小さな小腸炎症性病変―Crohn病の小病変の診断：術後再発病変診断の意義

Significance of Endoscopic Evaluation for Small Intestinal Lesion in Patients with Crohn's Disease

要旨　Crohn病は全消化管に病変を形成する原因不明の慢性炎症性腸疾患であり，わが国において疾患患者数は年々増加の一途をたどっている．近年，カプセル内視鏡，ダブルバルーン内視鏡をはじめとする小腸内視鏡検査機器の開発により，Crohn病の小腸病変に対する詳細な検討が可能となってきた．特に，Crohn病初期病変の診断のみならず，術後再発病変の粘膜治癒の状態を内視鏡で評価することも可能となっている．従来の栄養療法に加えて，免疫調節剤および生物学的製剤の使用は患者のQOL向上に貢献してきた．このような強力な薬物療法があるにもかかわらず観察される小腸病変を，臨床的にどのように捉えていくかが今後の課題である．

　Recent studies have suggested that the incidence of Crohn's disease（CD）in Japan is increasing. The development of wireless capsule endoscopy and double balloon endoscopy enables us to investigate small intestinal lesion of patients with CD in detail. In particular, these modalities were very helpful for gastroenterologists not only to diagnose primary lesions of CD but also to evaluate the grade of mucosal healing during medical therapy and to find post-surgical recurrence in CD patients receiving surgical treatment.

　In addition to conventional nutritional therapy, the use of immunomodulators and biologics contributed to the improvement of the quality of life of patients with CD. However, we were unable to observe mucosal healing in small intestinal lesions of patients with CD who had achieved clinical remission, despite these powerful medical therapies. Further study will be necessary to elucidate how to treat small intestinal lesions such as aphtha and erosions, which are endoscopically observed in patients with CD experiencing clinical remission.