上部消化管病変が契機となって診断されたCrohn病

The Posibility of Making a Diagnosis of Crohn's Disease by Upper Gastrointestinal Examinations

要旨　Crohn病と確診がついていない時点で，上部消化管検査によりCrohn病の存在を診断することが可能だったか否かについて検討した．1978年から1994年8月までに初診した163例中，手術や画像検査によるCrohn病の確診・疑診がついていなかったのは38例であった．このうち上部消化管検査や生検を契機としてCrohn病と診断された症例はなかったが，縦列する小潰瘍～びらんと十二指腸の多発性びらんは特徴的であり，肉芽腫は3例に検出された．下痢・腹痛を伴わず，炎症所見も軽度な臨床的非典型例やアフタのみから成るCrohn病の診断に際しては，上部消化管病変やその生検所見が決め手になることもありうると思われた．

　We investigated whether a diagnosis of Crohn's disease can be made by upper gastrointestinal examinations before it has became clear by other methods that a patient is suffering from Crohn's disease. The subjects consisted of 38 patients, who had been neither operated on nor examined by x-ray and/or endoscope. There was no patient diagnosed as having Crohn's disease by upper gastrointestinal examinations including biopsies through an endoscope. However, small ulcers and erosions arranged longitudinally and multiple erosions in the duodenum were considered to be characteristic findings indicating gastroduodenal lesions of Crohn's disease. Epitheloid cell granulomas were detected in three cases among ten biopsied cases.

　In future, when we try to diagnose unusual cases without typical clinical symptoms or data, and cases consisting solely of aphthoid ulcers throughout the alimentary tract, detection of upper gastrointestinal lesions and/or the presence of epitheloid cell granulomas in biopsy specimens, may come to be regarded as conclusive evidence of Crohn's disease.