潰瘍性直腸炎の診断とentityをめぐる若干の検討

A Study of the Diagnostic Process and the Clinical Entity of Ulcerative Proctitis

　いわゆる，潰瘍性大腸炎（以下UCと略）のvariantとして，“直腸型”あるいは“潰瘍性直腸炎”または“非特異性直腸炎”と呼ばれる，原因不明の直腸粘膜の慢性非特異性炎症性疾患については，従来，様々な問題が提起されてきた．ここでは，まず，その形態的変化の範囲が狭く，かつ軽度であることや，またその“selflimited”な性状から，診断面に多少の問題があると思われるので，本症の診断的問題点を明らかにしてみたい．次に本症のentityに若干の考察を加えてみる．

　The diagnostic process and the clinical entity for ulcerative proctitis is studied, based on 12 cases of ulcerative proctitis and 57 cases of ulcerative colitis.

　The difficult problem in the diagnosis of ulcerative proctitis is due to its mild symptoms and morphologic changes in the majority of the patients. Superficial mucosal ulcerations were identified only in one case with ulcerative proctitis. So the disease may be easily overlooked in some instances. The double contrast barium-enema findings in the five patients with ulcerative proctitis were interpreted as normal. For this reason endoscopic examination is essential for the diagnosis.

　No patient had extension of colitis involving more proximal portions of the colon during its clinical course. But we think that ulcerative proctitis is a variant of ulcerative colitis and that there is no fundamental distinction between them in remittent course, radiographic image, endoscopic picture and pathology. Most of the clinical differences between them can be explained by the area and the degree of the bowel involved.

　But it may be problems that minimal findings of ulcerative proctitis is called as “early change”, or that the disease is recognized as “early ulcerative colitis”. It seems appropriate that ulcerative proctitis is a mild type of ulcerative proctocolitis.