びらん・潰瘍を呈する食道病変の内視鏡診断—炎症性腸疾患合併例

Esophageal Involvement Associated with Inflammatory Bowel Disease

要旨●炎症性腸疾患（IBD）は近年国内外で急増しており，IBDに合併する食道病変の報告も増加している．IBDの食道病変は中部食道に好発しCrohn病では縦列傾向を認める多発アフタや潰瘍，Behçet病では多発アフタや単発の打ち抜き潰瘍など，下部消化管病変に類似した形態を呈することが多い．微細な病変も多く，観察には色素撒布が有用である．一方，食道では免疫抑制治療に伴うウイルス感染による病変を生じることもあるため，常に原疾患との鑑別を行う必要がある．IBD食道病変の治療は，胃酸分泌抑制薬のみでは効果が乏しく，原疾患に対する治療が有効である場合が多い．

　Recently, the prevalence of IBD（inflammatory bowel disease）is increasing and, the involvement of upper gastrointestinal lesions in IBD is becoming clear. Esophageal lesions in IBD are commonly observed in the middle portion of the esophagus. These lesions are often similar to lower gastrointestinal tract lesions, particularly, in Crohn's and Behçet's disease. The spraying of indigo carmine during endoscopy is often helpful in detecting the details of these fine lesions. However, these lesions caused by viral infection in immunosuppressive therapy are similar to the esophageal lesions in IBD；therefore, it is necessary to distinguish them from the primary disease. The treatments used for the lower gastrointestinal tract lesions in IBD could also be applied to the esophageal lesions that are refractory to acid-suppressing medications.