全身性自己免疫疾患における十二指腸・小腸病変の特徴

Duodenal and Small Intestinal Manifestations of Systemic Autoimmune Diseases

要旨　膠原病と呼ばれる全身性自己免疫疾患は，様々な結合織疾患や血管炎症候群が含まれる疾患群である．全身性自己免疫疾患ではしばしば消化管病変を来し，潰瘍による出血や穿孔など重篤な消化管合併症は予後に影響を与え臨床的な問題となっている．今回，十二指腸および小腸に病変を有した自験33例を対象とし，そのX線・内視鏡的所見を検討した．十二指腸・小腸病変として，潰瘍45％，発赤・びらん35％，浮腫33％，腸管拡張18％，顆粒状粘膜15％を認めた．血管炎関連疾患と非関連疾患で比較すると，前者では潰瘍，後者では腸管拡張を高率に認めた．これらの結果より，全身性自己免疫疾患の十二指腸・小腸病変では潰瘍が比較的多く，血管炎の関与が示唆された．

　Systemic autoimmune diseases, known as collagen diseases, are a group of various connective tissue diseases and vasculitis syndrome. Serious gastrointestinal complications such as ulcers, hemorrhage and perforation are important factors to be considered in any prognosis. 33 patients with duodenal and small intestinal involvement were analyzed by radiographic and endoscopic findings. Identified lesions included ulcers in 15 patients（45％）, erythema/erosion in 12（36％）, edema in 11（33％）, granular mucosa in 5（33％）, luminal dilatation in 4（12％）. Ulcers were more frequent in vasculitis-associated disorders, whereas luminal dilatations were more frequent in vasculitis-nonassociated disorders. These results indicate that there is a high prevalence of ulcers in the duodenum and small intestine in systemic autoimmune diseases.