主題 びらん・潰瘍・陥凹を示す病変の特徴と鑑別

Differential Diagnosis for Esophageal Erosive and Ulcerative Lesions

要旨●びらん・潰瘍・陥凹を呈するまれな食道病変のうち代表的な疾患について概説した．比較的大きな病変を呈するサイトメガロウイルス（CMV）感染症と腸管Behçet病では，辺縁隆起を伴う打ち抜き潰瘍を示し，食道結核では粘膜下腫瘍様の周堤を伴うことが特徴であった．Crohn病は多発するアフタないし小型の潰瘍性病変が多いが，縦列傾向などの配列に留意する必要がある．ヘルペス（HSV）食道炎は多発病変で多くは数mmから2cm以内の浅い潰瘍であるが，小潰瘍から癒合傾向のあるものまでさまざまな形態を呈する．食道壁内偽憩室症は粘膜に多発する円形から類円形の小孔を呈するが，カンジダ症に合併することが多く，白苔に覆われた粘膜面の十分な洗浄が観察には必要である．

　Here is a summary of the typical diseases among rare esophageal lesions, such as erosion, ulceration, and pitting. Cytomegalovirus infection and intestinal Behçet's disease cause relatively large esophageal lesions, which are characterized by punched-out ulcers along the marginal ridge, whereas the lesions in esophageal tuberculosis are characterized by submucosal tumor-like marginal walls. Crohn's disease often presents with multiple small ulcerative lesions or aphthous ulcers, and attention should be paid to the presence of longitudinal arrangement of the ulcers. Esophagitis caused by herpes simplex virus presents with multiple lesions, most of which are shallow ulcers, ranging from several millimeters to 2cm in size, with varying morphologies ranging from small ulcers to ulcers associated with adhesions. Esophageal intramural pseudodiverticulosis presents with multiple small round or roundish pouches in the esophageal mucosa. There is often concurrent candidiasis, and thorough washing of the mucosal surface covered by the white coating is required prior to observation.