臨牀消化器内科 Vol.13 No.12(8)


特集名 心身症と消化器疾患
題名 慢性膵炎 --疑診例とはなにか
発刊年月 1998年 11月
著者 中井 吉英 関西医科大学第一内科・心療内科部門
【 要旨 】 慢性膵炎疑診例は内科的治療に抵抗するものも多く，われわれは疑診例が心身症として取り扱われるべきか否かについて，疑診例50例と確診例30例とを比較しつつ検討した．その結果，疑診例では神経症的傾向が強く，過敏性腸症候群や胆道ジスキネジーの合併頻度が高く（78%，65%），depressionの合併頻度が54%に認められた．また，ERCPの際の造影剤注入の際に86%に疼痛が再現した．文献的な考察も加えると，疑診例を消化管の平滑筋全体の機能異常の病態として把握し，膵過分泌や十二指腸乳頭の過剰反応による膵管内圧の先進などの機序により引き起こされたirritable pancreasといった可逆的な機能異常の病態ではないかと推測している．
Theme Gastorointestinal Diseases --from the Standpoint of Psychosomatic Medicine
Title What is Suspicious Type of Chronic Pancreatitis ?
Author Yoshihide Nakai Psychosomatic Internal Medicine, Division in the First Department of Internal Medicine, Kansai Medical University
[ Summary ] In order to demonstrate the psychosomatic medical conditions associated with mild chronic pancreatitis (the suspicious type), a psychosomatic medical investigation was conducted on chronic pancreatitis comparing with 30 cases of severe chronic pancreatitis (the definit type). In the suspicious type, we observed a marked neurotic tendency, autonomic disorder, complications with IBS or biliary dyskinesia with high frequency (78% and 65%). This disease appears to be based on systemic autonomic disorder as well as general alimentary disorder in periphery. The frequency of accompanying depression was involved as high as 54%. Taking into consideration that antidepressants were immediately effective, it is thus suggested that the central nervous system participates in the crisis of this disease.
戻る