潰瘍性大腸炎，Crohn病と鑑別を要する腸の炎症性疾患―鑑別の進め方

Enteric Inflammatory Diseases that Need be Differentiated from Inflammatory Bowel Disease (UC, CD)

要旨　IBD（UC，CD）と鑑別を要する主な炎症性疾患についてその鑑別点を述べる．腸結核では輪状傾向の潰瘍，瘢痕萎縮帯，大型で融合性の非乾酪性肉芽腫を認める（CDとの鑑別）．アメーバ性大腸炎では潰瘍のタコイボ様形状や介在粘膜の血管透見像を認める（UCとの鑑別）．キャンピロバクター腸炎ではBauhin弁上の潰瘍を高率に認める（UCとの鑑別）．サルモネラ腸炎では直腸が健常である場合が多い（UCとの鑑別）．エルシニア腸炎では通常，縦走潰瘍の形成はない（CDとの鑑別）．腸管出血性大腸菌腸炎では腺管の融解や変性壊死を高率に認める（UCとの鑑別）．虚血性大腸炎では敷石像はなく（CDとの鑑別），直腸の病変はまれ（UCとの鑑別）．抗生剤起因性の出血性大腸炎では病変の主座は横行結腸（UCとの鑑別）．NSAIDs腸炎では軽微な病変が多く，縦走潰瘍は少ない（CDとの鑑別）．

　Points differentiating various enteric inflammatory diseases from IBD (UC, CD) were described.

　Intestinal tuberculosis had annular-like ulcers, a scar-atrophic band-like finding, and large confluent non-caseous granulomas somewhere in the lesions (points differentiating it from CD). Amoebic colitis had verrucose-shaped ulcers and distinct vascular pattern on the interposed mucosa at least somewhere (points differentiating it from UC). Campylobactor enterocolitis might often have an ulcer on the Bauhin's valve (a point differentiating it from UC). Salmonellosis might have a normal rectum (a point differentiating it from UC). Yersinia enterocolitis usually did not cause a longitudinal ulcer (a point differentiating it from CD). Enterohemorrhagic Escherichia coli enterocolitis frequently showed liquefaction of the duct and degenerative necrosis (a point differentiating it from UC). Ischemic colitis had no cobblestone appearance (a point differentiating it from CD) and rarely showed rectal lesions (a point differentiating it from UC). The main lesion of hemorrhagic colitis presented in the transverse colon (a point differentiating it from UC). NSAIDs enterocolitis usually had slight lesions and no longitudinal ulcer (a point differentiating it from CD).