潰瘍性大腸炎の小腸病変

Small Bowel Lesions of Ulcerative Colitis

要旨　潰瘍性大腸炎（ulcerative colitis ; UC）にも小腸病変が存在することが明らかとなってきたが，その病態については不明である．今回，小腸用カプセル内視鏡を施行した活動期UC 30例，大腸全摘出後11例の内視鏡所見および臨床所見について検討した．小腸病変（浮腫，潰瘍）は41例中15例（36.6％）に認められ，このうち小腸の広範囲に多数存在する潰瘍は6例だった．小腸の広範囲に多数存在する潰瘍6例と，それ以外の35例の臨床背景の比較検討では，潰瘍を有する群では検査時平均年齢24.8±10.8歳，発症時平均年齢20.8±8.7歳と有意に若く（p＜0.05），病型は6例とも全大腸炎型または回腸囊炎であり，有意に高い頻度だった（p＜0.05）．経過観察できた3例は全例小腸病変が消失し，うち2例はプレドニゾロンによる治療で比較的速やかに病変が消失した．さらに，6例のうち4例に上部消化管病変を伴っていたことはUCとの関連を示唆する所見と考えられた．今後，さらにUCにおける小腸病変の臨床的意義について詳細に検討する必要がある．

　Small intestinal lesions have been demonstrated in UC（ulcerative colitis）, but their pathology and frequency remain unclear. This study examined endoscopic and clinical findings in 30 active-phase UC patients and 11 patients following total colectomy who underwent small intestinal CE（capsule endoscopy）examination. Small intestinal lesions（edema, ulcer）were seen in 15 of 41 patients（36.6％）. Six of these patients had multiple ulcers over a wide range of the small intestine. Clinical characteristics of the six patients with multiple ulcers over a wide range of the small intestine and the other 35 patients were compared. The group with ulcers showed a mean age of 24.8±10.8 years at the time of examination and 20.8±8.7 years at onset, significantly younger than the other patients（p＜0.05）. The clinical entity was pancolitis and pouchitis in all six patients, representing a significantly high frequency（p＜0.05）. Small intestinal lesions disappeared in all three patients whose course could be observed, with lesions disappearing relatively quickly with treatment by PSL in two cases. The finding of small intestinal lesions accompanied by upper gastrointestinal tract lesions in four patients was thought to suggest a relationship with UC. In the future, more detailed investigations of the clinical significance of small intestinal lesions in UC may be warranted.