非特異性多発性小腸潰瘍症の長期経過

Long-term Follow-up Study on Nonspecific Multiple Ulcer of the Small Intestine

要旨　非特異性多発性小腸潰瘍症9例を平均18年間経過観察した結果，本症の主症状（持続する潜出血と貧血），小腸潰瘍の多発，手術後の再発などの病態は従来の記載とは全く変化していなかった．本症は手術によっては完治しないが，栄養療法の導入によって，社会生活に対する障害の程度は改善されている．本症のHLAはCrohn病のそれとは全く異なっていた．また，腸切除後，本症は小腸以外の十二指腸，大腸に特異な病変を生じた．特に十二指腸病変は鋭利な辺縁を有し，周囲の反応に乏しかった．両病変は組織学的に特異的な変化を認めないことより，本症に特徴的な病変の可能性が示唆された．すなわち本症は小腸に限局した疾患ではなく全消化管に及ぶ疾患であると考えられる．

　Since the first case report on nonspecific multiple ulcer of the small intestine by Okabe et al in 1966, we experienced 5 more cases and followed-up these 9 cases for an average of 18 years.

　The HLA pattern in the 6 cases studied markedly differed from that in Crohn's disease.

　The long-term prognosis of this disease was divided into three categories according to social activity of the patients for the recent few years; good in 2 cases, fair in 4, and poor in 3. Recurrence was observed in all cases surgically treated. Frequency of surgery may thus affect the long-term prognosis.

　Various complications emerged during the follow-up period. Relatively frequent were peptic ulcer of the stomach and cholelithiasis. These complications developed only in the surgical cases suggesting the relationship to short bowel syndrome.

　In 3 of the 6 cases endoscopically examined, there were minute shallow ulcers and/or fine convergencies in the second portion of the duodenum. The configuration of these ulcers was quite similar to that found in the ileum. In addition, in 3 of the 7 cases who had barium enema examination, there were multiple circular ulcers with eccentric deformity in the transverse or descending colon, distal from the ileocolonic anastomosis.

　These findings highly suggest that nonspecific multiple ulcer of the small intestine is a digestive tract disease affecting not only the small intestine but also the duodenum and/or colon.