腸管Behçet病・単純性潰瘍と他の炎症性腸疾患との鑑別診断―臨床の立場から

Differential Diagnosis of Intestinal Behçet's Disease and Simple Ulcer for Infectious Enterocolitis and Vasculitis

要旨　自験25例を対象として，腸管Behçet病と単純性潰瘍の臨床像と消化管病変の比較を行った．眼症状，副症状は腸管Behçet病ではみられたが，単純性潰瘍ではみられなかった．腸管Behçet病の特徴的病変とされている回盲部の深い打ち抜き様潰瘍は，腸管Behçet病では54％に，単純性潰瘍では92％にみられた．今回の検討では，腸管Behçet病の特徴的消化管病変は，多発する様々な深さの潰瘍であった．鑑別診断として，感染性腸炎ではカンピロバクター腸炎，腸結核，CMV腸炎が問題である．血管炎との鑑別も問題であり，古典的PN，RA・SLEの血管炎では，打ち抜き様潰瘍を呈するため類似している．しかし，ほとんどが罹患部位，回盲部定型病変の有無で鑑別可能であった．Churg-Strauss症候群，Wegener肉芽腫症，顕微鏡的多発血管炎では，浅い不整形潰瘍が多く鑑別は困難ではないが，穿孔例では潰瘍が深いため類似した形態を示すことがある．

　Clinical characteristics and gastrointestinal lesions were compared between 13 cases of intestinal Behçet's disease and 12 of simple ulcer. Lesions in the eye and side symptoms were found in the former group, whereas no lesions were observed in the latter. Typical ulcers of intestinal Behçet's disease such as ileocecal deep ulcers were found in 54％ of intestinal Behçet's disease group, but in 92％ of the simple ulcer group. In our study, characteristic endoscopic findings of intestinal Behçet's disease was multiple ulcers with various depth in the intestine. Differential diagnosis for infectious enterocolitis such as Campylobacter enterocolitis, intestinal tuberculosis and cytomegalovirus enterocolitis was necessary in both intestinal Behçet's disease and simple ulcer. Also, differential diagnosis for vasculitis was necessary in these disease. There were punched ulcers mimicking intestinal Behçet's disease and simple ulcer in classic polyarteritis nodosa, SLE（systemic lupus erythematosus）with vasculitis and RA（rheumatoid arthritis）with vasculitis. There were differences in location and the existence of typical ileocecal deep ulcers. There were shallow irregular shape ulcers in Schönlein-Henoch purpura, Churg-Strauss syndrome, Wegener's granulomatosis, and microscopic polyangitis. But sometimes, there were intestinal deep or perforated ulcers mimicking intestinal Behçet's disease and simple ulcer in these diseases.