pouchitisの診断と治療

Diagnosis and Treatment of Pouchitis

要旨　pouchitis（回腸囊炎)は，潰瘍性大腸炎に対する大腸全摘回腸肛門（管)吻合術後に発生する非特異的粘膜炎症である．診断は臨床症状や内視鏡検査により下される．わが国では，厚生労働省難治性炎症性腸管障害調査研究班（日比班)により回腸囊炎診断基準が作成された．内視鏡所見をとる際には，日比班から出されている「pouchitis内視鏡診断アトラス」が参考になる．治療は，metronidazoleおよびciprofloxacinなどの抗生物質が有効である．まれに，抗生物質投与を中止するとpouchitisを繰り返す症例がある．

　Pouchitis is defined as a non-specific mucosal inflammation developing in the ileal pouch after ileal J-pouch anal (canal) anastomosis for ulcerative colitis. Clinical symptoms and endoscopic findings play key roles in its diagnosis. Japanese diagnostic criteria for pouchitis have recently been proposed by the research committee of inflammatory bowel disease of the Ministry of Health, Labour and Welfare of Japan. The Pouchitis Atlas for endoscopic diagnosis, a monograph distributed by the committee, is widely available. Oral administration of antibiotics such as metronidazole and ciprofloxacin is the first choice for pouchitis therapy. A few patients have reccurence of inflammation when those drugs are terminated.