治療からみた腸結核

Therapeutic Approach to Intestinal Tuberculosis

　日本において，腸結核は抗結核剤の出現以来著しく減少したとはいえ，欧米におけるように皆無に近いものではない．当院においてここ10年間に経験した腸結核は30例で，最近関心が高まってきたクローン病の3例，非特異性多発性小腸潰瘍1例，非特異性大腸潰瘍2例，腸型べ一チェット病1例に比べると，はるかに多い疾患である．

　クローン病，潰瘍性大腸炎についてはすでに診断基準案が発表されているが，腸結核についてはまだない．このことは，腸結核はその成因としての結核菌との因果関係は明らかであるのに対し，一方診断基準の明確でないクローン病，潰瘍性大腸炎はむしろ腸結核および上記2疾患のうちいずれかを除外して初めて診断しうるという，あいまいな点があったためと思われる．

　Intestinal tuberculosis, although decreasing in its frequency since the advent of antituberculosis drugs, is still not so rare in Japan and is more frequent than Crohn's disease, simple ulcer of the colon or intestinal involvement of Behcet disease.

　The definite diagnosis of intestinal tuberculosis should be based on bacteriological and/or histological evidence. But practically without operation, it is very difficult to get the definite diagnosis even by endoscopic biopsy. From this point of view, it is valuable to try the therapeutic diagnosis, i.e., if symptoms, barium enema findings and endoscopic findings were improved by antituberculosis agents, the case should be diagnosed as intestinal tuberculosis. In our experience of 13 cases of colonic tuberculosis, it was very successful. But in four cases of tuberculosis of the small intestine, surgery was performed because of marked stenotic symptoms without any effect of antituberculous agents.

　The therapeutic diagnosis may be useful in differentiation from Crohn's disease and chronic ulcerative colitis, because it should be tuberculosis, when symptoms and other clinical findings were worsened with steroids and improved with anti-tuberculosis drugs.