| 特集名 | 消化器疾患と皮膚病変 | |
|---|---|---|
| 題名 | べーチェット病の消化管病変 | |
| 発刊年月 | 1999年 12月 | |
| 著者 | 星野 恵津夫 | 帝京大学医学部内科 |
| 【 要旨 】 | 厚生省べーチェット病研究班の診断基準に合致し，消化管に潰瘍性病変を有する場合に腸管べーチェット病と診断する．本邦における症例数は4,000人程度と推定され，罹患率に男女差はなく，消化管病変出現時の平均年齢は40歳である． 消化管の病変は喉頭，食道，胃，空腸，回腸，結腸，直腸のどこでも起こりうる．本症の消化管病変の定型像は回盲部にみられる類円形の打ち抜き様潰瘍であるが，クローン病や潰瘍性大腸炎に類似する所見を呈する症例や，大腸に類円形潰瘍が散在する症例もある．また小腸および大腸に多数の潰瘍を認め，穿孔や瘻孔形成をきたし死亡したり，腸管大量切除により短腸症候群となる症例もある．組織学的には，非特異的な炎症である． 治療は薬物，とくにステロイドが主体である．通常1日30～60mgのプレドニゾロンで開始し，徐々に減量し，1日5～15mgで長期間維持療法を続ける．必要に応じ，メサラジン，サラゾスルファピリジン，コルヒチン，免疫抑制薬，漢方薬などを併用する．専門医による十分な管理治療をうけている患者では，重大な合併症を起こすことはまれである． |
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| Theme | Gastrointestinal Tract Disease and Skin Manifestation | |
|---|---|---|
| Title | Gastrointestinal Manifestations of Behcet's Disease | |
| Author | Etsuo Hoshino | Department of Medicine, Teikyo University School of Medicine |
| [ Summary ] | Patients with ulcerative lesions of the gastrointestinal (GI) tract who fulfill the diagnostic criteria of Behcet's disease are diagnosed as having entero Behcet's disease(EB). The estimated number of patients with EB is 4,000 in Japan. The male to female ratio is 1:1. The mean age of onset of GI lesions was 40 years old. GI lesions can occur in any part of the GI tract. Well demarcated, round or oval shaped ulcers in the ileocecal region are typical of findings related to EB. Some patients have GI lesions similar to those of Crohn's disease or ulcerative colitis. Some patients have scattered round or aphthoid ulcers in the small and/or large intestines. Others have multiple ulcers with fistula and/or perforations which lead to septic shock or short bowel syndrome. Histological findings show non-specific inflammation. Drugs, especially corticosteroids, are the first-1ine of therapy. Usually initial dosages of prednisolone are 30 to 60 mg/day, followed by gradual dose reduction to 5 to 15 mg/day, which is the standard maintenance dose for most of these cases. Mesalazine, salazosulfapyridine, colchicine, immunosuppressants, or Kampo herbal formulas are also used. Patients who are regularly checked and treated by an experienced physician rarely develop serious complications. |
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