2) 腸結核

Small Bowel Tuberculosis

要旨　高齢化社会の到来や免疫抑制剤の多分野での使用に伴い，小腸結核は増えると考えられる．以前は小腸結核の診断は困難であったが2001年以降，新たな小腸内視鏡であるカプセル内視鏡とダブルバルーン内視鏡の登場により全小腸の観察が可能になり，今後は無症候性患者の拾い上げや早期診断が行われると思われる．当科では390例の小腸疾患診療の中で，胃や大腸に病変を認めない小腸結核確診4例を経験した．それらの内視鏡像では回腸が病変の主座であることが多く，不整形の浅い潰瘍性病変の多発と浮腫状粘膜が特徴的であった．治療は化学療法が中心となるが，難渋することがあり少なくとも1年間は継続することを勧めたい．

　The patients of small bowel tuberculosis will increase more because of this aging society and various uses of immunosuppressants. The process of diagnosis was not easy previonsly, but with the introduction of the new endoscopic procedures, video capsule endoscopy and double balloon endoscopy in 2001, it has become possible to observe the whole small bowel. Moreover, such endoscopy will enable us to diagnose asymptomatic patients at an earlier date. We diagnosed four patients with small bowel tuberculosis who completely lacked the gastric and colonic lesions. The features of the endoscopic findings with those patients were that the lesions were mainly seen in the ileum, and their ulcers were shallow and edematous. Chemotherapy is performed as the initial treatment for small bowel tuberculosis. The long-term administration of several medicines is needed for some cases so we recommend the continuation of the administration for over one year.