非腫瘍性十二指腸小病変の診断―Behçet病

Duodenal Involvement in Patients with Intestinal Behçet's Disease

要旨　Behçet病の消化管病変の存在部位，形態，病理所見，臨床経過を検討した．腸型Behçet病7例中，3例において十二指腸球部にびらんがみられ，1例において凹凸不整の粘膜が観察された．生検では粘膜固有層に慢性の炎症所見がみられるのみで血管炎の所見はみられなかった．抗潰瘍療法は効果がなく，ステロイド療法が著効した．Behçet病の十二指腸病変は他の消化管病変同様，びらん周囲の発赤や浮腫などの所見に乏しい特徴を有していた．腸型Behçet病の初発症状は右下腹部痛，下血，下痢などが主なものであるが，上部消化管の症状を主訴とするものがある．食道，胃，十二指腸に多発性のびらんまたは周囲の再生上皮に乏しい潰瘍性病変がみられるときはBehçet病の可能性も考え，詳細な問診や皮膚，眼病変の検索，下部消化管検索などを行う必要がある．

　Seven cases with intestinal Behçet's disease were examined to study the location, form, and clinical courses of gastrointestinal lesions. Of 7 cases, 3 had erosions in the duodenal bulb, and 1 case had uneven mucosa in the duodenal bulb. Biopsy specimens revealed chronic inflammation with lymphocytic infiltration in the proper lamina. There was no evidence of vasculitis. Antiacid therapy was not effective for erosions, but the erosions were dramatically healed by using steroid therapy. The endoscopic features of the lesions of the duodenum in Behçet's disease were characterized by erosions with almost normal surrounding mucosa, while the surrounding mucosa. of the erosions in ordinary duodenitis usually show friability. Most of the initial symptoms of Intestinal Behçet's disease are lower abdominal pain, hematochezia, and diarrhea, but some patients complain of upper abdominal symptoms. Detailed medical interview and exploration of the intestinal tract, the skin and ocular involvement are needed for patients with esophageal, gastric and duodenal erosions or ulcers whose surrounding mucosa shows little abnormality.