潰瘍性大腸炎の内視鏡診断

Endoscopic Diagnosis of Ulcerative Colitis

　潰瘍性大腸炎（以下uc）のは粘膜に主変化のあるびまん性の非特異性大腸炎であり，欧米人に多い疾患といわれてきたが，近年日本でもその増加が注目されている．

　1875年にWilksが最初の記載をなしてから1世紀経過したが，謎にみちた疾患であることに変わりがない．炎症がなぜ粘膜に限局するのか，なぜ直腸からびまん性に拡がるかなどという基本的な事項すらほとんどわからないといってよい状態である．しかし本態はわからなくとも診断，治療の方面は大いに進歩し，大部分の例で完治は望めないまでも，少なくともcontrol可能な疾患になったということはできる，本論文では内視鏡的に経過が追えた例（Table 2）における内視鏡像の推移と，手術を施行した高度の炎症像をしめす例における本症の肉眼像の特徴について検討を加えた．

　Ulcerative colitis lacks any pathognomonic findings, but both clinically and macroscopically or endoscopically it shows characteristic features. Its diagnosis is generally not difficult.

　Of greatest significance for the prognosis would be the extent of the affected parts, which usually corre-sponds to the severity of inflammation. For its determination X-ray mostly suffices. In acute stage it would be better to refrain from endoscoping the more proximal part of the colon. The degree of inflammation can be ascertained on the whole by clinical symptoms including the severity of bloody discharge, nature and frequency of stools and general condition of the patient. Romanoscopy, which can be done more easily without any previous preparations, is also undisputedly essential to the diagnosis of ulcerative colitis. What, then, would be the role and significance of colonoscopy in the diagnosis and determination of outcome for uncerative colitis？ Observation of the deeper parts of the colon, if performed without specific purposes, seems to harbor a danger of being only a means to follow personal likings of an endcscopist.

　We are well aware of such a possibility, and yet we have to go on exploring positively the more proximal parts of the colon by colonoscope in order to determine how important the recently developed colonoscopy is for the diagnosis and judment of prognosis for this disease. We have to go on exploring because ulcerative colitis has been studied in western countries chiefly by romanoscopy which has a long history behind it. It is also because we are still unable to arrive at a final conclusion how important a part colonoscopy can play in the overall estimation of ulcerative colititis.

　Ulcerative colitis is said to primarily occur in the rectum, but usually inflammation of the rectum is not so severe. Inflammatory polyposis is rerely found in the rectum. Inflammatory changes are often most prominent in the sigmoid, and, though seldom, in the right half of the colon. Even when the rectum and lower part of the sigmoid are in a state of remmission, active inflammation is often found in the more oral part of the colon. At present, our experienced cases are few, and especially as the time for follow-up observation has been short, we are in no position to say definitely in favor of colonoscopy in the diagnosis of ulcerative colitis. However, according as its cases are accumulated with increasing-term follow-up, the significance of colonoscopy for ulcerative colitis would be more clarified, including a possibly reverse conclusion that colonoscopy be not a ‘must’ for the diagnosis of ulcerative colitis.