大腸の炎症性疾患の診断に注腸X線検査は必要か―内視鏡（直視画像）を重視する立場から

Inflammatory Bowel Disease, from the Favorable Standpoint of Endoscopic (Direct Visualizing) Examination

要旨　広義の炎症性腸疾患におけるcolonoscopyの直視画像(直画)は形態像と機能像としてとらえられ，前者は点・線・面の要素に凹凸を伴った像として，後者は収縮・伸展，血管像，ならびに出血性の像としてとらえられる．潰瘍性大腸炎(UC)にはこれら両方の像が重複して存在し，炎症を基盤とした疾患の直視画像を把握するうえでの基本的位置づけにある．一方，診断面における種々の所見についての検査方法との比較論は確定されておらず，各項目につき(X線)と(直画)の画像解析可能性について検討した．大腸粘膜を病変の主座とするUC，アメーバ性大腸炎(AC)，感染性腸炎では，直視画像は機能像の把握が可能であり，治療との関連性において有用であった．

　We assessed radiologic examination of the colon and colonoscopic examination for the diagnosis and follow-up examination of the inflammatory bowel disease from the standpoint of direct visualization. Direct visualized pictures could demonstrate functional status such as edematous changes and bleeding tendency in addition to the shape, therefore, the direct visualized pictures were useful in diagnosing inflammatory disorders such as ulcerative colitis. The direct visualization disclosed pictures of the various active stages that were associated with the appropriateness of therapy. Intractable ulcerative colitis cases might show relatively characteristic direct visualized images that indicated intractability and limitation of medical treatments. Early diagnosis and treatment are essential for acute colitis and O 157 enteritis and colonoscopic examination is valuable for their diagnosis. These results suggest that direct visualization is useful for the diagnosis of ulcerative colitis and infectious colitis except for Crohn's disease.