Crohn病の上部消化管病変の臨床的検討―経過を含めて

Clinical Analysis of an Upper Gastrointestinal Tract Lesion of Crohn's Disease―Including Clinical Course of the Lesion

要旨　Crohn病59例に対して上部消化管病変に関する臨床的検討を行った．その結果，上部消化管病変は高率に認められた（78.0％）．十二指腸ではアフタ・びらん（41.3％）と不整形潰瘍（28.3％），胃では竹の節状外観（39.1％）とたこいぼ型びらんを含むびらん性病変（37.0％）などを比較的高率に認めた．経過例の検討によって，竹の節状外観，notch状外観，敷石状外観の成立機序には共通の要因があることが示唆された．また，Crohn病におけるたこいぼ型びらんは，通常のたこいぼ型胃炎とは異なった局在，形状，経過を示した．上部消化管病変の軽快と増悪はCDAIとの相関を認めず，下部消化管病変とは別の経過を辿ることも示唆された．上部消化管病変に対する薬物療法として酸分泌抑制剤やmesalazineの粉末が使用されているが，たこいぼ型びらんや幽門・十二指腸狭窄に対しては効果は乏しくinfliximab投与を考慮する必要性が示唆された．病理組織学的検討では，上部消化管病変におけるgranulomaの検出率は12.5％，Helicobacter pylori陽性率は13.3％と低率であった．Crohn病の上部消化管病変を早期診断し，幽門・十二指腸狭窄などの重篤な合併症を予測し予防することが必要と考えられた．

　We carried out a clinical analysis of upper gastrointestinal tract lesions in 59 cases with Crohn's disease. As a result, upper gastrointestinal tract lesions were recognized at a high rate (78.0％). We recognized, at a relatively high rate, aphtha and erosion (41.3％) and irregular-shaped ulcer (28.3％) in the duodenum, and bamboo-kot shaped appearance (39.1％) and various erosive lesions including Takoibo (octopus wart)-type erosion (37.0％) in the stomach.

　It is suggested that there was a common factor in the formation mechanism of bamboo-knot shaped appearance, notch-shaped appearance and cobblestone appearance. In addition, Takoibo-type erosion in Crohn's disease showed localization and configuration, the course of which were different from usual Takoibo-type gastritis.

　We did not recognize correlation with CDAI in remission and aggravation of upper gastrointestinal tract lesions. Anti-acid secretion medicine and powder of mesalazine were used as pharmacotherapy for upper gastrointestinal tract lesions, but their effect was poor, and the necessity to consider infliximab therapy was suggested for Takoibo-type erosion and a pylorus/duodenal stenosis.

　By histopathological examination, the detection rate of granuloma was 12.5％ and the H. pylori positive rate was 13.3％. Both of these rates can be considered as low.

　It is thought that, by early diagnosis of upper gastrointestinal tract lesions of Crohn's disease, we were able to prevent severe complications such as a pylorus/duodenal stenosis.