クローン病を特集するにあたって―用語，定義の問題をふくめて

On the Special Features in This Issue on Crohn's Disease

　Crohn病は1932年，CrohnとMount Sinai Hosp.，N. Y.の共同研究者により初めて回腸終末部の病気として発表された¹⁾ものであるが，これはただちに回腸のどこにも同様病変の発生することが示唆され，さらにその後空腸も侵されることがわかり，regional enteritisと呼ばれるようになった．さらに1952年，Wells²⁾は同一疾患が大腸に起こりうることを初めて発表し，1959年，Brooke³⁾は大腸のCrohn病と潰瘍性大腸炎は内科的，外科的治療に対する反応が異なるので両者の鑑別が重要であることを強調した．彼は特にCrohn病において全大腸摘出後の空腸炎再発に重要な意義をおいている．このようにして1960年代になると両者の鑑別⁴⁾⁵⁾について，その臨床的，放射線学的，また病理学的判定規準が研究されるようになり，現時点においても欧米における消化器内科・外科・放射線医および病理学者はこの両疾患の鑑別を消化器病診断学領域における最も挑戦的な主題の1つにしているのである．

　1972年5月発行のClinics in Gastroenterology1巻2号はCrohn病特集号⁶⁾である．Editorial boardのひとりB. N. Brookeがその緒言に次のように書いている．

　Crohn's disease was made known in 1932 as an affection involving the terminal end of the ileum, but it has been subsequently made clear that not only the terminal ileum but the other segments of the ileum, jejunum and even colon could be affected as well. Indeed all the parts of the digestive tract are now considered to be affected by it. However, its etiology remains unclarified yet, and there are no distinct histologic pictures specific to this disease. Further, its clinical manifestations are so variegated according to the segments involoed that even a suspicion is entertained whether or not this disease could be a single clinical entity.

　In western countries it has aroused special interest among those connected with the diseases of the gastrointestinal tract including internists, surgeons, radiologists, pathologists and more recently immunologists. An immense number of reports and studies are therefore published from year to year. Nevertheless, the results of immunologic studies based on the latest investigational methods remain conflictory. The pathogenesis of this affection is still hidden, as it were, in a veil of mystery.

　In Japan reports of typical cases initially described by Crohn have been so far and few between that not much interest was displayed in this subject. However, with its enlarged definition and with increasing concern about the diffrentiation between it and ulcerative colitis now becoming more frequent here, we are compelled to pay more attention to this disease.

　Crohn's disease has been taken up in this issue as special features in the expectation that active progress be made in this country for independent study of this disease.

　Finally, the names and their comments are described relevant to the papers from Council for International Organizations of Medical Sciences recommended for international use as a complement to the WHO International Classification of Diseases (1974).