炎症性腸疾患の病変部位と鑑別診断—回盲部病変

Ileocecal Lesion of Inflammatory Bowel Disease

要旨●回盲部に潰瘍性病変を認める代表的な炎症性腸疾患として，Crohn病，腸管Behçet病/単純性潰瘍，trisomy 8関連腸病変，家族性地中海熱，腸結核，エルシニア腸炎，カンピロバクター腸炎，薬剤起因性腸潰瘍が挙げられる．Crohn病では腸間膜付着側の縦走潰瘍と敷石像がみられる．腸管Behçet病/単純性潰瘍，trisomy 8関連腸病変の典型像は回盲部の円形ないし卵円形の打ち抜き潰瘍であり，回盲部の潰瘍に加えて消化管の広範囲に境界明瞭な打ち抜き様の多発潰瘍がみられる．一方，家族性地中海熱の消化管病変では回盲部を含む多彩な潰瘍性病変が認められる．回盲部の潰瘍性病変の鑑別に際しては，trisomy 8関連腸病変や家族性地中海熱を含む多くの疾患における病変の特徴を熟知しておくことが重要である．

　Inflammatory bowel diseases with ileocecal involvement include Crohn's disease, intestinal Behçet's disease/simple ulcer, ileocecal ulcer in trisomy 8, Familial Mediterranean fever（FMF）, intestinal infections such as intestinal tuberculosis, yersiniosis, and Campylobacter infection, and drug-induced ulcers. In trisomy 8, multiple ulcers of the small bowel and large intestine occur predominantly in the ileocecal region. In FMF, erosion and ulcers, such as longitudinal ulcer, are noted anywhere in the small and large bowel. To accurately diagnose ileocecal ulcers, it is necessary to understand the endoscopic findings of the diseases, including novel disorders such as trisomy 8 and FMF.