難治性腸管合併症の特徴と治療戦略―難治性瘻孔・狭窄の診断

The Diagnostic Potential of Computed Tomography Enterography for Refractory Stenosis and Fistulae in Crohn's Disease

要旨　Crohn病は慢性的な腸管壁全層におよぶ炎症を起こす疾患特性から，狭窄や瘻孔などの難治性合併症を高率に合併する．これらの危険因子として，病悩期間の他，病変範囲と局所の炎症の程度が関連することが指摘されている．CTやMRIは腸管と腸管外の画像情報を同時に提供し，病変範囲だけでなく，病変の炎症の状況も評価できる．特に，MDCT（multi detector-row CT）によるCTE（CT enterography）は，他の検査法と比較して，狭窄部の炎症の評価と瘻孔の描出をより可能にした．CTEの画像情報は，生物学的製剤の早期導入やバルーン内視鏡の適応などの治療戦略を検討する際に有用な情報を提供でき，X線造影検査やバルーン内視鏡検査とともにCrohn病の狭窄・瘻孔病変の診断に重要な検査方法である．

　The nature of Crohn's disease, which sets up transmural inflammation in the intestine makes small bowel stenosis the most frequent and refractory complication following fistula. There is evidence that disease location, duration and the level of intestinal inflammation are important risk factors for the formation of strictures and fistulae. CT and MRI enable physicians to assess not only disease location, but also the level of inflammation with both luminal and extraintestinal images. Especially, CTE（CT enterography）in combination with MDCT provides comprehensive imaging, which enables physicians to assess the inflammation in the stenosis as well as detecting fistulae more adequately than alternative methods. Further, the CTE images are valuable for selecting an appropriate treatment for patients with small bowel stenosis and fistula, including an effective regimen of biologic and endoscopic balloon dilatation. We believe that CTE is a clinically valuable diagnostic strategy for Crohn's disease as well as small bowel imaging and balloon endoscopy.