Crohn病の内視鏡的重症度評価─カプセル小腸内視鏡による重症度評価

Evaluation of Severity Using Small Bowel Capsule Endoscopy

要旨●小腸病変を有するCrohn病（CD）に対するカプセル小腸内視鏡検査（SBCE）は，低侵襲に小腸粘膜の炎症像を視覚化できる検査法でありCDの診断や病状評価・経過観察に有用である．SBCEのスコアリングにはLewis scoreとCECDAIがある．治療介入前後の変化を明瞭化した．一方で，臨床的疾患活動度やbiomarkerとの不一致例の存在や，粘膜治癒後の瘢痕狭窄もスコアに影響を及ぼし，単純に合算した数値では，疾患活動性を十分に評価できない問題がある．重症度の評価のためのスコアは，臨床的疾患活動度と相関し，治療措置および転帰に影響を及ぼすべきである．情報の蓄積により，CDに特徴的なSBCE所見を抽出し，治療介入の機会や病態の把握につながる新規スコアリングの開発も期待したい．

　SBCE（Small bowel capsule endoscopy）is a procedure during which images of inflammation of the small bowel mucosa can be visualized with minimum invasion in patients with CD（Crohn's disease）with small bowel lesions. SBCE is useful for diagnosing CD, as well as for evaluating the disease state and performing follow-ups. SBCE findings are scored using the Lewis score and the Capsule Endoscopy Crohn's Disease Activity Index. In particular, changes after treatment intervention are clarified. However, the level of clinical activity, presence of cases not matching with biomarkers, and occurrence of cicatricial stenosis following mucosal healing also affect the score. Disease activity cannot be solely evaluated based on the addition of scores. The score for evaluating severity is correlated with the level of clinical disease activity and influences treatment measures and outcomes. We are expecting the development of a new scoring system that is linked with SBCE findings characteristic of CD, as well as new opportunities for treatment intervention and a better understanding of clinical conditions through the accumulation of information.