非特異性多発性小腸潰瘍症の小腸内視鏡所見―非ステロイド性抗炎症剤起因性小腸潰瘍症との比較

Enteroscopic Features of Chronic Nonspecific Multiple Ulcers of the Small Intestine: Comparison with Nonsteroidal Anti-inflammatory Drug Induced Enteropathy

要旨　非特異性多発性小腸潰瘍症（CNSU）とNSAIDs起因性小腸潰瘍症（NSAIDs腸症）各6例の臨床像と小腸内視鏡所見を比較した．CNSUは診断時年齢が低く女性が多い傾向にあったが有意差はなかった．易疲労と腹痛，貧血，低蛋白血症，軽微な炎症所見が両群に共通した臨床像で，ヘモグロビン値は鉄剤を投与されていたCNSUで高かった．単発ないし多発性の全周性狭窄をCNSUの6例（100％）とNSAIDs腸症の3例（50％）に認め，狭窄部の開放性潰瘍は前者の5例と後者の1例にみられた．一方，辺縁明瞭な浅い非狭窄性輪状潰瘍はCNSUの3例（50％）とNSAIDs腸症の4例（67％）にみられ，前者全例と後者の1例では開放性であった．NSAIDs腸症2例に小潰瘍を，CNSUの3例に縦走・斜走潰瘍を認めた．以上より，CNSUとNSAIDs腸症の臨床像は類似するが，腸病変の内視鏡像は異なり前者は慢性開放性潰瘍を，後者は治癒傾向の強い潰瘍を特徴とすると考えた．

　Chronic nonspecific multiple ulcers of the small intestine (CNSU) and nonsteroidal anti-inflammatory drug-induced enteropathy (NSAID-enteropathy) share common clinicopathologic features characterized by histologically nonspecific ulcers and persistent blood loss. The aim of this investigation was to compare clinical and enteroscopic findings of CNSU and NSAID-enteropathy. Twelve patients with CNSU or NSAID-enteropathy were examined by intraoperative enteroscopy, push enteroscopy, retrograde ileoscoy or double-balloon enteroscopy. Three patients with NSAID-enteropathy and all six patients with CNSU had concentric stenosis. Circular ulcers were found in four patients with NSAID-enteropathy and in three patients with CNSU. Longitudinal or oblique ulcer was seen in three patients with CNSU and in none of the patients with NSAID-enteropathy. The ulcers were active in three patients with NSAID-enteropathy and in five patients with CNSU. These findings suggest that CNSU is characterized by enteroscopically active ulcers. This observation conforms to the intractable nature of the disease.