腸管アフタ様病変の鑑別―内視鏡を中心に

Endoscopic Differential Diagnosis of Aphthoid Lesions in the Intestine

要旨　各種炎症性腸疾患の腸管粘膜にみられるアフタ様病変の形態を大別すると，Ⅰ群からⅣ群までに内視鏡分類された．このような病変は潰瘍性大腸炎では2.6％，Crohn病77.4％，単純性潰瘍80％，キャンピロバクター腸炎20％，出血性腸炎9.5％，偽膜性腸炎40％にみられ，腸管Behoet病と腸結核，アメーバ赤痢，エルシニア腸炎では全例にみられた．病変の出現した病期をみると，急性期ないし初期，活動期にみられたが，無症状となった時期や炎症の回復期でも確認されることがあった．Crohn病と単純性潰瘍の病変は難治性であり，長期間の経過観察においても形態の変化は少なかったが，他疾患ではすべて消失した．発生部位も疾患別に特徴的であった．したがって，その形態や発生部位，時間的推移などに注目すれば，アフタ様病変からみた各種炎症性腸疾患の鑑別診断は難しくないことが強調された．

　Aphthoid lesions of various inflammatory bowel diseases in the intestine could be endoscopically classified into four groups (group Ⅰ to Ⅳ). Aphthoid lesions were observed in 2.6% of ulcerative colitis, 77.4% of Crohn's disease, 80% of simple ulcer, 20% of Campylobacter enterocolitis, 9.5% of hemorrhagic colitis, 40% of pseudomembranous colitis, and 100% of intestinal Behcet disease, intestinal tuberculosis, amoebic colitis and Yersinia enterocolitis. They were observed both in acute, early or active phase and asymptomatic or recovery phase of the disease. The lesions of Crohn's disease and simple ulcer were resistant to treatments, however, those of the other diseases were cured with treatments. The site of the lesions were characteristic of each disorder. Accordingly, the differential diagnosis of various inflammatory diseases can be made by the shape, site and responsibility to treatments of the aphthoid lesions.