潰瘍性大腸炎の上部消化管病変の臨床と経過―画像所見を中心に

Endoscopic Findings, Diagnosis and Treatment of Gastroduodenitis Associated with Ulcerative Colitis

要旨　潰瘍性大腸炎（UC）における上部消化管病変の特徴的な内視鏡所見は，もろい粘膜，細顆粒状粘膜，多発アフタである．多発アフタは他疾患でもみられるため，多発アフタをUCに関連した病変とするには，陰窩膿瘍などの組織学的な裏付けとCrohn病などの臨床的除外が必要になる．これら内視鏡所見を有する症例やその疑診例，その上部消化管病変が治癒または緩解したと思われる症例，組織学的に確認される微小病変を伴う症例を含めると，UC関連上部消化管病変は26％に達し，決してまれな病態ではないと考えられる．治療は大腸病変と同様の方法に準じるが，mesalazineは粉砕してパウダー化したものを用いる．胃粘膜保護薬が有用なこともある．

　The distinctive, endoscopic findings of gastroduodenitis associated with ulcerative colitis (GDUC) include friable and granular mucosa or multiple aphthae. Since multiple aphthae are seen in other disorders, histological evidence(s) such as crypt abscess and clinical exclusion of other diseases such as Crohn's disease are required to determine that multiple aphthae are GDUC. The prevalence of GDUC including definite, suspicious, minimal and healed (remission) cases reaches 26％, suggesting this condition is not rare. The treatment strategy for colorectal lesions in ulcerative colitis could be applied to that of GDUC, and there are several reports showing the efficacy of corticosteroids. Powdered mesalazine (crashed tablets) has a therapeutic effect, and mucoprotective drugs such as ecabet sodium or rebamipide may be useful for the treatment of GDUC.