難治性潰瘍性大腸炎の内視鏡診断

Endoscopic Diagnosis of Refractory Ulcerative Colitis

要旨　難治性潰瘍性大腸炎（難治性UC）の内視鏡像の特徴と臨床像を明らかにする目的で，ステロイド抵抗例41例とステロイド奏効例27例を対象に縦走潰瘍，広範粘膜脱落，打ち抜き潰瘍，不整形潰瘍などの難治性病変の頻度および出現部位に関して両群で比較検討した．ステロイド抵抗例では，縦走潰瘍と広範粘膜脱落の出現頻度が高く，深部大腸に有意に重度の病変が存在していた．難治性病変が存在するUC症例はステロイド治療に抵抗する可能性が高いため，追加治療を念頭に置いた経過観察が必要であると考えられた．内視鏡検査により難治性病変の有無や治療の効果判定などを正確に診断することは，追加治療の必要性，今後の方針を考慮していくために重要な因子であると考える．

　To make endoscopic characteristics and clinical appearance of refractory ulcerative colitis clear, we studied the frequency and location of refractory lesions, longitudinal ulcer, extensive mucosal abrasion, punched out ulcer, and irregular ulcer, of 41 patients who had steroid resistant ulcerative colitis (UC) and 27 patients who had steroid effective UC. In steroid resistant UC, longitudinal ulcer and extensive mucosal abrasion were found with high frequency, and there were refractory lesions significantly in the depths of the colon. In case of UC with refractory lesion, there is a high possibility that treatment will be ineffective. Therefore, it is necessary to observe this with additional therapy in mind. It is very important to decide on a patient's medication by relying on exact diagnosis concerning the condition of UC by endoscopy.