1) Crohn病

Crohn's disease

要旨　Crohn病は近年その症例数は増加の一途を辿り，いまや小腸疾患の代表と言える．近年の様々な検査機器，検査技術の進歩により小腸の詳細な情報を得ることが可能となった．また生物製剤など新たな治療薬の開発で栄養療法中心の治療から欧米型の薬物療法主体の治療へと変化を遂げた．Crohn病の画像上の特徴はまず初期の病変と考えられるアフタ様潰瘍/病変，不整形潰瘍が縦走化し，次いで縦走潰瘍，敷石様外観へと進展しさらに狭窄，瘻孔，膿瘍などの合併症を惹起する．また，手術適応の頻度として最も高い合併症である狭窄に対して，近年のダブルバルーン小腸内視鏡による内視鏡的拡張が可能となり手術を回避できる症例も増加している．

　Recently, Crohn's disease has been increasing also in Japan. Now, it is the typical illness of the small intestine. It has become possible to acquire detailed information of the small intestine because of the progress of various inspection devices and technology. Moreover, development of a new curative medicine has made it possible to move from treatments based on nutrition to the medical treatment used in Europe and America.

　Apthoid ulcer/lesion and discrete ulcer are typical early lesions for Crohn's disease. They progress to a longitudinal ulcer after several years, and, eventually, cause complications, such as, stricture, fistula and abscess.

　Moreover, endoscopical dilatation of a severe stricture area is possible, by using double-balloon enteroscopy, and cases where an operation can be avoided are increasing it.