INTESTINE Vol.20 No.6(7)


特集名 診断に迷うIBDの非典型例
題名 非典型像を示した潰瘍性大腸炎
発刊年月 2016年 11月
著者 井上 拓也 大阪医科大学第二内科/いのうえ消化器内科クリニック
著者 村野 実之 むらのクリニック
著者 柿本 一城 大阪医科大学第二内科
著者 岡田 俊彦 大阪医科大学第二内科
著者 川上 研 大阪医科大学第二内科
著者 樋口 和秀 大阪医科大学第二内科
【 要旨 】 潰瘍性大腸炎(UC)の内視鏡所見は,血管透見像の消失と,粗糙な粘膜や細顆粒状の変化をびまん性に認めることが特徴であり,本邦のUCの診断基準にも含まれる.そして,これらの所見は歯状線直上の直腸粘膜から口側に連続して認められるのが典型的である.しかし,症例数の蓄積および近年の内視鏡技術,前処置法の進歩に伴ってより微細な粘膜の炎症性変化が捉えられるようになってきており,多くの非典型像に接する機会が増えてきた.非典型像を認めた場合でも,典型的な内視鏡像をその肛門側などに伴っていることや病変局所の内視鏡像が典型像に類似することが多いことなどから,非典型像のみにとらわれずに慎重な内視鏡診断を行うことがUCの内視鏡診断において重要と考えられる.
Theme Atypical cases of inflammatory bowel disease diagnosed with difficulty
Title Atypical endoscopic features in ulcerative colitis
Author Takuya Inoue Second Department of Internal Medicine, Osaka Medical Callege / Inoue Gastroenterology & Endoscopy Clinic
Author Mitsuyuki Murano Murano Clinic
Author Kazuki Kakimoto Second Department of Internal Medicine, Osaka Medical Callege
Author Toshihiko Okada Second Department of Internal Medicine, Osaka Medical Callege
Author Ken Kawakami Second Department of Internal Medicine, Osaka Medical Callege
Author Kazuhide Higuchi Second Department of Internal Medicine, Osaka Medical Callege
[ Summary ] Endoscopy is an important diagnostic modality in ulcerative colitis because endoscopic features of ulcerative colitis are characterized by diffuse loss of vascular pattern, small yellowish spots, and mucous exudates. Since endoscopic features of ulcerative colitis are characteristic and atypical features are rarely observed during colonoscopic procedures, diagnostic strategy based on endoscopic features has not been complicated. However, endoscopic technology and the method of bowel preparation have recently improved considerably. Therefore, we are often aware of atypical endoscopic features, such as appendiceal orifice inflammation, aphthoid lesions, and skip lesions of inflammation. Thus far, the clinical implications of these atypical endoscopic features have not been determined. Atypical lesions without gross appearance often make endoscopic diagnosis difficult. However, these atypical features include the possibility of early lesions of ulcerative colitis. Careful follow-up is required.
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