INTESTINE Vol.14 No.1(2-9)


特集名 下血/血便をきたす腸疾患─non-IBDを中心に
題名 [各論]炎症性腸疾患と大腸癌以外の出血をきたす各種腸疾患の画像上の鑑別診断と治療 (9) 直腸粘膜脱症候群とcap polyposis
発刊年月 2010年 01月
著者 赤松 泰次 信州大学医学部附属病院内視鏡診療部
著者 長屋 匡信 信州大学医学部消化器内科
著者 中村 直 丸の内病院内科
【 要旨 】 直腸粘膜脱症候群では排便習慣の異常を認めることが多く,直腸下部前壁に隆起性病変や潰瘍形成がみられる.一方,cap polyposisは粘血便や粘液下痢を訴えることが多く,しばしば低蛋白血症を伴う.直腸からS状結腸に好発し,典型例では表面に粘液が付着した多発性広基性病変が半月ひだに沿って認められる.従来,両疾患は類縁疾患と考えられていたが,臨床所見,内視鏡所見,病理組織所見,治療経過に相違がみられることから,成因が異なる疾患と考えられる.
Theme Bloody stools in non -- IBD intestinal disorders
Title Mucosal prolapse syndrome and cap polyposis
Author Taiji Akamatsu Department of Endoscopy, Shinshu University Hospital
Author Tadanobu Nagaya Department of Internal Medicine, Gastroenterology, Shinshu University School of Medicine
Author Naoshi Nakamura Department of Internal Medicine, Marunouchi Hospital
[ Summary ] Mucosal prolapse syndrome is thought to occurr due to chronic mechanical stimulation. It is often recognized in prolapsing colostomies, with colonic multiple diverticles, and in the rectum. Patients with mucosal prolapse syndrome in the rectum often strain during defecation, and have polypoid lesions and/or ulcerations in the anterior wall of the lower rectum. The etiology of cap polyposis is still unknown, however, some patients with cap polyposis have recently been cured through eradication therapy for Helicobacter pylori. Patients with cap polyposis usually complain of mucous bloody stools and/or mucoid diarrhea. Hypoproteinemia is often recognized in patients with multiple sessile polyps on the apices of the transverse mucosal fold of the rectum and the sigmoid colon.
Previously, these both diseases were thought to have similar etiologies. However, there are many different points of comparison between mucosal prolapse syndrome of the rectum and cap polyposis. This is true not only in terms of clinical, endoscopic, and pathological features, but also in terms of clinical responses to treatments. On the basis of these findings, we believe that cap polyposis is not a mucosal prolapse syndrome, but a new clinical entity which may have a different pathogenesis.
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