炎症性腸疾患の上部消化管病変

Upper-gastrointestinal Lesions in Patients with Inflammatory Bowel Diseases

Crohn病（CD）と潰瘍性大腸炎（UC）は原因不明の慢性炎症性腸疾患（IBD）であり，CDでは口腔から肛門までの消化管のあらゆる部位に炎症性変化を認め，上部消化管病変の出現頻度も高い．一方，UCは大腸に限局して炎症が起こるとされており，上部消化管病変の出現頻度は低い．CDの上部消化管病変として，特徴的なものは，胃の竹の節状外観であり，その他に前庭部びらん，胃潰瘍，十二指腸のnotch様陥凹などがみられる．UCにおいては胃・十二指腸の多発びらんやアフタ，潰瘍，顆粒状変化など大腸にみられるUC病変に類似した所見を認める．各所見の観察には色素撒布が有用である．治療としてはプロトンポンプ阻害薬（PPI）などの通常の潰瘍治療薬は無効な場合が多く，原疾患の治療が効果的である．

　CD（Crohn's disease）is an IBD（inflammatory bowel disease）in which inflammatory lesions occur throughout the entire GI（gastrointestinal）tract and, as a result, various associated abnormalities are frequently detected in the upper GI. Conversely, UC（ulcerative colitis）tends to show diffuse ulcerations from the rectum to the proximal colon, while inflammatory lesions are only rarely detected in other parts of the GI tract, including the upper GI. A bamboo-like appearance is a characteristic finding of the stomach in CD patients. These patients also often show erosions and ulcers in the stomach, as well as notches in the duodenum. UC patients sometimes demonstrate erosions and ulcerations in both the stomach and duodenum, which are therefore considered to be characteristic findings in the colon of UC patients. Spraying indigo carmine is helpful to detect the details of these findings using endoscopy. Performing appropriate treatments for CD or UC, while refraining from administering anti-ulceration treatments, is therefore considered to be a useful strategy to relieve these upper GI lesions.