雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Stomach and Intestine(Tokyo) Volume 44, Issue 10 （September 2009）

胃と腸 44巻10号（2009年9月発行）

Japanese English

今月の主題潰瘍性大腸炎の初期病変とその進展・経過

主題

潰瘍性大腸炎の初期病変―内視鏡的特徴と鑑別診断 Endoscopic Findings of Initial Active Ulcerative Colitis 村野実之 ¹ , 井上拓也 ¹ , 倉本貴典 ¹ , 森田英次郎 ¹ , 村野直子 ¹ , 江頭由太郎 ² , 森川浩志 ³ , 佐野村誠 ⁴ , 平田一郎 ⁵ , 梅垣英次 ¹ , 樋口和秀 ¹ Mitsuyuki Murano ¹ , Takuya Inoue ¹ , Takanori Kuramoto ¹ , Eijiro Morita ¹ , Naoko Murano ¹ , Yutaro Egashira ² , Hiroshi Morikawa ³ , Makoto Sanomura ⁴ , Ichiro Hirata ⁵ , Eiji Umegaki ¹ , Kazuhide Higuchi ¹ ¹大阪医科大学第2内科 ²大阪医科大学第1病理 ³森川クリニック ⁴北摂総合病院消化器内科 ⁵藤田保健衛生大学消化管内科 ¹Second Department of Internal Medicine, Osaka Medical Collage, Takatsuki, Japan ²First Department of Pathology, Osaka Medical Collage, Takatsuki, Japan ³Morikawa Clinic, Sakae, Japan ⁴Department of Gastroenterology, Hokusetsu General Hospital, Takatsuki, Japan ⁵Department of Gastroenterology, Fujita Health University, Toyoake, Japan キーワード：潰瘍性大腸炎初期病変 , アフタ様病変 , skip lesion , lymphoid follicular proctitis , 鑑別診断 Keyword: 潰瘍性大腸炎初期病変 , アフタ様病変 , skip lesion , lymphoid follicular proctitis , 鑑別診断 pp.1492-1504

発行日 2009年9月25日 Published Date 2009/9/25

DOI https://doi.org/10.11477/mf.1403101750

PDF(1023KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference
サイト内被引用 Cited by

要旨　近年，内視鏡技術の進歩に伴う大腸微細病変の拾い上げが可能となり，潰瘍性大腸炎（ulcerative colitis;UC）の非典型的所見の報告もみられるようになった．しかし発症初期UCの内視鏡像やその進展について検討された報告は少ない．今回，発症初期の未治療UCの内視鏡像を対象とし，虫垂開口部病変，skip lesion，アフタ様病変，直腸顆粒状粘膜に着目し検討した．虫垂開口部病変は68.8％に認められ，skip lesionは29.9％で上行結腸に高率に認められた．直腸顆粒状粘膜は9例（11.7％）と少数だが，その80％に虫垂開口部病変が併存していた．従来UCの典型所見である直腸連続性病変のみの症例は27.7％にすぎず，skip lesion例とほぼ同程度であり，直腸連続性病変に虫垂開口部病変を併存した症例が42.2％と最も多く認められた．UCの初期病変は直腸と虫垂というリンパ濾胞の発達した部位から進展したものであると示唆され，UCの病因にも深く関与していると推測される．また初発UC例の診断において感染性腸炎との鑑別は治療による感染増悪の点からも慎重に行うべきである．

　Continuous inflammation within the colorectum has been one of the characteristic features of typical ulcerative colitis（UC）, so far. Recently, owing to the advancement of colonoscopic technology, we can easily detect minute changes in the large intestine due to UC. However, there are few reports about the endoscopic findings of initial active UC.

　In 77 patients with initial active UC which had been examined by total colonoscopy within 6 months after onset at Osaka Medical College, we focused on the atypical endoscopic findings of initial active UC, such as aphtoid lesions, the lesions around the appendiceal orifice, skipped lesions, and rectal granular lesions. Fifty-three patients（68.8％）of the seventy-seven patients had a lesion around the appendiceal orifice. Skipped lesions were noted in 29.9％ of the patients with initial active UC. While the continuous inflammation from rectum that was originally typical of UC was recognized in 27.7％, the rectal continuous lesions additional to the lesion around the appendiceal orifice was recognized as co-exisiting in 42.2％ of the cases. This may be a development process in inflammatory lesions of initial UC. It is suggested that the incipient lesion of UC progresses from the lymphoid follicles in the rectum and appendit, and plays a big part also in the etiology of UC.

　Additionally, we described patients with various enteric inflammatory diseases differentiated from the initial active UC. Once the initial UC is diagnosed, it is necessary to discriminate it carefully from the infective exacerbation by treatment of infectious enteritis.