クローン病18例の分析よりみた臨床診断とその問題点

Diagnostic Problem in Crohn's Disease

　腸の炎症疾患は悪性腫瘍と異なり，病理学的特異性を有しないことがある．したがって，一時点のみの病理学的検索では決定的な診断を下すことができない場合があり，臨床と病理のあらゆる情報を総合して診断する必要が生じてくる．その典型的なものが病理学的には“非特異性潰瘍”と診断せざるを得ない，治癒した腸結核であろう．

　クローン病は，欧米では古くから疾患単位として確立された疾患¹⁾²⁾でありながら，今なお，論議の対象とされているのは，病因の未知，予後の不良³⁾⁴⁾，などと合せ，診断の面でも決定的な所見を欠くことにあると考えられる．

　We studied about clinical manifestations, radiological and endoscopic findings of eighteen patients with Crohn's disease which we have experienced in these eight years, and obtained a conclusion such as follows.

　1. The age of onset was from ten to twenties in seventeen patients (94%). Sixteen patients (89%) complained of abdominal pain. Evidence of inflammation such as fever, accelerated ESR, positive CRP, elevated level of α₂-globulin was available in more patients than those in the reports in Europe and America.

　2. In X-ray examination, longitudinal ulcers were recognized in the small intestine in ninety per cent of the non-operated patients with involvement of the small intestine. Longitudinal ulcer seemed one of the characteristic findings in the small intestine in Crohn's disease. On the other hand, longitudinal ulcers could be seen only in twenty-five per cent of the post-operated recurrent patients in the small intestine, and seen in the colon in fifty per cent of the patients with colonic involvement.

　Inflammatory polyps were more frequently recognized than cobblestone in X-ray films, however, the discrimination is often difficult. Macroscopic and pathological study may be necessary for the clear-cut discrimination of the two.

　3. Endoscopic examination was helpful for further evaluation of X-ray findings and recognition of tiny lesions.

　We think it is in appropriate to make the diagnosis of Crohn's disease only by determination of sarcoid-like granuloma from the lesion. It rather seemed to have more diagnostic value to prove granuloma from the mucosa of normal appearance

　4. Clinical course was obviously different from that of ulcerative colitis and intestinal tuberculosis.

　From those results written above, we want to insist that the diagnosis of Crohn's disease should be made after comprehensive evaluation of these findings such as follows. ① clinical manifestations, ② radiological and endoscopic feature, histological findings of biopsy specimens, ③ clinical course, ④ macroscopic and pathological findings of resected specimens.