Crohn病における食道病変

Esophageal Involvement with Crohn's Disease on Upper Gastrointestinal Endoscopy

要旨　過去10年間にCrohn病で上部消化管内視鏡検査を実施した482例中23例（4.8％）に食道病変を認めた．有症状が19例，無症状が4例であった．検査時に胃病変を156例（32.4％）に，十二指腸病変を190例（39.4％）に認めた．食道病変は敷石状粘膜や粘膜橋形成が2例，縦列を示す潰瘍あるはびらんが5例，アフタ様潰瘍あるいはびらんが8例，多発するびらんや顆粒状小びらんが8例であった．1例に瘻孔形成を認めた．19例の食道病変に生検を施行し非乾酪性肉芽腫を1例（5.3％）に認めた．発病から食道病変が認められるまでの期間は10年以上が13例と多く，2例はCrohn病の初発病変として観察された．腸病変は20例が活動性であり，3例が非活動性であった．治療薬として，mesalazine粉末，PPI，infliximab，prednisoloneなどが自覚症状の改善に有効であった．

　In the period of ten years (1997～2006), we have carried out upper gastrointestinal endoscopy on 482 patients (337 men and 145 women, aged 15～74, mean, 34.1±10.8 years, 299 for symptoms and 183 for screening) with Crohn's disease. Esophageal involvement was recognized in 23 patients (4.8％), and although upper GI involvement was not recognized in 4 of there patients, 19 of them had complaints referable to upper GI. At the same time, gastro-duodenal involvement was observed in the stomach of 156 patients and duodenal involvement was found in 190 patients. Endoscopic findings of the esophageal lesions were cobblestone appearance in 2 patients, linear ulcers in 5 patients, aphthous and punched-out ulcers in 8 patients and small erosions in 8 patients. The formation of fistula involving the bronchus was revealed in one patient. Biopsy specimens were taken from the esophageal lesions of the 19 patients and noncaseating epithelioid cell granuloma, which is characteristic of Crohn's disease, was identified in only one patient (5.3％). Esophageal lesions of 13 patients were found more than 10 years after their onsets but 2 patients suffered the esophageal lesions as initial signs of Crohn's disease. The drugs such as mesalazine, PPI, infliximab and prednisolone were effective for the esophageal lesions and their symptoms.