Crohn病の長期予後

The Long-term Prognosis of Crohn's Disease

Crohn病（CD）は初期には腸管の炎症を認めるのみであるが，経過とともに狭窄・瘻孔・穿孔などの合併症を来し，腸管切除を余儀なくされる進行性の疾患である．従来の内科治療では，このようなCDの長期経過を改善することは困難とされてきた．しかし，抗TNF-α抗体製剤の登場により，高いレベルでの寛解維持を達成することが可能となった．なかでも，CD発症初期からの免疫調節薬や抗TNF-α抗体製剤の導入により，高度の腸管障害への進展を予防すれば，本症の自然経過を変えうることが証明されつつあり，腸管障害の側面からみたCDの長期予後は今後改善される可能性が高い．

　CD（Crohn's disease）is a chronic inflammatory disease, developing from inflammatory luminal disease to advanced disease complicating stenosis, fistula, and perforation, which require intestinal surgery. So far, medical treatment has been presumed to be insufficient for the improvement of the long-term clinical course of CD. However, with the use of anti-TNF-α antibody treatment, it has become possible to maintain deep remission with mucosal healing. Furthermore, it has been recently indicated that immunosuppressive drugs or anti-TNF-α antibody treatment for patients in the early phase of the disease improves the natural course. Further accumulation of clinical evidence is necessary to establish the therapeutic strategy for improvement of the long-term prognosis of CD.