いわゆる“Simple Ulcer”とは

Historical Review of So Called “Simple Ulcer” of the Intestine

　‘Simple ulcer’，‘primary ulcer’，‘solitary ulcer’，‘idiopathic ulcer’，‘non-specific ulcer’，‘benign ulier’…etc．いわゆる“simple ulcer”と呼ばれる疾患に対する名称はこんなに多い．‘Non-specific simple ulcer’のように2つの形容詞を組み合わせて用いられることも少なくない．わが国ではこれらの翻訳名が用いられている．1つの疾患単位（？）にこれほど多種多様の名称が用いられているのは何故であろうか？　われわれはいわゆる‘simple ulcer’という疾患に対してあるイメージを持っていたが，これを独立した疾患単位として認めていてもよいのだろうか．

　本稿ではいわゆる“simple ulcer”が歴史的にどのように記載され認識されてきたかを振り返ることによって，この原因不明で奇妙な疾患のentityをもう一度考えなおしてみようと思う．いわゆる“simple ulcer”は大腸にも小腸にも発生するが，文献的にも両者は別々に記載されていることが多いので，ここでも別に取り扱うことにする．

　‘Simple ulcer’ of the intestine has many synonyms such as ‘primary ulcer’, ‘idiopathic ulcer’, ‘nonspecific ulcer’, ‘benign ulcer’ and combination of these terms. It has been believed that French pathologist J. Cruveilhier is the first to discribe this peculiar disease in 19th century. Reading his original article, he seems to has noticed and discribed this condition although the drawings in his book does not seem to be identical to so called “simple ulcer” in recent meaning.

　Applying the criteria of Cade (1913) and Grasmann (1925); ‘sharp-bordered, solitary ulceration with no surrounding inflammation of unknown cause, indefinite pathogenesis, and acute or chronic course’, variety of abnormal conditions with ulceration could be included under this term. By reviewing a large number of literature it became clear that ‘simple ulcer’ probably included recently established disease entity such as ischemic entero-colitis and Behçet entero-colitis. However, after excluding these conditions from ‘simple ulcer’ there still exist svariable ulcerating lesions of the intestine with unknown cause, among which there is a particular type of cecal ulcer with characteristic appearances, being most common type of “simple ulcer” in Japan unlike in western countries. Although ‘simple ulcer’ does not seem to be a definite disease entity, this punched ulcer of the cecum appears to be a disease entity and it was recommended to separate this condition as a narrow category of so called “simple ulcer” from a wide category of ‘simple ulcer’. As to the spectrum of ‘simple ulcer’ of the small bowel we do not have enough experiences to make narrow category as in the large bowel yet. As ‘simple ulcer’ of the intestie is rather rare condition, it is most important for us to cooperate to collect cases in order to know its clinical and histological spectrum more precisely.