Crohn病診断基準の問題点―肛門病変から

Issues of Diagnostic Criteria for Crohn's Disease: From the Proctologist's Standpoint

要旨　肛門科の立場から，Crohn病の診断に有用な，Crohn病に特異的な肛門病変がいかなるものであるかを述べ，次いでCrohn病診断基準（案）についての私見を述べた．①Crohn病に特異的な肛門病変は浮腫，腫脹の著明な多発するskin tag，排便時のとう痛の乏しい多発する創部の汚い裂肛，そして裂肛や潰瘍を原発口とする30歳未満の若年者にみられる複雑な瘢管走行をする多発する痔瘢で，以上の肛門病変は単独で存在するより混在して存在する点に特徴がある．②Crohn病の診断基準（案）で肛門病変は診断の基準に入れられていないが，Crohn病に特有な肛門病変は診断の基準において主要所見でなくとも副所見となりうる．また病型分類において，肛門病変は診断においてだけでなく治療の面からも重要な点であるため，新たに肛門型として付け加えられてよい．

　From the proctologist's standpoint, I first describe some features of anal lesions that are helpful for the diagnosis of Crohn's disease, then present my recommendations with regard to the current dignostic criteria.

　(1) The special features of anal lesions present in patients with Crohn's disease are : edematous, markedly swollen, multiple skin tags ; multiple rough fissures but with no severe pain at bowel movement ; and complex multiple fistulas with a fissure or ulcer as the primary opening, especially in patients under 30. These lesions are likely to exist concomitantly rather than independently.

　(2) Although standard diagnostic do not include anal lesions, these characteristic lesions should be considered as diagnostic criteria ― if not main, at least as sub-criteria. Anal lesions are important not only for making a diagnosis but for decisions of treatment, and should be added to the clinical classification of Crohn's disease.