臨牀消化器内科 Vol.30 No.3(2)


特集名 小児の消化器内視鏡診療
題名 小児の上部消化管疾患
発刊年月 2015年 03月
著者 青松 友槻 大阪医科大学小児科
【 要旨 】 上部消化管疾患の頻度は成人より低いが,小児でも「上部消化管内視鏡を実施すべき状況」が確かに存在する.良性疾患が圧倒的に多く,肉眼観察では正常な部位も含めて広い範囲から複数個の生検が必要となることが多い.小児で内視鏡の適応を決定するうえで重要なことは,「器質的疾患を疑うべき臨床徴候」,すなわち,夜間目覚めるような強い腹痛,体重減少,成長障害,血便,肛門周囲病変,微熱やCRP高値の持続,炎症性腸疾患や消化性潰瘍の家族歴などに注意することである.反復性腹痛のみで検査を行っても有所見率は低い.本稿では,内科領域でも遭遇する頻度が高い,もしくは小児と成人の違いを認識しておく必要のある代表的な上部消化管疾患について概説する.
Theme Gastrointestinal Endoscopy in Children
Title Upper Gastrointestinal Disorders in Children
Author Tomoki Aomatsu Department of Pediatrics, Osaka Medical College
[ Summary ] The frequency of upper gastrointestinal disorders in children is lower than in adults ; however, there are children who require upper gastrointestinal endoscopy. Because most of the disorders in children are benign or inflammatory disorders, multiple biopsies are often necessary, even if macroscopically normal. In considering the indications for upper gastrointestinal endoscopy in children, physicians should be aware of 'red flags', such as pain awakening the patient from sleep, weight loss or growth retardation, hematochezia, perianal lesions, persistence of low‒grade fever or elevated CRP, and family history of inflammatory bowel diseases or peptic ulcer. Endoscopic examination rarely identifies organic disorders when there are no clinical signs except for recurrent abdominal pain. In this section, five representative pediatric upper gastrointestinal disorders that possess some difference between adults and children and that might be encountered by gastroenterologists are discussed.
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