INTESTINE Vol.21 No.6(1)


特集名 小腸の炎症性病変を見直す
題名 総論─小腸炎症性疾患の診断法
発刊年月 2017年 11月
著者 竹内 健 東邦大学医療センター佐倉病院内科学講座消化器内科学分野
【 要旨 】 小腸炎症性疾患の診断には,詳細な病歴聴取,血液生化学検査,血清学的検査,遺伝子学的検査,細菌学的検査,画像検査などで総合的に診断することが必要である.小腸は胃と大腸に挟まれ,また非常に長い臓器のため解剖学的にアプローチが困難であり,内視鏡による画像診断が困難だったが,カプセル小腸内視鏡やバルーン小腸内視鏡がそれを可能にしている.また,クローン病では病変が非連続性に発症し,腸管にとどまらず腸管外にも及ぶため,CTやMRIにより腹部全体を俯瞰し横断的に画像診断することも重要である.他の症状とともに病変は形態だけではなく,分布にも注意し診断する必要がある.
Theme Reviewing inflammatory diseases of small bowel
Title Review -- Diagnostic methods useful for the assessment of small bowel inflammatory disease
Author Ken Takeuchi Department of Internal Medicine, Sakura Medical Center, Toho University
[ Summary ] Diagnosis of inflammatory bowel disease of the small intestine requires comprehensive evaluation based on a detailed medical history, biochemical and bacteriological examination of the blood, serological and genetic assessment, as well as imaging studies. Because the small intestine is located between the stomach and the large intestine and is a very long and tortuous organ, it is difficult to approach endoscopically. However, the introduction of capsule and balloon-assisted endoscopy has facilitated accurate and easy observation of the entire small intestine. The lesions of Crohn's disease involving the small intestine often show a segmental and asynchronous distribution in addition to extra-intestinal involvement/manifestations. Therefore, it is important that the entire abdomen be assessed using cross-sectional imaging such as computed tomography or magnetic resonance imaging. In addition to considering other symptoms, the diagnosis of small intestinal inflammatory bowel disease should be based on a thorough evaluation of the morphology, as well as the distribution of lesions.
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