Crohn病の上部消化管病変の臨床と経過―胃・十二指腸病変を中心に

Clinical Features and Course of Gastroduodenal Lesions in Patients with Crohn's Disease

要旨　上部消化管検査を施行したCrohn病患者78例を対象に，胃・十二指腸病変の所見と肉芽腫の検出率，Helicobacter pylori（H. pylori）感染率，さらに内視鏡所見の経時的変化について検討した．その結果，胃・十二指腸病変は80.8％（63例）に認められた．胃での特徴的な所見である竹の節状外観は59％（46例）に認め，肉芽腫の検出率は9.1％（4/44例）であった．また，竹の節状外観は経過をみても消失することはなかった．一方，主に前庭部に出現するびらんは35.9％（28例）に認め，肉芽腫の検出率は12.5％（2/16例）であったが，しばしば経過とともに消失し，通常のびらん性胃炎との鑑別が難しかった．十二指腸病変での肉芽腫の検出率は7.4％（2/27例）で，経過によって内視鏡所見は消失することは少なく，逆に球部での潰瘍性病変が出現する場合が多かったことから，Crohn病の一所見である可能性が高いと考えられた．しかし，胃・十二指腸病変の有無および内視鏡所見の経時的変化と活動性指数との間に相関はなかった．H. pylori感染率はわずか11.5％（9例）であり，Crohn病に対する治療薬との有意な関連性は認めなかった．以上の結果から，Crohn病における上部消化管病変は，H. pylori感染やCrohn病の活動性によって生じるものではなく，Crohn病の病態に基づき高頻度に生じる病変と考えられた．したがって，Crohn病の確定診断や鑑別に上部消化管検査による胃・十二指腸病変の検索が重要であることが再認識された．

　We investigated the endoscopic features of gastroduodenal lesions, the prevalence of Helicobacter pylori (HP) infection and granulomatous lesions arising from the lesions, and the endoscopic changes during follow-up study. Seventy-eight patients with Crohn's disease (CD) who underwent endoscopy were analyzed. Endoscopic abnormalities in the upper gastrointestinal tract including stomach and duodenum were found in 63 patients (80.8％). “bamboo joint-like appearance” at the gastric body and cardia, which is a characteristic finding in CD, was seen in 46 patients (59％) and did not disappear during the follow-up. Granulomas were found in 9.1％ (4 of 44) in biopsies from this lesion. Although gastric erosions, mainly detected at the antrum of the stomach, were seen in 35.9％ (28 patients), it was difficult to distinguish them from the usual erosions in chronic gastritis. The detection rate for granulomas in duodenal lesions was 7.4％ (2 of 27). Instead of improvement or disappearance of much lesions, the development of endoscopic duodenal abnormalities, especially ulcerative lesions in the bulbus, was often observed after follow-up. The presence and changes of gastroduodenal lesions did not correlate with the activity of CD. The incidence of HP infection was only 11.5％ and there was no significant association with the medications for the treatment of CD. These results indicate that the development of gastroduodenal lesions in CD patients may be associated with the nature of CD itself without the influence of HP infection or disease activity. As a conclusion, it could be surmised that endoscopy for evaluation of upper gastrointestinal lesions may be a useful modality for diagnosing CD.