潰瘍性大腸炎にみられる胃・小腸病変の所見と経過―小腸病変

Diagnosis and Clinical Course of Small Bowel Lesions Associated with Ulcerative Colitis

要旨　潰瘍性大腸炎（UC）に合併した小腸病変については不明な点が多い．今回，全結腸炎型UCおよび大腸全摘後症例に対し，カプセル内視鏡検査を施行した3例および既報告症例を中心にその臨床像について検討した．カプセル内視鏡検査を施行した症例では中部から下部小腸を中心に発赤やアフタ，小潰瘍を認め，このうち2例についてはびまん性に病変が存在していた．また，大腸病変に対するプレドニゾロン治療後に再検査しえた2例で小腸病変の改善を認めた．現時点ではカプセル内視鏡検査のみではUCに関連した小腸病変か確定は困難だが，びまん性に存在する病変の存在はUCとの関連を疑う所見と考えられる．今回のカプセル内視鏡検査による検討で，UCにも広範囲にわたる微細な病変が小腸に存在することが明らかとなった．今後，さらにUCにおける小腸病変の臨床的意義について詳細に検討する必要がある．

　The facts about upper gastrointestinal tract lesions complicating ulcerative colitis（UC）are being elucidated, but with the exception of backwash ileitis and pouchitis many aspects of widespread small bowel lesions are unclear. In the present study we assessed the clinical picture centered on 3 cases in which capsule small bowel endoscopy examinations were performed in pancolitis type UC and post-total-colectomy cases, and cases in the existing literature. In the cases in which capsule endoscopy was performed, erythema, aphthae, and small ulcers were observed, mainly from the mid-portion to the distal small bowel, and in 2 of the cases lesions were present diffusely. Moreover, improvement of the small bowel lesions was observed in 2 cases in which a repeat examination was possible after prednisolone therapy for large bowel lesions. At the present time it is difficult to determine by capsule endoscopy alone whether there are small bowel lesions associated with UC, but the presence of diffuse lesions seems to be a finding that raises suspicion of an association with UC. The investigations by capsule endoscopy in this study showed that minute lesions are also present over a large extent of the small bowel in UC. In the future it will be necessary to investigate the clinical significance of small bowel lesions in UC in greater detail.