炎症性腸疾患における粘膜治癒と長期経過

Mucosal Healing and Long-term Prognosis in Management of IBD

要旨●IBDの診療に長期予後の改善を目的としてtreat to targetのコンセプトが導入され，内視鏡的寛解（粘膜治癒）が治療目標として設定された．粘膜治癒の概念は臨床試験のみならず日常臨床にも普及しつつあり，粘膜治癒の達成が長期予後に相関するというエビデンスも蓄積しつつある．一方で，潰瘍性大腸炎では臨床症状がなくても内視鏡的活動性のみで治療介入するのか，Mayo内視鏡サブスコア＝0を目指すべきなのかといった課題，Crohn病では内視鏡的評価の妥当性や利便性など解決すべき課題も残されている．

　The concept of“treat to target”has been introduced in the management of inflammatory bowel disease for improving long-term prognosis, and endoscopic remission（mucosal healing）has been set as a treatment target. The concept of mucosal healing has been disseminating not only in clinical trials but also in daily clinical practice, and evidence that achievement of mucosal healing correlates with long-term prognosis has also been accumulating. On the other hand, unresolved issues also remain. Answers to questions such as whether strong treatment should be administered even in ulcerative colitis patients without clinical symptoms with endoscopic activity and whether the treatment target should have a Mayo endoscopic subscore of 0 are unclear. The validity of endoscopic evaluation in Crohn's disease is inferior to that in ulcerative colitis, and problems such as feasibility and accessibility in small-intestinal endoscopy continue to exist in daily clinical practice.