臨牀消化器内科 Vol.29 No.10(2-6)


特集名 CT colonographyの現状と将来
題名 各論 (6) CT colonographyを用いたIBSの診断
発刊年月 2014年 09月
著者 水上 健 国立病院機構久里浜医療センター内視鏡検診センター
【 要旨 】 過敏性腸症候群(IBS)は腸管運動異常・知覚過敏,脳腸相関異常が病態とされる.IBSの診断基準にはストレスの評価項目がなく,腹部手術歴がIBS群に多いなどストレスと関係ない病態が存在する.これまでわれわれは,無麻酔大腸内視鏡を施行すると検査自体がストレス負荷となりIBSの一部に鎮痙薬で抑制されない腸管運動異常が見出されること,見出されないものは発症契機のストレスを自覚しない大腸内視鏡挿入困難症例でS状結腸回転異常や下行結腸間膜を有すること,を報告した.CT colonography(CTC)は腸管形態を描出でき,排便障害を起こすねじれや腸管径不同をわかりやすく描出して解決策の提示が可能である.CTCのIBS診断への応用方法を供覧する.
Theme Now and Feature of CT Colonography
Title Morphological Colonic Investigation of IBS Patients with CT Colonography
Author Takeshi Mizukami Department of Endoscopy Center, NHO Kurihama Medical and Addiction Center
[ Summary ] We report on sedative-risk free colonoscopy termed, "WATER NAVIGATION COLONOSCOPY". We also report on the bowel motility of healthy subjects being suppressed with antispasmodics. We also report on the persistent abnormal bowel motility with irritable bowel syndrome (IBS) observed in response to the psychological stress of "colonoscopies" (NGM2009). We also found there are some IBS patients without abnormal bowel motility and reported that there are 2 types of IBS resulting from colonoscopy, the "Abnormal bowel motility type" and the "Abnormal bowel morphology type" (DDW2010). CT colonography may not only be used to evaluate neoplasms but also to produce a three dimensional picture of the colon. Abnormal colon morphology such as mesocolon descendens and sigmoid colon malrotation was frequently observed, i. e, 91.0 % of IBS cases. IBS patients with abnormal colon morphology only did not experience stress related to the symptoms. Colon caliber change (X 2) was significantly frequently observed with IBS-D 74 % and-M 71 % being greater than-C 30 %. Abnormal colon morphology is very common in Japanese IBS patients, and seems to cause disorders related to defecation. Colon caliber change is often observed in IBS patients with diarrhea. These seem to be the same mechanisms observed in diarrhea associated with colonic stenosis such as colon cancer or sigmoid volvulus.
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