Crohn病の胃・十二指腸病変の長期経過―内視鏡所見の定量化による評価

Long-term Follow-up the Gastroduodenal Lesions of Crohn's Disease: Quantitative Analysis of the Endoscopic Findings

要旨　Crohn病の胃，十二指腸病変の内視鏡像を潰瘍性病変，隆起性病変のそれぞれにスコア化して検討した．初回検査のスコアは病型，活動指数，および炎症所見と相関はなく，胃，十二指腸病変は腸病変の緩解増悪とは無関係にみられた．Crohn病286例の経過中6例に幽門狭窄を合併した．累積幽門狭窄合併率は，発症後10年で2.7％，診断後10年で3.1％で，狭窄は比較的急速に敷石像へと進展し発現した．幽門狭窄6例と上部消化管内視鏡検査の観察期間が10年以上の非狭窄28例の初回内視鏡像の比較では，狭窄例の隆起スコアが有意に高値であった．すなわち隆起性病変の高度なものが幽門狭窄へ進展しやすいことが示唆された．非狭窄例の初回内視鏡検査の潰瘍スコアは最終検査より高値であった．びらんや潰瘍などの病変は進行性ではなく，またCrohn病の病態に関与した病変と，通常の潰瘍，びらんと同じ機序のものが混在していることが推測された．

　Endoscopic findings on the gastroduodenal lesions of Crohn's disease are evaluated by assessing ulcerative and elevated lesions using original scores. Score of the gastroduodenal lesion of the initial endoscopic findings did not correlate with classification, activity index, and inflammatory findings, therefore extends of gastroduodenal and intestinal lesions did not seem to be mutually related. Six out of 286 cases of Crohn's disease were complicated with pyloric stenosis during the follow-up period. Cumulative rates of pyloric stenosis were 2.7％ in 10 years after the initial symptoms and 3.1％ in 10 years after diagnosis. Pyloric stenosis developed in comparatively rapid fashion with cobblestone-like appearance. Six cases of Crohn's disease with pyloric stenosis (stenosis group) were compared with 28 cases of Crohn's disease without pyloric stenosis that were followed for more than 10 years (non-stenosis group). Elevation score of the initial endoscopic pictures in the stenosis group was significantly higher than that in the non-stenosis group. This suggested that cases with advanced elevated lesion might have tendency to develop pyloric stenosis. Ulceration score of the initial endoscopic pictures was higher than that of the last endoscopic pictures. Ulcerative lesions like erosion and ulcer may not be progressive and may be composed of lesions associated with Crohn's disease and lesions caused by the same mechanism as the ordinary ulcer and erosion.