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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

潰瘍性大腸炎の上部消化管病変の臨床と経過―頻度と経過を中心に Clinical Course of Diffuse Ulcerative Upper-gastrointestinal Mucosal Inflammation (DUMI) 久部高司 ¹ , 松井敏幸 ¹ , 宮岡正喜 ¹ , 頼岡誠 ¹ , 西村拓 ¹ , 村上右児 ¹ , 長浜孝 ¹ , 高木靖寛 ¹ , 平井郁仁 ¹ , 八尾建史 ¹ , 津田純郎 ¹ , 池田圭祐 ² , 岩下明徳 ² , 二見喜太郎 ³ , 眞武弘明 ⁴ Takashi Hisabe ¹ , Toshiyuki Matsui ¹ , Masaki Miyaoka ¹ , Makoto Yorioka ¹ , Taku Nishimura ¹ , Yuji Murakami ¹ , Takashi Nagahama ¹ , Yasuhiro Takaki ¹ , Fumihito Hirai ¹ , Kenshi Yao ¹ , Sumio Tsuda ¹ , Keisuke Ikeda ² , Akinori Iwashita ² , Kitaro Futami ³ , Hiroaki Matake ⁴ ¹福岡大学筑紫病院消化器科 ²福岡大学筑紫病院病理部 ³福岡大学筑紫病院外科 ⁴またけ内科胃腸科クリニック ¹Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan ²Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan ³Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan ⁴Matake Clinic, Kasuga, Japan キーワード：潰瘍性大腸炎 , 上部消化管病変 Keyword: 潰瘍性大腸炎 , 上部消化管病変 pp.449-460

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

DOI https://doi.org/10.11477/mf.1403101020

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要旨　潰瘍性大腸炎（UC）に合併した上部消化管病変を以下のごとく定義し，その頻度，臨床像および経過について検討した．①びまん性で大腸病変に類似する．②抗潰瘍剤に抵抗性でUCの治療により改善する．③病理所見でUCに類似する．④Helicobacter pyloriの関与がない．⑤他疾患が否定できる．この5つの項目のうち①を必須項目としその他2項目以上を有するものとした．この定義に合致した上部消化管病変は上部消化管検索を行いえたUC患者158例中8例（5.1％）であった．病型は8例すべて全大腸炎型で，それぞれ全大腸炎型70例中6例（8.6％），大腸全摘後24例中2例（8.3％）に認めた．病理組織学的所見はびまん性炎症細胞浸潤や陰窩炎などUCに類似した所見であった．病変範囲は胃から十二指腸に病変を認めたものは2例，胃から小腸に認めたものは1例，十二指腸にのみ認めたものは5例であった．治療はステロイド剤で改善したものが5例，ステロイド剤と白血球除去療法が1例，粉末mesalazineが2例であり，全例内科的治療により病変は改善した．また上部消化管病変の活動性は大腸病変の活動性と相関する傾向にあった．今後，UCの診断治療に際しては上部消化管病変の存在も考慮していかなければならない．

　Cases of “diffuse ulcerative upper-gastrointestinal mucosal inflammation” (DUMI) were defined as shown below and their frequency of occurrence, clinical presentation and clinical courses were examined.

　Definition : (1) A diffuse condition resembling colonic lesions. (2) A lesion resistant to anti-ulcer agents but reacting favorably to the treatment intended for UC. (3) Resemblance to UC in its pathological presentation. (4) Non-involvement of H. pylori. (5) Involvement of other diseases negated.

　Among these 5 items, to be diagnosed as having DUMI the patient must exhibit (1), which is accompanied by at least 2 others. Lesions of the upper digestive tract that meet the definition given above were found in 8 of the 158 UC patients (5.1％) who were available for the examination of the digestive tract. As for clinical entity, all 8 were classified as total colitis and 2 had undergone total colectomy. Six (8.6％) were found among the 70 patients who were classified as the type with total colitis, and 2 (8.3％) were found among 24 patients who had undergone total colectomy. The pathological region was found between the stomach and the duodenum in 2, between the stomach and the small intestine in 1, and in the duodenum only in 5. For treatment, 5 improved with steroid administration, one with a steroid administration and leukocytapheresis, 2 with the administration of a mesalazine powder. All lesions responded well to medical therapy. A tendency was noted in which the disease activity in the upper digestive tract paralleled that of the colon. To diagnose and treat UC in future, one should be reminded that it is possible for a lesion to be present in the upper digestive tract.