腸管Behçet病・単純性潰瘍と他の炎症性腸疾患との鑑別診断―臨床の立場から

Intestinal Behçet's Disease and Simple Ulcers Differential Diagnosis from Other Inflammatory Bowel Disease

要旨　腸管Behçet病（腸管B病）および単純性潰瘍は，回盲部に打ち抜き様の深い潰瘍を伴う場合が多い．しかし両疾患ともに，回盲部以外の消化管部位にも非定型的病変を認めることがある．自験38例の検討では，14例（37％）で大腸を主体に潰瘍やアフタ様びらんがみられ，特に腸管B病で高頻度であった．なお，腸管B病の2例は定型的病変を欠き，大腸の広範囲に深い潰瘍が多発していた．こうした非定型的病変の分布はまばらで，縦列傾向などの規則性は認めなかった．定型的病変を欠き，非定型的病変のみの腸管B病は，Crohn病やNSAID起因性腸病変，非特異性多発性小腸潰瘍症など他の炎症性腸疾患との鑑別が必要になる．鑑別診断に当たっては，病歴の聴取や臨床症状を把握することはもちろん，潰瘍の形態や分布，上部消化管病変，病理組織学的所見などを総合的に評価することが重要である．

　BD（intestinal Behçet's disease）and SU（simple ulcers）are usually characterized by well-demarcated, punched-out, deep ulcers in the ileocecal region. In both diseases, however, atypical lesions may develop in parts of the gastrointestinal tract other than the ileocecal region. We found ulcers and aphthoid erosions arose mainly in the colon in 14（37％）of 38 patients. The incidence of such lesions was particularly high in patients with BD. Two patients with BD had multiple deep ulcers occurring extensively in the colon, with no typical lesions. These atypical lesions were distributed in a scattered fashion, with no regular pattern, such as a trend toward vertical alignment. BD associated with only atypical lesions and lacking typical lesions must be differentially diagnosed from other inflammatory intestinal diseases such as Crohn's disease, NSAID（nonsteroidal anti-inflammatory drug）-induced bowel lesions, and nonspecific multiple ulcers of the small intestine. Differential diagnosis should be based on a comprehensive evaluation of the shape and distribution of ulcers, upper gastrointestinal lesions, and histopathological findings, as well as the medical history and clinical symptoms.