collagenous colitisの16例―内視鏡像と組織像との関連

Collagenous Colitis: Clinical, Endoscopic and Histological Diagnosis and Their Mutual Relationships

要旨　近年CCに関して，粘膜面の異常や血管異常などの内視鏡所見，原因薬剤との関連性を示唆する報告も増えている．本稿では自験例CC 16症例に関して，内視鏡異常所見（血管網増生・走行異常，色素撒布後の粗糙・顆粒状粘膜，線状縦走潰瘍・瘢痕，発赤）の大腸分節ごとの出現頻度，分布を検討した．また背景因子や内視鏡所見，病理組織学的所見，CBの厚さ，好中球浸潤，被蓋上皮の脱落）についても相互に対比した．結果：原因薬剤はランソプラゾールが81％を占めた．大腸の左右側内視鏡所見出現度を比較したところ，血管網増生・走行異常所見は高頻度（100～88％）であるが左右差はなかった．粗糙・顆粒状粘膜は右側結腸で63％，左側結腸で25％，であり左右差があった（p＝0.03）．線状縦走潰瘍は左側結腸に高い傾向があった．便回数の高低別，関連薬剤別に比較したが，臨床像により内視鏡所見などに差異はなかった．病理組織学的所見の程度と内視鏡異常所見の両者に関連はなかった．ただし，粗糙・顆粒状粘膜所見と血管網増生・走行異常所見は相関した（p＜0.026）．結論：以上より，粗糙・顆粒状粘膜は右側結腸に出現率が高かった．内視鏡異常所見強度同士は相関するものがあった．したがって，CCの診断上，右側結腸で粗糙・顆粒状粘膜を認めればCCに伴う内視鏡異常所見の可能性が高く，また生検をする部位を内視鏡所見により選択する必要性はなく，右側を含む多数の生検が有用と考えられた．

　The aim of this study is to clarify endoscopic abnormalities in 16 patients with collagenous colitis（CC）. Materials and methods : Endoscopic abnormalities, congested and tortuous vascularity, coarse granular mucosa after dye spreading, linear ulcer and mucosal redness were examined. As histological abnormalities, thickened collagen band, neutrophilic infiltration to the epithelium and mucosa were examined. Clinical pictures including severity of diarrhea and hazardous drugs were also investigated in relation to the other factors. Results : Lansoprazole is the most frequent（81％）responsible drug to cause CC. Endoscopically, engorged vascularity was found in almost all the segments of the colon（100～88％）, but laterality in the colonic segments of this endoscopic abnormality was not found. Coarse granular mucosa was found frequently in the proximal colon（63％）and significantly less（25％, P＝0.003）in the distal colon. Linear ulcer was found only in the distal colon. There was no relationship between frequency of diarrhea and responsible drugs with the background characteristics and intensity of the endoscopic abnormalities. Also no relationship of endoscopic abnormalities and histological abnormalities was found. However, coarse granular mucosa and the intensity of the engorged vascularity were significantly related（p＝0.026）. Conclusions ; From the above results, it is concluded that the coarse granular mucosa which was found more frequently in the proximal colon was related with engorged vascularity. Therefore these two findings seem to be important and specific findings in CC. However, biopsies sites should be selected irrespective of endoscopic findings and multiple biopsy are needed to diagnose CC definitely.