Crohn病の初期病変―他疾患との鑑別を中心に

Early Lesion of Crohn's Disease―Focused on Differential Diagnosis

要旨　Crohn病の初期病変を明らかにするため，初回検査で縦走潰瘍や敷石像を欠く，治療歴のないCrohn病10例の一般臨床像，X線・内視鏡所見を検討した．またアフタ様病変を示す他疾患との鑑別点について症例呈示を中心に考察した．Crohn病の大腸アフタ様病変の内視鏡所見は5型（1群：平坦な小びらん，2群：わずかな小隆起，3群：中央に小陥凹・びらんを伴う小隆起，4群：類円形の明らかなびらん・潰瘍面を伴い，わずかに隆起するもの，5群：鮮鋭な境界を有するdiscrete ulcerないしそれに近いもの）に分けられ，3群のアフタが10例中9例と最も高頻度にみられたが，Behҫet病や他の炎症性疾患とのアフタのみでの形態学的鑑別は困難であった．アフタの鑑別には臨床経過，上部消化管や小腸病変，病理所見，消化管外症状などを総合した診断が必要である．

　We reviewed 10 cases of Crohn's disease presenting solely aphthoid lesions. Epitheloid cell granulomas were detected in all cases. Clinical, radiological, and endoscopic findings of these cases were analyzed. Endoscopic findings of aphthoid lesions in the colon were classified into five groups. The first group was a flat form, the second group a slight elevation, the third group an elevation with a small clear erosion or depression on its summit, the forth group a shallow ulceration with slight elevation, and the fifth group a discrete ulcer with a distinct margin. Aphthoid lesions of the third group were most commonly recognized (in 9 cases). We also compared aphthoid lesions of Crohn's disease with those in the other diseases including Behҫet disease, ulcerative colitis, infectious diseases, and so on. Differential diagnosis through the morphological features of the aphthoid lesions was difficult and required an evaluation of the findings of the upper gastrointestinal tract, the small intestine as well as extraintestinal findings.