INTESTINE Vol.20 No.1(9)

特集名 『早期大腸癌』からの20年,『INTESTINE』からの今後20年
題名 潰瘍性大腸炎診療の将来像
発刊年月 2016年 01月
著者 大塚 和朗 東京医科歯科大学消化器内科
著者 渡辺 守 東京医科歯科大学消化器内科
【 要旨 】 潰瘍性大腸炎(UC)は,遺伝的素因に種々の環境因子が関与して腸内細菌に対する免疫異常が起こり,病像が形成されると考えられている.今後の課題として,病態に応じた新規治療薬の開発,予後や治療効果の予測ができるバイオマーカーの開発,腸内細菌叢制御による治療,背景粘膜の遺伝子異常検出による腫瘍高危険群の絞り込み,高齢患者や妊婦への対応,等がある.粘膜治癒が予後を改善することから,腸管バリア機能の回復が重要と考え,われわれは上皮幹細胞を用いた再生医療の確立をめざしている.また,厚生労働省班会議では,治療指針の改訂やアトラスの作成等を通じ情報の普及に努めている.UC診療のいっそうの進歩が必要であり,期待される.
Theme "Early Colorectal Cancer" and "Intestine", Road to future
Title Present and possible future concepts concerning ulcerative colitis
Author Kazuo Ohtsuka Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University
Author Mamoru Watanabe Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University
[ Summary ] Concepts concerning the pathogenesis of ulcerative colitis (UC) have evolved from it being a simple immunological disorder to more complex conditions. It is now thought that deviated immune responses to intestinal flora, influenced by genetic predisposition and environmental factors may contribute to this condition. Discovery of disease mechanisms is important for the development of new medicines which respond to specific targets. The development of biomarkers which accurately reflect disease activity and predict therapeutic effects, as well as improving prognoses is also anxiously awaited. Control of intestinal flora may also become a future therapy. Detection of genetic abnormalities in the background mucosa will be helpful in determination of patients who are at high risk of colitis associated neoplasia. Specific populations, such as the elderly or pregnant patients require further consideration. Mucosal healing has achieved better prognosis. Therefore, recovery of gut barrier functions is a key for healing. We propose a form of regenerative medicine using technology of colon-stem cell expansion that our team established. The Ministry of Health, Labour and Welfare of Japan facilitates the dissemination of information through guidelines and atlases. Further progress relating to medical care for UC patients is anticipated.