collagenous colitisの鑑別診断と治療

Differential Diagnosis and Treatment of Collagenous Colitis

要旨　当科で経験したCC（collagenous colitis）8例を対象に臨床像，内視鏡像，治療などについて検討を行い，鑑別診断，治療について考察を加えた．内視鏡的な異常は8例中6例にみられ，血管透見低下が最も多く6例に，易出血性，血管増生，縦走潰瘍・縦走潰瘍瘢痕が3例に，横走潰瘍・横走潰瘍瘢痕が1例にみられた．内視鏡検査に起因すると思われる粘膜の裂創が2例に，特徴的な長い縦走潰瘍が1例にみられた．縦走潰瘍の症例は虚血性大腸炎を疑い，血管透見低下と易出血性がみられた1例はアミロイドーシスを疑い生検した．他の4例は内視鏡像よりCCを疑って生検した．治療は薬剤中止により明らかに軽快したものが5例でいずれもランソプラゾールが投与されていた症例であった．1例はランソプラゾールとNSAIDを中止しても症状は軽快せず，著明な蛋白漏出を伴っていたためプレドニゾロンの投与を行い軽快した．他の2例は薬剤の関与はなかった．

　We examined the clinical and endoscopic features, treatments, and other characteristic of 8 patients with collagenous colitis（CC）in our department, with considerations of differential diagnosis and treatment. Endoscopic abnormalities were found in 6 of the 8 patients. Decreased vascular permeability, which had the highest incidence, was observed in 6 patients, easy bleeding and vascular growth and longitudinal ulcers/ulcer scars in 3, and transverse ulcers/ulcer scars in 1. Endoscopy-induced mucosal tears were found in 2 patients, and a characteristic long longitudinal ulcer in 1. The patients with longitudinal ulcers were suspected to have ischemic colitis, and one patient with decreased vascular permeability and easy bleeding was suspected to have amyloidosis, leading to the taking of a biopsy specimen. Four other patients were suspected to have CC based on endoscopic features, and they also underwent biopsies. Five patients obtained clear remission of symptoms with drug discontinuation, and each of them had been treated with lansoprazol. Symptoms in one patient did not resolve with the discontinuation of lansoprazol and NSAID. Because the symptoms were accompanied by marked protein loss, prednisolone was administered, which led to remission of symptoms. The abnormalites in two other patients were not associated with drug administration.