下痢の臨床的諸問題

Clinical Problems of Diarrhoea

はじめに

　下痢は日常診療上，腹痛に次いでしばしば遭遇する症状であり，その原因となる疾患の診断およびそれに対する適切な治療は極めて重要である．

　最近2年間の筆者らの内科外来での集計では，腹痛を訴えた患者が24.5％を占めるのに対して，下痢を訴えたものは5.9％であった．

　松永ら¹⁾の集計でも，下痢患者は全外来患者の7.6％を占めているが，約10年前の同様な集計（9.4％）と比較して減少の傾向を認め，それは社会状況の好転と自宅療法，とくに抗生物質により容易に治療できることが原因と考え，また，大学病院という特殊性による急性下痢の減少もその一つの要因として挙げている．

　このように，下痢は全体としては減少の傾向がみられ，とくに急性下痢では著しいが，逆に，抗生物質による下痢をはじめ，lactase deficiency，WDHA症候群などのように最近になってその病態が明らかとなりつつある下痢疾患もあって，下痢が依然として重要な症状の一つであることには変りない．

　ここでは，下痢に関してその病態生理のほか，原因疾患の診断，治療など臨床的諸問題について述べようと思う．

　Next to abdominal pain, diarrhoea, or watery, liquid discharge of feces, is a symptom most often encountered in our daily practice. Recent statistical investigation in our out-patient department for internal medicine shows that abdominal pain accounts for 25.4 per cent of complaints of all the out-patients, and diarrhoea, for 5.9 per cent of them.

　Frequency of diarrhoea as classified by causative diseases is more or less different according to clinics. However, either functional diarrhoea such as irritable colon or acute gastroenteritis, namely, infectious diarrhoea are commonly and most frequently seen in the all clinics. Diseases associated with diarrhoea involve not only gastrointestinal tract but various other organs as well, so that other far less frequent diseases must also be taken into full account.

　The causes of diarrhoea are manifold: abnormal bowel movement seen in irritable colon, regional enteritis and ulcerative colitis; abnormal secretion of succus entericus as is observed in Aollinger-Ellis syndrome, WDHA syndrome and disturbed function of the pancreas; digestive disturbance found after gastrectomy, partial resection of the small intestine, or in functional disorders of the pancreas and lactase deficiency; disturbed absorption due to inflammatory diseases of the small intestine, sprue and partial resection of the small bowel; abnormal secretion from the intestinal mucosa caused by inflammatory diseases or neoplasms of the intestinal tract. In most instances, these causes are so interwoven with one another that a very complex picture is presented in diarrhoea.

　In the management of diarrhoea, its real causes must always be looked for, and instead of or in addition to mere symptomatic treatments, the pertinent management of diarrhoea is most important.