わが国におけるクローン病の現況―「クローン病検討委員会」の研究経過の紹介も含めて

The Present Condition of Crohn's Disease in Japan: Including a progress report of the “Crohn's Disease Researching Committee”

　クローン病は，Crohnら（1932）によって最初regional ileitisの名称で報告された回腸末端部を好発部位とする慢性炎症性肉芽腫性疾患であるが，その後回腸末端部ばかりでなく小腸のその他の部分，大腸，胃などをも侵すことが明らかになったので，限局性腸炎regional enteritisとも称せられている．わが国では，1939年塩田により非特種性局所性腸炎として紹介されてから本症についての関心が高まり，あいついで症例が報告され，ことに1975年に「目本消化器病学会クローン病検討委員会（委員長：山形敞一）」と「厚生省特定疾患クローン病調査研究班（班長：土屋周二）」が発足し，また1973年以来目本大腸肛門病学会，日本消化器内視鏡学会，日本消化器病学会であいついでシンポジウムとして取り上げられるに及んで，一躍脚光を浴びるようになってきている．筆者は幸いにそのすべてに参加しているので，この機会にわが国におけるクローン病研究の現況について，「日本消化器病学会クローン病検討委員会」の経過の紹介をも含めて，筆者が理解している範囲で解説したいと思う．それには，最初にクローン病の概念と名称について述べ，診断基準について触れておきたいと思う．

　An explanation on the present condition of the study of Crohn's disease, its concepts and diagnostic standards, as well as an introduction of the progress report by “The Japanese Society of GastroenterologyCrohn's Disease Researching Committee” are presented. According to a nationwide research conducted by the “Crohn's Disease Investigational Research Group of the Ministry of Health and Welfare”, there are presently at least 127 cases which have been diagnosed as Crohn's disease, and there are over 70cases definitely diagnosed as such by the “Japanese Society of Gastroenterology-Crohn's Disease Researching Committee”. It is natural that these cases are on the same level as those of Europe. Moreover, in Japan, many cases of Crohn's disease which show a longitudinal ulcer along mesenteric attachment of the small intestine are becoming evident. At the same time, we are now confronted with the problem of its discrimination from intestinal tuberculosis, and evidently there is also possibility of a number of undefinable cases which do not meet the diagnostic standards for Crohn's disease nor those for other diseases. These may be clarified gradually through pursuing study of the development of those definitely diagnosed as Crohn's disease, and of the cases without granuloma.

　But for this more time would be required. In spite of a substantial alteration in the concept and the diagnostic standards of Crohn's disease, we can say that research of Crohn's disease in Japan is showing steady progress.