出血を主徴とする小腸非腫瘍性病変の診断と治療─その他の非腫瘍性疾患

Diagnosis and Management of Small Hemorrhagic and Non-tumorous Intestinal Diseases：Miscellaneous Diseases

要旨●出血を主徴とする小腸の非腫瘍性疾患のうち，多発潰瘍を形成する血管炎症候群（IgA血管炎，好酸球性多発血管炎性肉芽腫症，多発血管炎性肉芽腫症，クリオグロブリン血症性血管炎），非特異性多発性小腸潰瘍症，腸管Behçet病について概説し，自験例を提示した．いずれの疾患においても内視鏡検査が診断法の中心であるが，病変分布や局在の評価に関してはX線造影検査の有用性が高く，確定診断にも有益な情報を与えてくれる．一方，治療に関しては，非特異性多発性小腸潰瘍症の腸管狭窄に対するバルーン拡張術は有用な場合があるものの，多発病変を形成する頻度が高いこれらの疾患では，原則的に内科治療が主体となるため，内視鏡的止血術を行う機会は少ない．

　We reviewed inflammatory disorders that can cause multiple small intestinal ulcers, including vasculitis syndrome, CEAS（chronic enteropathy associated with SLCO2A1 gene）, and intestinal Behçet's disease. Although endoscopic procedures are crucial for the diagnosis of such diseases, radiographic investigation is more useful than endoscopy for the evaluation of distribution and localization of small bowel mucosal lesions. In addition, radiology offers more information for differential diagnoses compared with endoscopic observations. Endoscopic balloon dilation is useful for the treatment of intestinal strictures of CEAS. However, since many small intestinal ulcers caused by diseases are usually treated by medications such as systemic steroids, immunomodulators, and biologics, interventional endoscopic hemostasis is rarely applied in the management of these conditions.