アフタ様病変のみで診断されたCrohn病の長期経過

Long-term Clinical Course in Crohn's Disease of Aphthous Type

要旨　アフタ様病変のみで初回診断されたCrohn病のうち，臨床経過が10年以上追跡可能であった5例のX線・内視鏡所見を検討した．3例では，初回診断から39か月以内に回腸ないし大腸にCrohn病の典型像が確認されたが，他の2例ではアフタの出没をみるのみで経過した．典型像出現例のうち2例は短期間の栄養療法で改善し，栄養療法ないし無治療で緩解を維持しているが，1例では狭窄のため手術に至った．十二指腸病変の長期経過が追跡可能であった3例では，アフタ様病変の出没を繰り返していた．以上より，アフタ様病変のみから成るCrohn病の臨床経過は多彩であるが，短期間で小腸ないし大腸に典型像の出現をみるものと長期にわたってアフタ様病変にとどまるものに大別される可能性が示唆された．

　Radiographic and endoscopic findings of five patients with Crohn's disease of aphthous type who were observed for more than 10 years were retrospectively analyzed. Typical findings compatible with Crohn's disease developed in three patients, whereas the remaining patients were free from such findings. Time duration from initial diagnosis until confirmation of the findings ranged from 29 to 39 months. While one of the former three patients was operated on because of severe ileal stenosis, Crohn's disease in the other two patients remained inactive even though no specific treatment was administered. In the two patients without typical Crohn's disease, disappearance and recurrence of the aphthous lesions was able to be confirmed. These findings suggest that the clinical course of Crohn's disease of aphthous type is not uniform, and that this peculiar form of the disease possibly includes a subtype which does not progress aggressively.