本邦における消化管結核の現況─近年の本邦報告例の解析

Current Status of Alimentary Tract Tuberculosis in Japan: A Review of the Literature（1995-2015）

要旨●近年21年間（1995〜2015年）の本邦の消化管結核報告583例を収集し，主に腸結核の臨床像について過去の八尾集計（1985〜1994年）との時代的変遷も含め，その臨床像について解析した．その結果，罹患部位は八尾集計同様に大腸，回盲部，小腸の順に高率であったが，近年では大腸の報告は減少し小腸結核報告が増加しており，高齢発症者の割合が増加していた．消化管結核の補助診断法はツベルクリン反応からIGRAへ移行してきており，CT画像診断の普及などにより肺結核診断能が向上し，近年では原発性腸結核は3割程度にまで減少してきていた．一方，今日においても腸結核の確定診断は容易ではなく，通過障害や穿孔による手術例が半数以上認められ，今後はバイオ製剤に伴う腸結核発症にも注意が必要である．最後に，腸以外の消化管（食道，胃，肛門）結核の特徴についても言及した．今回の解析から，今日においても腸結核のX線・内視鏡による画像診断の重要性に変わりはないことが検証された．

　A total of 593 reports of the last 21 years（1995-2015）on alimentary tract tuberculosis in Japan were collected. This study was focused on the analysis of the clinical features of intestinal tuberculosis, including antique changes with the former Yao paper（1985-1994）. The results were as follows.

　The disease part was high rate in the following order：large intestine, ileocecal lesion, and small intestine. However, reports have indicated that the incidence rate of tuberculosis in the large intestine decreased, whereas that of the small intestine increased. In addition, the number of infected elderly patients（over 80 years of age）was increasing. The auxiliary tubercular diagnostic method was shifting to IGRA from the tuberculin reaction. Because of the advancements in the diagnostic imaging of lung tuberculosis, the incidence of primary tuberculosis of the intestine decreased to approximately 30% in the recent years. More than 50% of the intestinal tuberculosis cases were surgically treated using stenosis, perforation, etc. Nowadays, a great attention must be given to the onset of tuberculosis induced by anti-TNF-α antibody therapeutic agents. Finally, the features of some other parts of the alimentary tract（the esophagus, stomach, and anus）tuberculosis were outlined.

　This analysis showed that a confirmed diagnosis of intestinal tuberculosis is difficult ; therefore, the use of diagnostic imaging, such as barium enema and colonoscopy, is important.