回腸囊炎の診断と臨床経過―初期病変の診断を目指して─経過を中心に

Diagnosis and Clinical Course of Pouchitis after Pouch Operation for Ulcerative Colitis

要旨　潰瘍性大腸炎pouch operation後のフォローアップ79例を対象に回腸囊炎の診断と経過を検討した．観察期間（中央値69か月）に34例を回腸囊炎と診断，5年累積発生率は36.0％であった．初回診断時の内視鏡像をびまん炎症型，潰瘍型，混合型に分類した．抗菌剤・抗生剤治療にて速やかに症状が改善するが，67.6％が再燃寛解型・慢性持続型の経過をたどり，内視鏡的寛解には抗菌剤・抗生剤長期投与を必要とするものが少なくない．回腸囊炎による排便回数増加やsoilingは肛門合併症や肛門括約機能不全を来す危険性がある．内視鏡検査は回腸囊炎の診断のみならず治療・経過観察においても重要である．

　Seventy-nine patients who underwent pouch operation for ulcerative colitis were followed up for a median of 69 months. Thirty-four of the patients developed pouchitis again. The cumulative occurrence rate is 36％ after five years. Endoscopic findings of pouchitis at the first diagnosis are classified into three types ; diffuse inflammatory type, ulcerative type, and mixed type. In about 70％ of patients with pouchitis the endoscopic types are sustained at the time of relapsing. Although symptoms of pouchitis rapidly improved due to administration of antimicrobial agents or antibiotics in most cases, long-term administration was necessary for endoscopic remission in more than a few cases. Lasting frequent bowel movement and soiling may bring on anal complications or anal sphincteric dysfunction. Endoscopic examination is important in not only diagnosis but also in management of pouchitis.