| 特集名 | 感染性腸炎 | |
|---|---|---|
| 題名 | ［各論］感染性腸炎との鑑別診断 -- 虚血性腸炎，薬剤性腸炎，IBD | |
| 発刊年月 | 2004年 07月 | |
| 著者 | 平田 一郎 | 大阪医科大学第2内科 |
| 著者 | 勝 健一 | 大阪医科大学第2内科 |
| 【 要旨 】 | 急性感染性腸炎と虚血性腸炎，薬剤性腸炎，IBDとの鑑別診断に関して主に内視鏡的所見を中心に述べた． 虚血性腸炎と鑑別を要する感染性腸炎はカンピロバクター腸炎，サルモネラ腸炎，腸管出血性大腸菌腸炎などである．これらは，いずれも縦走病変を形成することがあるが，病変好発部位がいずれも虚血性腸炎と異なる．すなわち，前二者は終末回腸も侵し，後者は上行結腸にもっとも強い変化をきたす． 薬剤性腸炎には出血性大腸炎，偽膜性腸炎，NSAIDs腸炎がある．出血性大腸炎と鑑別を要する感染性腸炎は腸管出血性大腸菌腸炎，細菌性赤痢などである．出血性大腸炎に比して，腸管出血性大腸菌腸炎の腸管炎症は高度であり，細菌性赤痢は下部大腸に病変が好発する．偽膜性腸炎と鑑別を要するのは，白苔が偽膜様に盛り上がったアメーバ赤痢であるが，アメーバ赤痢はたこいぼ様潰瘍が見られる．NSAIDs腸炎と鑑別を要するものは，エルシニア腸炎，サルモネラ腸炎などであるが，いずれもNSAIDs腸炎よりも病変が高度である． UCと鑑別を要するのは，アメーバ赤痢，カンピロバクター腸炎，腸管出血性大腸菌腸炎，サルモネラ腸炎などである．CDと鑑別を要するのは，エルシニア腸炎，アメーバ赤痢，CMV腸炎などである．とくに，CMV腸炎はUCの経過中に少なからず合併することがあるので注意を要する． |
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| Theme | Infectious Enterocolitis | |
|---|---|---|
| Title | Differential Diagnosis of Infectious Colitis: Ischemic Colitis, Drug-induced Colitis, IBD | |
| Author | Ichiro Hirata | The Second Department of Internal Medicine, Osaka Medical College |
| Author | Kenichi Katsu | The Second Department of Internal Medicine, Osaka Medical College |
| [ Summary ] | This paper mainly discussed colonoscopy findings which can be used to differentiate infectious colitis from other types of colitis, e.g., ischemic colitis, drug-induced colitis, and IBD. It is important to differentiate colitis caused by Campylobacter, Salmonella, and Enterohemorrhagic E.coli (EHEC) from ischemic colitis. All of these diseases can produce longitudinal lesions (mucosal redness or ulcers), but the susceptible regions are different in each type. For example, Campylobacter and Salmonella colitis usually affects the terminal ileum, but EHEC is likely to involve the ascending colon, in contrast with the ischemic colitis mostly involving the sigmoid colon and the descending colon. Drug-induced colitis is represented by hemorrhagic colitis, pseudomembranous colitis, and NSAIDs colitis. EHEC colitis and bacillary dysentery are examples of infectious colitis which need to be differentiated from drug-induced hemorrhagic colitis. Compared to drug-induced hemorrhagic colitis, mucosal inflammation from the former appears to be more severe. Also, in bacillary dysentery, the distal colon is more likely to be involved. Amebic dysentery With thick, white plaques over ulcers can mimic pseudomembranous colitis, endoscopically. In this instance, the presence of a verrucous ulcer favors the former diagnosis. Yersinia and Salmonella enterocolitis are examples of infectious colitis that need to be distinguished from NSAIDs colitis. More often, mucosal lesions is more pronounced in infectious colitis. Bacillary dysentery, Salmonella, Campylobacter, and EHEC colitis can mimic ulcerative colitis. Yersinia, amebic dysentery, and CMV colitis can resemble Crohn's disease, endoscopically. It is also important to note that superimposed CMV infection during the course of ulcerative colitis is not a rare occurrence. |
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