炎症性腸疾患と鑑別困難な感染性腸炎の診断と経過―潰瘍性大腸炎との鑑別を中心に

Diagnosis and Clinical Course of Infectious Enterocolitis, which is often Confused with Ulcerative Colitis

要旨　潰瘍性大腸炎と間違いやすい感染性腸炎としてカンピロバクター腸炎，サルモネラ腸炎，アメーバ性大腸炎について述べた．ほとんどが内視鏡的に鑑別可能であるが，カンピロバクター腸炎では鑑別が難しい例もみられる．潰瘍性大腸炎の経過中に発症したカンピロバクター腸炎・サルモネラ腸炎についても述べた．潰瘍性大腸炎と誤診しないためにはこれらの感染性腸炎の内視鏡像および潰瘍性大腸炎の内視鏡像に精通していることが重要である．細菌性腸炎との鑑別では必ず便培養を行うことが重要である．アメーバ性大腸炎との鑑別では，内視鏡像でアメーバの可能性を考えること，診断は生検のみに頼らず血清アメーバ抗体などを併用することが重要である．

　This paper deals with Campylobacter enterocolitis, Salmonella enterocolitis and amebic colitis, which are all types of infectious enterocolitis often confused with ulcerative colitis. Distinguishing these types of infectious enterocolitis from ulcerative colitis is endoscopically possible in most cases. However, there are some cases of Campylobacter enterocolitis that are difficult to distinguish from ulcerative colitis. Cases of Campylobacter enterocolitis and Salmonella enterocolitis developing during the course of ulcerative colitis are also discussed. To avoid misdiagnosis of these types of infectious enterocolitis as ulcerative colitis, physicians are required to have adequate knowledge of the endoscopic features of these types of infectious enterocolitis as well as the features of ulcerative colitis. Fecal culture is indispensable for accurate identification of bacterial enterocolitis. To distinguish ulcerative colitis from amebic colitis, it is essential to consider the possibility of amebic colitis when evaluating endoscopic images, and to make a differential diagnosis based on a combination of findings from biopsy and blood anti-amebic antibody test, etc., instead of relying on biopsy findings alone.