潰瘍性大腸炎における生検の問題点

Evaluation of the Role of the Biopsy in the Diagnosis of Ulcerative Colitis

要旨　適応を厳格にすれば潰瘍性大腸炎（UC）における生検はさほど頻繁に行う必要がない．生検が必要なのは，UCに合併するdysplasiaと癌の診断―これらには組織診が肉眼診断より精密である―を別にすれば，罹病範囲の決定，治癒の判定においてである．UCの組織像は特徴的であり，組織（生検）像からUCの診断を下しうるが，そのような例では内視鏡肉眼診断の段階で診断がつく．診断自体に生検は必要でなく，むしろ鑑別診断の参考といった要素が強い．

　Biopsy is not so useful in the diagnosis of ulcerative colitis. Because endoscopic pictures, together with clinical data such as symptoms and the way of onset, is often enough for the diagnosis, Histology is useful in cases where endoscopic pictures are equivocal. Ulcerative colitis has characteristic histology to make a different diagnosis from ischemic colitis, infectious colitis, aphthoid colitis, solitary ulcer syndrome and so on. Biopsy is also useful in the differential diagnosis of ulcerative colitis from Crohn's disease, The distribution of lesions (skip, segmental) is sometimes critical for the diagnosis of the two conditions.

　Biopsy study is not essential for the assessment of severity of ulcerative colitis and follow-up study except for the diagnosis of complete cure (healed).