口腔内アフタの有無別からみた腸管Behçet病および単純性潰瘍の病変分布と臨床経過

Distinction of Intestinal Behçet's Disease and Simple Ulcer Based on the Presence of Recurrent Oral Ulcer and Other Clinical Features

要旨　腸管Behçet病（BD）および単純性潰瘍（SU）の区別は重要な問題であり，現在の診断基準も十分とは言えない．そこで，SUもしくは腸管BDと診断された27例を見直し，口腔粘膜の再発性アフタ性潰瘍をはじめとするBD症状の有無別から非BD群5例とBD群22例に分けて，消化管病変の性状，分布と臨床経過について検討した．その結果，（1）非BD群では5例全例に，BD群では22例中17例（77％）に回盲部の定型的病変を認めたが，病変の分布において，非BD群の5例中4例（80％）が回盲部に限局するのに対し，BD群は回盲部限局が22例中8例（36％）と少なく（p＝0.07），回盲部以外の小腸，結腸・直腸にも多発する症例が認められた．（2）経過中に非BD群よりBDへ病型変化したものはなかったが，BD群では22例中2例（9％）で病型変化が認められた．（3）経過中，非BD群では5例中3例（60％）に外科手術が行われ，全例が再手術を受けていた．BD群における手術率は41％（22例中9例）で，さらにこのうち55％が再手術となった．（4）非定型的な病変として，BD群2例の大腸に潰瘍性大腸炎に類似した病変が認められた．以上から，非BD群は回盲部に限局する傾向があり，BD群に回盲部以外にも多発する可能性や病型の変化するものも含まれ，病態は異なることが示唆された．再発性口腔内アフタを主症状として重要視すれば，いわゆるSUの頻度は低く見積もられた．

　The aim of this study is to distinguish SU（simple ulcer）and intestinal BD（Behçet's disease）, based on the new Japanese criteria using 27 cases in our hospital. Comparison of clinical features, X-ray and endoscopic pictures were made among the patients without BD symptom（non-BD group : 5cases）and those with BD symptom（BD group: 22 cases including 12 cases of suspected BD and 10 cases of incomplete BD）. Twenty-one of the 22 BD group patients had recurrent oral ulcers. The results were summarized as follows.（1）All the five patients（100％）in the non-BD group and 17 of 22（77％）in the BD group of patients had typical deep and sharply demarcated ulcers in the ileo-cecal area. In the non-BD group,80％ of the patients had ulcers limited to the ileo-ceacal area, but, in the BD group, only 36％ of the patients had ulcers limited only to the ileo-ceacal area, and remaining 74％ of the patients also revealed single or multiple ulcerative lesions in diverse parts of the GI（gastrointestinal）tract（esophagus : 4 cases, stomach : 1 case, jejunum : 1 case, ileum : 7 cases, colo-rectum : 7cases）.（2）In the observation period of the BD group, two patients developed BD manifestations ; 1 with suspected BD developed an ocular lesion and a genital ulcer, and another one with incomplete BD developed 2 typical ileal ulcers,2 years and 28 years after the initial diagnosis. But in the non-BD group, no patient developed symptomatic changes such as oral ulcer.（3）During the follow-up period, three of 5（60％）of the non-BD patients underwent surgical resection and all the 3 cases needed additional surgery for anastomotic recurrences. In the BD group, nine of 22（41％）patients underwent surgery and only 5 cases needed the second resection.（4）In the BD group, two patients revealed extremely atypical colo-rectal findings similar to ulcerative colitis.

　It is still controversial whether simple ulcer and intestinal BD are the same disease or separate entities. However, results of our study suggested that the distinction of the 2 diseases seems to be possible based on diverse BD manifestations including recurrent oral ulcer.