臨牀消化器内科 Vol.13 No.5(1)


特集名 慢性膵炎 --新しい診断基準をめぐって
題名 慢性膵炎の成因,病態,治療の今日の考え方
発刊年月 1998年 05月
著者 福満 健一郎 産業医科大学第三内科学教室
著者 大槻 眞 産業医科大学第三内科学教室
【 要旨 】 慢性膵炎は,慢性,進行性の疾患であり反復性または持続性の腹痛や背部痛で発症し,病状の進行とともに膵外・内分泌障害をきたし,ついには消化吸収障害や糖尿病を引き起こす難治性疾患である.本疾患の成因としてはアルコール性,特発性,胆石性が大部分を占める.慢性膵炎は膵機能障害の程度から代償期と非代償期および移行期の三つの病期に分けられる.代償期の治療の目標は腹痛をはじめとする諸症状の改善および膵炎の進展・増悪の防止にある.禁酒指導がもっとも重要であり,その他経口プロテアーゼインヒビター,抗コリン剤の投与などを行う.非代償期では消化吸収障害,膵性糖尿病の管理が治療の主体となる.移行期には病態に応じて代償期の治療と非代償期の治療を併用する.このように慢性膵炎においては病期,病態を的確に把握し,それに応じた適切な治療を行うことが重要である.
Theme New Criteria of Chronic Pancreatitis
Title Chronic Pancreatitis : Etiology, Clinical Features and Medical Management
Author Ken-Ichiro Fukumitsu Third Department of Internal Medicine. University of Occupational and Environmental Health. Japan, School of Medicine.
Author Makoto Otsuki Third Department of Internal Medicine. University of Occupational and Environmental Health. Japan, School of Medicine.
[ Summary ] Chronic pancreatitis (CP) is an inflammatory disease in which progressive and irreversible structural changes to the pancreas result in permanent impairment of both exocrine and endocrine functions. Patients with chronic pancreatitis may present with episodes of abdominal pain that are clinically and biochemically indistinguishable from acute pancreatitis. The pancreatic duct and its branches are often dilated and irregular, and intraductal protein plugs and calcifications may form. The pancreatic acini are eventually destroyed in CP and replaced by fibrosis. Alcoholism accounts for 54% of all cases of CP : the remainder are idiopathic (35%) , gallstones (8%) , and the others(5%). It may be convenient to classify CP into 1) painful CP with recurrent attacks or persistent pain with no impairment of both exocrine and endocrine pancreatic functions (compensatory stage), 2) signs and symptoms of pancreatic insufficiency and complications (decompensated stage), or 3) transitional stage presenting with either pain or insufficiency. The treatment of CP focuses on pain relief, correction of maldigestion and malabsorption, and the management of complications. Anticholinergic agents are useful for pain relief by reducing stimulation of the gland. Oral protease inhibitor and/or pancreatic enzyme supplements may reduce pain in certain patients. Trypsin is possibly beneficial for pain but patients with steatorrhea require lipase. Thus, the treatment for CP should be selected according to signs and symptoms.
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