| 特集名 | 血流障害と消化管疾患 | |
|---|---|---|
| 題名 | 血管炎 (1) IgA血管炎による消化管病変 | |
| 発刊年月 | 2019年 01月 | |
| 著者 | 岡田 圭次郎 | 日本赤十字社和歌山医療センター消化器内科 |
| 著者 | 谷 泰弘 | 日本赤十字社和歌山医療センター消化器内科 |
| 著者 | 三長 孝輔 | 日本赤十字社和歌山医療センター消化器内科 |
| 著者 | 山下 幸孝 | 日本赤十字社和歌山医療センター消化器内科 |
| 【 要旨 】 | IgA血管炎は，IgA免疫複合体が血管壁に沈着することで生じる全身性の細小血管炎であると考えられている．皮膚症状，関節症状，消化器症状，腎症状がおもな4徴で，その他神経症状や呼吸器症状などさまざまな全身症状を呈する．消化管病変は全消化管に起こりうる．とくに十二指腸を含む小腸に病変が認められることが多いとされる．内視鏡所見は浮腫，発赤，びらん，潰瘍など多彩な像を認め，広範囲に及ぶこともある．診断は臨床所見に加え，生検による組織所見により行うが，腹部症状が先行する例では内視鏡所見より本疾患を想起することが必要である．多くは対症療法で軽快するが，持続する腹痛や消化管出血，腎障害など臨床的に問題となる症状や症候を有する場合はステロイドを使用する．多くの症例でステロイド治療が著効し，予後は良好とされる． | |
| Theme | Gastrointestinal Disease Due to Blood Flow Damage | |
|---|---|---|
| Title | Gastrointestinal Involvement in IgA Vasculitis | |
| Author | Keijiro Okada | Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center |
| Author | Yasuhiro Tani | Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center |
| Author | Kosuke Minaga | Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center |
| Author | Yukitaka Yamashita | Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center |
| [ Summary ] | IgA vasculitis is a systemic vasculitis affecting the small vessels of the skin, joints, the gastrointestinal (GI) tract, and the kidneys. The primary clinical manifestations are abdominal pain, nausea, vomiting, and melena, which are attributable to bowel ischemia and edema. Serious complications include intestinal invagination, intestinal infarction and perforation. Endoscopic features of this condition are diffuse mucosal redness, petechiae, as well as hemorrhagic erosions and ulcers. IgA vasculitis affects the entire GI tract. GI involvement is often observed predominantly in the small bowel, however, the esophagus, stomach, terminal ileum, and the colon may also be affected. Diagnosing IgA vasculitis may be difficult, particularly in patients with abdominal symptoms that precede the appearance of the characteristic palpable purpura. Typical endoscopic findings may alert gastroenterologists to consider this condition (to ensure early diagnosis and prompt treatment) in patients with a high clinical suspicion of this disease even in the absence of characteristic skin lesions. Treatment is often symptomatic because the disease usually runs a benign course. Steroid therapy may be required in patients with severe GI complications or the development of proliferative glomerulonephritis. |
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