アフタ，不整形潰瘍

Criteria for the Diagnosis of Crohn's Disease (Preliminary Proposal): Aphthoid and Discrete Ulcers

要旨　1990年4月から1995年10月までに当科で診断，治療したCrohn病63例の各種画像所見を分析し，新しいCrohn病の診断基準案の中のアフタ，不整形潰瘍について解説した．大腸内視鏡検査では，アフタは74.6％，不整形潰瘍は54％に出現し，同時期に施行した注腸X線検査における出現率60％，51.4％に比較して高率に認められ，Crohn病の大腸の微細所見の検出に内視鏡は有用であった．一方，領域を有し，診断に変形が重要となる典型病変の縦走潰瘍，敷石像の出現率は，注腸X線検査でそれぞれ45.7％，31.4％と，内視鏡検査での23.8％，19％に比較して高く，変形の指摘と概観撮影法として優れていた．小腸においては空腸から上部回腸，骨盤内回腸と肛門側の小腸で微細病変，典型病変ともに所見の出現率は高かった．所見の多い骨盤内回腸においては，有管法による小腸造影に比べて内視鏡的逆行性回腸造影ですべての所見の出現率は高く，骨盤内回腸の詳細な所見の拾い上げに有用であった．内視鏡的生検標本425個におけるルーチン生検標本の検討からgranulomaの検出率は症例数では39.6％であり，個数では11.8％であった．所見別では不整形潰瘍からのgranuloma検出率は8.6％と低かったが，アフタからのgranuloma検出率は15.1％と高く，特に直腸，盲腸のアフタからのgranuloma検出率が高く，Crohn病の早期診断にアフタの発見，生検は有用と考えられた．

　We explained recently some proposed criteria for the diagnosis of Crohn's disease, especially focusing on aphtha and discrete ulcers. From April, 1990 to October, 1995, we diagnosed and treated 63 cases of Crohn's disease and performed magnified colonoscopy 212 times, double contrast barium enema study (DCBE) 66 times in 35 cases, small bowel enema study (SBE) 76 times in 41 cases, and endoscopic retrograde ileography (ERIG) 65 times in 34 cases. Compared with DCBE, the use of colonoscopy was much more effective for detecting aphtha and discrete ulcers. Conversely, typical lesions such as longitudinal ulcers and cobblestoning were more effectively detected with DCBE than with colonoscopy. In the small intestine, incidences of findings for Crohn's disease in the anal legion increased espescially in the intrapelvic ileum. In the intrapelvic ileum, all the findings were more effectively demonstrated with ERIG than with SBE. Thus, ERIG proved to be a useful modality in the imaging diagnosis of Crohn's disease. 425 biopsy specimens were used for the detection of noncaseating epitheloid cell granulomas for definitive diagnosis of Crohn's disease. The detection rate of granuloma was 39.6% in 53 cases and 11.8% in 425 specimens. On the specimens taken from aphtha, especially those located in the rectum and caecum, a higher detection rate of granuloma indicative of Crohn's disease (ie; longitudinal ulcers and cobble stoning) was Obtained compared with that obtained by endoscopic findings. Aphtha and discrete ulcers are thought to be early lesions of Crohn's disease, and may play an important role in the progression of Crohn's disease.