潰瘍性大腸炎にみられる回腸終末部病変

Aphthoid Erosions at the Terminal Ileum in Ulcerative Colitis

要旨　潰瘍性大腸炎患者80例中26例（32.5％）の回腸終末部に，backwash ileitisとは明らかに異なる2～5mm程度の小さいアフタ様びらんが散在性に数個～十数個存在することが確認された．病理組織学的には好中球，リンパ球などの炎症性細胞浸潤が軽度ないし中等度みられたが，特異的な炎症像はなかった．回腸終末部病変の臨床的意義をみる目的で，性，年齢，罹患年数，臨床経過，病変範囲などの因子と発生頻度を対比したが，特に一定の傾向はみられず，初発時や緩解期にも，直腸炎型にも発生が確認された．25例中21例（84.0％）では4か月後にびらんは消失した．潰瘍性大腸炎であっても回腸終末部に高い頻度で炎症が存在する事実は興味深く，本症の病因や病態に対する従来の考え方を見直すべきであることを強調した．

　Eighty patients with ulcerative colitis underwent total colonoscopy, and several tiny aphthoid erosions were inspected at the terminal ileum in 26 cases (32.5％). The erosions were arranged scatterdly and quite different from the so called backwash ileitis. Histological findings showed mild or moderate infiltration of inflammatory cells in the mucosa of the terminal ileum, but no specific changes.

　To clarify the clinical meaning of these erosions, backgrounds of the patients with or without erosions were compared; sex, age at the onset and time of examination, suffering periods, clinical course, site of lesion, and so on. However, no characteristic differences were detected in the two groups. Erosions were detected in 20％ of the patients even in the initial attack, and also 33.3％ of the patients had suffered these lesions for over 15 years. These lesions were revealed in the remission phase and in the proctitis type. More over, erosions healed in 84.0％ of the cases without any treatment within four months.

　Although ulcerative colitis is idiopathic, and the terminal ileum has generally received little attention, the involvement of the terminal ileum is not rare. We must pay much more attention to these lesions to clarify the pathogenesis of ulcerative colitis.