直腸肛門部の炎症性疾患―そのほかの直腸潰瘍性病変

Rectal Ulcers other than IBD, Infectious Diseases, Mucosal Prolapsed Syndrome and Cap Polyposis

要旨　IBD，感染性腸炎，粘膜脱症候群，cap polyposis以外の直腸潰瘍の概念，症状，診断，治療について概説した．本稿で取り上げた疾患は放射線性腸炎，虚血性直腸炎，急性出血性直腸潰瘍，直腸Dieulafoy潰瘍，宿便性潰瘍，NSAID坐剤起因性直腸炎である．放射線性腸炎やNSAID坐剤起因性直腸炎は，病歴からの診断が比較的容易である．直腸Dieulafoy潰瘍も特徴的な内視鏡像から容易に診断できる．しかし，虚血性直腸炎，急性出血性直腸潰瘍，宿便性潰瘍についてはそれぞれ病像が異なるものの，十分に理解されていないため混同される傾向がある．一方で直腸潰瘍の疾患概念がなお混沌としているのも事実であり，今後サイトメガロウィルス感染の関与を含めて明らかにしていく必要がある．

　The concepts, clinical features, diagnoses and treatment of rectal ulcers other than IBD, infectious diseases, mucosal prolapsed syndrome and cap polyposis are described. The disorders dealt with in this chapter include radiation proctitis, ischemic proctitis, acute hemorrhagic rectal ulcer, rectal Dieulafoy-type ulcer, stercoral ulcer and NSAID-suppository induced proctitis. Radiation proctitis and NSAID-suppository induced proctitis can be diagnosed based on the anamneses. Rectal Dieulafoy type ulcer can be easily recognized from the characteristic endoscopic images. However, the other disorders are often confused with each other because of insufficient recognition, although clinical features are considerably different among the disorders. On the other hand, the concept of rectal ulcers should be reviewed and the implication of cytomegalovirus infection should be elucidated.