腸管アフタ様病変の鑑別―大腸の急性炎症を中心に

Differential Diagnosis of Aphthoid Lesions in the Intestine, Focused on Acute Inflammatory Diseases of the Colon and the Rectum

要旨　急性炎症における大腸のアフタ様病変の特徴を薬剤性大腸炎38例，感染性腸炎13例，原因不明な腸炎22例を対象として検討した．女性に多く，30歳代で好発したが薬剤性では高年齢層にもかなりみられた．X線検査では約半数に小透亮像を認めるにすぎず，診断には内視鏡検査が有用であった．内視鏡的には，病変は薬剤性および原因不明例では円ないし類円形，細菌性では不整形のことが多く，薬剤性では細菌性および原因不明例に比し密在し，紅量の発赤が高度という傾向がみられたが，確定診断には薬剤投与歴や細菌学的所見が重要であった．原因不明例ではCrohn病などの炎症性腸疾患と鑑別するために，治癒するか確診がつくまで経過を追う必要がある．

　To evaluate aphthoid lesions in the colon and the rectum, the following cases of acute inflammatory diseases were analyzed: 38 cases of drug-associated colitis, 13 cases of infectious colitis, and 22 cases of colitis of unknown etiology. They were more common in female than in male, and most common in their thirties, but drug-associated colitis was fairly common in the elderly. X-ray examination showed small translucent areas in about a half of the cases. Therefore, endoscopic examination was more valuable than radiologic one as a diagnostic procedure. Endoscopically, lesions of drugassociated and unknown etiological colitis were round or oval, but those of infectious colitis were irregular. Lesions of drug-associated colitis were tend to be more aggregated and had mor esevere erythematous halo than those of infectious and unknown etiological colitis. Previous history of medication and bacterial fecal culture were crucial to make a final diagnosis. Aphthoid lesions of unknown etiology need to be followed until they would be cured or a definite diagnosis would be made in order to be differentiated from inflammatory bowel diseases.