8) 門脈圧亢進症性小腸症（portal hypertensive enteropathy；PHE）

Portal Hypertensive Enteropathy

要旨　門脈圧亢進症は食道胃静脈瘤，門脈圧亢進症性胃症，門脈圧亢進症性腸症を合併する．これらは消化管出血や貧血の原因となり，臨床上重要である．本稿では，門脈圧亢進症性小腸症について，今までの報告とダブルバルーン内視鏡を中心とした当科での知見を概説した．門脈圧亢進症における小腸病変として，発赤，びらん，毛細血管拡張様所見，静脈瘤が今までにも報告があったが，今回，数の子様粘膜を新たな特徴的所見として加えた．小腸の数の子様粘膜は，絨毛の浮腫，毛細血管の拡張像を表したものであり，脾容積増加，門脈圧亢進症性胃症，門脈圧亢進症性腸症の存在，血小板減少などの門脈圧亢進を示す症候に多かった．

　Portal hypertension involves the gastrointestina (GI) tract and complications like esophageal varices, portal hypertensive gastropathy (PHG) and portal hypertensive colopathy (PHC) develop subsequently. These complications are clinically important because they are sources of GI tract bleeding and anemia. In this review, we outlined portal hypertensive enteropathy (PHE) by analyzing the previous literature and our own study mainly using double balloon endoscopy (DBE). Erythema, erosion, telangiectasia and varix were observed in the small intestine in patients with portal hypertension, as previously reported. Herring roe appearance has appeared as a new characteristic finding for PHE. Histopathological examination revealed shortened and edematous villi, and dilation of mucosal capillaries. This was related to the existence of features of portal hypertension such as the incidence of PHG and PHC, splenomegaly, and thrombopenia.