潰瘍性大腸炎の内科療法

MEDICAL TREATMENT OF ULCERATIVE COLITIS

Ⅰ．はじめに

　潰瘍性大腸炎の成因については古くから感染説，アレルギー説，精神身体症説，自律神経障害説，リゾチーム説などの諸説があり，最近になって自己免疫に関する研究も行なわれているが，未だ解明されていない¹⁾²⁾．またこの疾患の原因を多元的とする説も有力である³⁾．したがって治療法に関しても多くの問題が残されている現状である．私どもは本疾患に各種の内科療法を試み，第54回消化器病学会総会のシンポジウムにおいて「潰瘍性大腸炎の内科療法」のテーマで報告したので，ここにその概要について述べる．

　A study was made on the medical treatment of my personal cases of ulcerative colitis. This disease was classified into three types by its clinical course: chronic intermittent, chronic continuous and acute fulminating. It was also classified into five types according to anatomic type. Corticosteroid (CS) as drug therapy was effective mostly in mild cases and good results were demonstrated by the longterm use of it. Topical therapy of CS had an excellent effect in cases of left sided colitis. There was a few cases in which relapse was induced by rapidly decreasing CS doses. Salicylazosulfapyridine is a drug adequate for mild cases and also useful as maintenance treatment after the use of CS. Anabolic steroid showed a marked effect in the improvement of nutritional deficits. With the object of investigating the role of dietary factor, a modified method of diet trial for allergic disease was conducted. In some, an exacerbation of symptoms was noted. A case of relapse after the ingestion of milk went into clinical remission by giving a milk-free diet. Psychologic tests (Y-G Test, CMI Fukamachi Test), interview, etc., were carried out from the psychosomatic point of view. In some cases a neurotic tendency and partial character were noted and ther was a case in which relapse occurred because of emotional disturbances. In such a case psychotherapy will be needed. Depending on the symptom and colonic involvement of the disease, adequate medical therapy should be aimed at preventing relapses and complications. Attention should be paid to an indication for chirurgical therapy for severe cases.