Crohn病診断基準の問題点―臨床の立場から

Some Problems in New Criteria of Crohn's Disease

要旨　Crohn病（CD）の診断基準改訂案の問題点を明らかにするために，当科初診時に一連の検査で確診がつかなかったCD10例の臨床像の検討を行った．その内訳は，臨床的にCDを疑わずに小腸検査が施行されなかった3例，前医での潰瘍性大腸炎の診断を鵜呑みにして深部大腸～小腸の検索が不十分だった4例，消化管にアフタ・小潰瘍を有し，原因不明熱あるいは肛門部病変を認めるものの非乾酪性類上皮細胞肉芽腫を認めない3例であった．難治性痔瘢などの肛門部病変はCDに高率に合併する最も特徴的な病態の1つで，初発症状としても多くみられるため，診断基準への復活を検討してもよいと思われた．特に初期病変のみのCDの早期診断に寄与する可能性が示唆された．

　To clarify the problem of Japanese diagnostic criteria for Crohn's disease (1995), we examined the clinical data of 10 patients with CD who could not be definitely diagnosed during their first visit to hospital. In three patients, small bowel enema had not been carried out, because CD was not suspected clinically. Four patients had undergone insufficient examination of the area from the small intestine to the proximal colon, as we didn't doubt the diagnosis of ulcerative colitis that had been made in the previous hospital. Three patients had multiple intestinal aphthas and small ulcers with perianal lesions or fever. However, as epithelioid cell granulomas had not been detected in their biopsied specimens, they could not be definitely diagnosed as having CD. Perianal lesions, for example, intractable periproctal fistulas, are highly complicated, and this type of lesion is one of the most characteristic lesions of CD and often occurs at the onset. Because of this, we think that perianal lesions may be restored to the Japanese diagnostic criteria of CD. The addition of perianal lesion would certainly contribute to diagnosis of CD, especially in early stage CD.