十二指腸の非腫瘍性びまん性病変の診断―潰瘍性大腸炎

Diffuse Duodenitis Associated with Ulcerative Colitis

要旨　潰瘍性大腸炎に関連した十二指腸のびまん性炎症を伴った15例を集計し分析した．発症年齢や性比には特徴はなかったが，全例全大腸炎型であった．十二指腸病変の多くは大腸病変に遅れて出現し，5例では大腸全摘後にみられた．内視鏡所見では，主に発赤，びらん，粘膜の粗糙，顆粒状変化や血管透見像の消失，偽ポリポーシス様変化，Kerckring皺襞の消失や腫大など，組織所見では，炎症細胞浸潤や腺管の減少や破壊，陰窩膿瘍，陰窩炎，びらんなどが，潰瘍性大腸炎の大腸病変と類似した特徴的な所見と考えられた．Hp感染は陰性だった．治療では，抗生剤，H₂-blocker，PPIなどは無効であり，steroid剤が有効なことが多かった．

　We collected 15 cases with diffuse duodenitis associated with ulcerative colitis and analysed them to clarify the clinical characteristics. Distribution at the age of onset and gender ratio of these cases was similar to that of usual cases of ulcerative colitis. They all had total colitis and, in most cases, duodenitis appeared after the onset of ulcerative colitis. Five patients suffered from diffuse duodenitis after total proctocolectomy. Characteristic findings of gastroduodenoscopy were redness, erosion, rough or granular mucosa, loss of visible vascular pattern, pseudopolyposis, loss or thickening of Kerckring's folds, and so on. In the histological findings, inflammatory cell infiltration, decreased number in glands, destroyed glands, cryptabscess, cryptitis, erosion, etc. were observed in biopsied specimens just as in specimens of ulcerative colitis. Five patients all showed negative as regards Helicobacter pylori infection. H₂-blockers or proton pump inhibitors were ineffective for diffuse duodenitis, but prednisolone was effective in most cases.