohn病の胃病変の病理組織学的特徴―特に内視鏡像との対比によるその発生から進展様式の解析 Histological Features of Gastric Lesions in Crohn's Disease―Analysis of Its Development with Reference to Endoscopical Features 八尾隆史 ¹ , 古賀秀樹 ² , 松本主之 ² , 王寺裕 ¹ , 具嶋正樹 ¹ , 飯田三雄 ² , 恒吉正澄 ¹ Takashi Yao ¹ , Hideki Koga ² , Takayuki Matsumoto ² , Yutaka Ohji ¹ , Masaki Gushima ¹ , Mitsuo Iida ² , Masazumi Tsuneyoshi ¹ ¹九州大学大学院医学研究院形態機能病理 ²九州大学大学院医学研究院病態機能内科 ¹Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyusshu University, Fukuoka, Japan ²Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan キーワード： Crohn病 , 胃炎 , focally enhanced gastritis , 類上皮細胞肉芽腫 , 竹の節様外観 Keyword: Crohn病 , 胃炎 , focally enhanced gastritis , 類上皮細胞肉芽腫 , 竹の節様外観 pp.383-392

発行日 2007年4月25日 Published Date 2007/4/25

DOI https://doi.org/10.11477/mf.1403101014

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要旨　Crohn病患者94人の胃からなされた198個の生検材料を対象として，それらの組織学像と内視鏡像の関連を検討した．炎症のタイプは，びまん性活動性胃炎：DCAG 15個（7.6％），巣状活動性胃炎：FEG 67個（33.8％），活動性炎症なし116個（58.6％）に分類された．DCAGのほとんどではHelicobacter pylori陽性または組織学的びらんを認めた．類上皮細胞肉芽腫は11個（5.6％）に認め，それらではすべてFEGの所見を有し，その検出率は慢性胃炎の程度が強いもので高率であった．正常部でもFEGはしばしばみられ（21.3％），肉芽腫も1例（1.6％）に認められた．びらん・潰瘍は前庭部（幽門腺粘膜）に高頻度にみられ，同病変ではFEG（51.1％），DCAG（17.0％），肉芽腫検出率（12.8％）が最も高率に認められ，慢性炎症細胞浸潤の程度も強かったが，リンパ球集簇（6.4％）は低率であった．発赤粘膜ではFEGは33.3％にみられ，肉芽腫は2例（11.1％）にみられた．竹の節様外観は体部から穹窿部（胃底腺粘膜部）のみにみられ，同病変ではFEGは32.7％に認めたが，炎症は軽度以下のものが多く，リンパ球集簇と浮腫が高率であったが，肉芽腫の検出は1例のみであった．また，裂溝様びらん（fissure-like cleft）は竹の節様外観に特徴的組織像であったが5例に認めるのみであった．顆粒状・粗ぞう粘膜ではFEGは20％に認めたが，肉芽腫は検出されなかった．これらの所見よりCrohn病の胃病変の発生から進展の過程は，そのごく初期には肉眼ではほとんど変化のない粘膜にFEGが生じ，炎症の活動性が増すにつれびらん・潰瘍を形成するようになり，活動性が低下し慢性期になると前庭部では発赤や瘢痕となり，体部や穹窿部では竹の節様外観や顆粒状・粗ぞう粘膜を呈するようになるものと推察された．

　The correlation between histological and endoscopical features was evaluated by using 198 gastric biopsy specimens from 94 patients of Crohn's disease. The inflammatory types were classified into three ; diffuse chronic active gastritis (DCAG) : 15 lesions (7.6％), focally enhanced gastritis (FEG) : 67 lesions (33.8％) and no active inflammation : 116 lesions (58.6％). Most lesions with DCAG were accompanied by Helicobacter pylori infection or histological erosions. Epithelioid cell granulomas were identified in 11 lesions (5.6％), and the inflammatory type of all 11 lesions with granulomas was FEG. Granulomas were more frequently seen in those with moderate to severe inflammation than those with no or only mild inflammation.

　FEG (21.3％) and granulomas (1.6％) were also seen even in the specimens with endoscopically normal mucosa. Endoscopical erosions/ulcers were frequently seen in the antrum (antral mucosa). In the specimens from erosions/ulcers, FEG (51.1％), DCAG (17.0％) and granulomas (12.8％) were most frequently recognized and inflammation was more prominent than in other lesions, but lymphoid aggregates were infrequent (6.4％). In the specimens from reddish mucosa, FEG (33.3％) and granulomas (11.1％) were occasionally recognized. Bamboo-joint-like appearance (BJA) was only seen in the gastric body to the cardia. In the specimen from it, inflammation is relatively mild and granulomas were seen only in one lesion although FEG (32.7％) was occasionally seen. In addition, edema and lymphoid aggregates were frequently seen in those from BJA. Fissure-like clefts or erosions were a characteristic histological feature of BJA, but it was only recognized in 5 lesions. In the specimens from granular/rough mucosa, FEG (20.0％) was occasionally seen, but no granuloma was identified.

　From the above findings, FEG is considered to be an incipient histological change in Crohn's disease and it is present even in endoscopically normal mucosa. During progression of inflammation, it develops into erosions/ulcers occasionally with granulomas. At the resolving to healed phase, reddish mucosa is formed in the antrum and BJA or granular/rough mucosa is formed in the body to the cardia.