大腸の炎症性疾患の診断アルゴリズム

Algorithms for the diagnosis of coloproctitis

要旨

本稿では腸炎，特に大腸炎の診断アルゴリズムを解説する。腸炎は症候，問診，身体診察，臨床検査，画像検査所見を総合的に判断することで診断に至る。多彩な疾患が含まれるため，各疾患の特徴を理解し，重要な情報を効率よく収集することが重要である。下部消化管内視鏡検査では病変の形態，性状，分布，配列，位置関係を評価し，生検による病理組織診断も積極的に行う。診断に難渋することも多いが，疾患に特異的な所見を熟知し，小病変であっても見逃さないように注意する必要がある。

　This article describes a diagnostic algorithm for inflammatory bowel diseases in the broad sense. The diagnosis of enteritis is based on a comprehensive evaluation of symptoms, interview, physical examination, clinical examination, imaging findings, and histological findings. Since a wide variety of diseases are included, it is important to understand the characteristics of each disease and to collect important information properly. During colonoscopy, the morphology, characteristics, distribution, arrangement, and positional relationship of lesions should be evaluated, and histopathological diagnosis by biopsy is also performed aggressively if necessary. Although the diagnosis is often difficult, it is very important to be familiar with disease-specific findings and to be careful not to overlook even small lesions.