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要旨 〔症例 1〕は29歳,女性.主訴は上腹部痛.17歳時発症の全大腸炎型潰瘍性大腸炎で19歳時に劇症化のため大腸全摘・回腸嚢肛門吻合術を受けた.29歳時に上腹部痛が出現し,上部消化管内視鏡検査で十二指腸球後部から第2部にびまん性の粗ぞう粘膜と多発潰瘍を指摘された.UCの十二指腸病変と判断しmesalazineとranitidineの投与を開始したが,18か月後の上部消化管内視鏡検査では改善は認められていない.〔症例 2〕は69歳,男性.2005年1月に潰瘍性大腸炎を発症し当科に入院した.大腸内視鏡検査では全大腸炎型潰瘍性大腸炎でステロイドの全身治療を開始した.上部消化管内視鏡検査では十二指腸球後部から第2部に多発する小潰瘍を認め,大腸病変の改善に伴って十二指腸病変の瘢痕化が確認できた.潰瘍性大腸炎ではびまん性十二指腸病変を合併することが知られているが,この病変は多彩な経過を示す可能性が示唆された.
〔Case 1〕was a 29-year-old female with abdominal pain. She had been diagnosed as ulcerative colitis (UC) of pancolitis type and treated by total proctocolectomy 10 years previously. Esophago-gastro-duodenoscopy (EGD) showed ulcers and coarse, granular mucosa in the duodenal bulb and in the second portion of the duodenum. Although she was treated with ranitidine and 5-aminosalicylic acid (5-ASA) for 18 months, her duodenal lesions remained unchanged.
〔Case 2〕 was a 69-year-old male with a history of UC for 4 months. EGD revealed multiple ulcers in the duodenal bulb and in the second portion of the duodenum. Under treatment with prednisolone and 5-ASA, his duodenal lesions, as well as UC, markedly improved. Our cases suggest that duodenal involvement of UC, referred to as “ulcerative duodenitis”, shows a heterogeneous clinical course as seen in its colonic involvement.
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