臨牀消化器内科 Vol.31 No.6(8-2)


特集名 IBD治療のcritical point ― 私ならこうする
題名 クローン病―手術適応と手術後の治療方針 (2) 内科医が術後フォローする立場から
発刊年月 2016年 06月
著者 山本 章二朗 宮崎大学医学部内科学講座消化器血液学分野
著者 三池 忠 宮崎大学医学部内科学講座消化器血液学分野
著者 橋本 神奈 宮崎大学医学部内科学講座消化器血液学分野
著者 安倍 弘生 宮崎大学医学部内科学講座消化器血液学分野
著者 田原 良博 宮崎大学医学部内科学講座消化器血液学分野
著者 下田 和哉 宮崎大学医学部内科学講座消化器血液学分野
【 要旨 】 クローン病は慢性的な進行性の疾患である.長期経過に伴い,外科的手術を要することも多い.手術適応には,穿孔,膿瘍,大出血,腸閉塞,狭窄,瘻孔,難治,癌合併などがあるが,個々の状態により内科治療も検討する.手術後は危険因子に基づいて,5‒アミノサリチル酸製剤や免疫調節薬,生物学的製剤に成分栄養剤を加えた寛解維持療法を行うが,定期的な内視鏡をはじめとする画像検査により,再発の有無を確認し,治療内容が適切であるかを検討する.手術後も再発が高率で,再手術率も低くないため,一度手術を行った例は二度と手術に至らないよう内科的な寛解維持治療を的確に行うことが重要である.
Theme How Do You Choose Treatment Strategies for IBD Patients with a Critical Situation?
Title Crohn's Disease : Surgical Indication and Therapeutic Strategy after Surgery
Author Shojiro Yamamoto Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
Author Tadashi Miike Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
Author Kanna Hashimoto Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
Author Hiroo Abe Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
Author Yoshihiro Tahara Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
Author Kazuya Shimoda Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
[ Summary ] Crohn's disease is a chronic progressive inflammatory disease that often requires surgical operation during its clinical course. Surgical operation indications for Crohn's disease are as follows : perforation, abscess, hemorrhage, intestinal obstruction, stenosis, fistula, medical treatment resistance, and cancer. Medical treatment is still one of the therapeutic options for such conditions. After surgery, remission maintenance therapy with 5‒aminosalicylic acid, immunomodulatory drugs, biologics, and elementary diet are required based on the risk factors of recurrence. Imaging analysis, including endoscopic examination, should be planned to assess the disease status and to choose the optimal therapy. The relapse rate after surgery in Crohn's disease is not low, and sometimes reoperation is required. Proper medical remission maintenance therapy is important avoid reoperation.
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