Crohn病診断基準の問題点―臨床の立場から

Problems on Diagnostic Criteria for Crohn's Disease: From the Clinical Viewpoint

要旨　臨床的にCrohn病と診断したが，新しいCrohn病診断基準で確診・疑診とされない症例は94例中5例であった．縦列傾向や上部消化管病変を認めず肉芽腫も検出されないアフタのみの症例が3例で，大腸に大型不整形潰瘍の多発がみられる症例が2例であった．前者では全例に肛門部病変がみられ栄養療法が著効した．今後このような症例の増加が予想されるためこれらを疑診となるようにすべきと考えられる．そのためには診断基準に肛門部病変を入れることが最もよいと思われた．現在のところ後者は文献的にほとんど報告がなくまれと思われるため，大腸に大型不整形潰瘍の多発を示すCrohn病が存在することを附記する程度でよいと考えられた．また，主要所見，副所見の問題点についても考察した．

　According to the new diagnostic criteria for Crohn's disease, five out of 94 patients were not able to be definitely diagnosed or suspected as having Crohn's disease though all of them were clinically defined as Crohn's disease. Three patients presented with aphthoid ulcer alone, without either longitudinal tendency or gastro-duodenal lesions. Two patients had multiple large discrete ulcers in the colon. The former three patients had anal lesions, which were markedly improved by nutritional therapy. Since such cases will increasingly be found, these cases mentioned above should be considered as suspected Crohn's disease. Accordingly, it is suggested that the diagnostic criteria should include anal lesions. To embrace also the latter two cases, although rare and not yet reported in the literature, it would be better to mention in the criteria that multiple large discrete ulcers may also indicate Crohn's disease, In addition, problems on major and minor findings were discussed.