Crohn病十二指腸病変の内視鏡所見―頻度と形態学的特徴

Endoscopic Findings in Duodenum of Crohn's Disease Patients

要旨　Crohn病に伴う十二指腸病変を(a)陥凹性病変(びらん，潰瘍)，(b)隆起性病変，(c)細敷石像様外観に分け十二指腸球部，上十二指腸角近傍，十二指腸第2部の部位別における各病変の出現頻度，縦列傾向の有無を調べた．(1)Crohn病患者215例中151例(70.2％)に(a)～(c)いずれかの病変を認めた．部位別では球部：32.6％，上十二指腸角近傍：66.3％，第2部：40.0％に病変がみられた．(2)各病変の頻度を部位別にみてみると(a)陥凹性病変(びらん)：球部14.9％，上十二指腸角近傍32.5％，第2部36.3％，(潰瘍)：球部2.3％，上十二指腸角近傍2.5％，第2部0.9％，(b)隆起性病変：球部15.3％，上十二指腸角近傍23.8％，第2部3.3％，(c)細敷石像様外観：球部11.2％，上十二指腸角近傍27.5％，第2部0％であった．(3)病変の性状は1例の潰瘍とタコイボびらん様の病変を除けば他の疾患にはみられない特徴的な様相を示した．上部消化管検査によるCrohn病の診断には，Crohn病の十二指腸病変の特徴を把握し，また上十二指腸角近傍に高率に病変がみられたことから球部，第2部に加え上十二指腸角近傍も慎重に観察する必要があると思われた．

　We investigated the endoscopic findings of the duodenum. The incidence of depressed lesions (erosion, ulcer) elevated lesions, and fine cobblestone-like lesions were determined by reviewing the upper gastrointestinal endoscopy of 215 patients with Crohn's disease 70.2％ of the patients had at least one of the above lesions. These lesions were located most frequently around the superior duodenal angle within the duodenum. As for the relationship between the endoscopic findings and localization within the duodenum, the incidence of erosion was especially low in the duodenal bulb and fine cobblestone-like lesions were rarely found in the duodenal second part. In conclusion, the endoscopic findings mentioned in the present study and the high incidence of the lesions in the superior duodenal angle might be helpful for making a diagnosis of Crohn's disease in upper gastrointestinal endoscopic examination.