クローン病における胃・十二指腸の微小病変

Small Superficial Gastroduodenal Lesions in Crohn's Disease

　本邦でもクローン病に関する研究報告が増加している．しかし，小腸や大腸病変についての報告がほとんどであり，クローン病の上部消化管病変，特に胃・十二指腸の微細，微小病変についての報告は皆無に近い．われわれはクローン病の確診

例5例と疑診例3例について，胃・十二指腸を精査した結果，確診例の4例に上部消化管に微小な病変を認め，組織学的にも非乾酪性肉芽腫および肉芽腫様病変を証明しえたので，若干の考察を加えて報告する．

　Crohn's disease may involve any part of the gastrointestinal tract. In fact, however, gastroduodenal lesions of Crohn's disease have been believed to be rare and the incidence quoted in the literature varies from 1 to 7% of this disease. In Japan, despite the fact that the number of patients with Crohn's disease is gradually increasing, the studies on small superficial lesions in the stomach and the duodenum have not been reported before.

　There were five definite and three probable cases of Crohn's disease treated in our hospital during the past three years. The ages of the five definite cases when the patients underwent the upper gastrointestinal tract examinations were 25, 17, 30, 40 and 49 years respectively. Of those five cases, ileocecal lesion and longitudinal ulcer of more than 5 cm in length were found in four cases; large bowel lesion in two; and anal fistula in three.

　For all definite and probable cases we conducted the routine and preferentially detailed upper gastrointestinal tract examinations by double contrast radio-graphy, endoscopy with dye spraying technique, and endoscopic biopsy. As a result, small minute gastroduodenal lesions were observed in four out of the five definite cases which had Crohn's disease in the lower intestinal tract, while no abnormal lesions were detected in the gastroduodenum in the three probable cases. In all the definite cases, the gastric lesions were mainly confined to the lower portion of the stomach. One of the radiographical findings characteristic of those definite cases was the multiple small nodular lesion of elevated type with irregular, sharply demarcated central depression similar to aphthoid ulcer in the lower digestive tract. By means of endoscopy, erosion or superficial shallow ulcer with yellowishwhite coats was visualized at the top of the elevated lesion and between those nodular lesions. In one case (49-year-woman), multiple small ulcer were recognized in the gastric body, esophagus and pharynx radiologically and endoscopically. Histological inves-tigation of biopsy specimens obtained from the antral mucosa identified tiny non-caseating epithelioid cell granuloma in three cases, and granulomatous lesion with multinuclear giant cells in the mucosa of duodenal bulb in one case.

　From the above mentioned results, we believe that the gastroduodenal involvement of Crohn's disease is commoner than is generally realized.