INTESTINE Vol.23 No.4(3-3)

特集名	原因不明消化管出血（OGIB）
題名	患者背景と病歴から組み立てるOGIBの診断戦略 (3) 肝疾患を背景にもつ小腸出血
発刊年月	2019年 08月
著者	藤森俊二	大日本医科大学千葉北総病院消化器内科／日本医科大学消化器内科学
著者	星本相理	日本医科大学消化器内科学
著者	橋野史彦	日本医科大学消化器内科学
著者	片岡宏章	日本医科大学消化器内科学
著者	梅田隆満	日本医科大学消化器内科学
著者	高木信介	日本医科大学消化器内科学
著者	西本祟良	大日本医科大学千葉北総病院消化器内科／日本医科大学消化器内科学
著者	大森順	日本医科大学消化器内科学
著者	岩切勝彦	日本医科大学消化器内科学
【要旨】	肝硬変ではangioectasiaや小腸静脈瘤の発生，さらに出血傾向を伴うことから小腸出血が起きやすい状態にある．肝硬変患者では小腸angioectasiaが非肝硬変患者と比較して6倍近く認められると報告されている．同時にangioectasiaの多発傾向も認められ，出血傾向も伴う肝硬変患者ではangioectasiaの治療後も，非肝硬変患者と比較して4倍もの再出血率が報告されている．門脈圧の亢進と小腸の浮腫に相関が認められ，小腸浮腫で門脈圧が亢進しているかを推定できる可能性がある．門脈圧とangioectasiaの間に明らかな相関は認められていない．肝硬変患者では原疾患によりその予後が強く規定されており，小腸出血患者の長期予後の報告はなく，予後は不良と考えられる．

Theme	Obscure gastrointestinal bleeding (OGIB)
Title	Small intestinal bleeding in patients with hepatic disease
Author	Shunji Fujimori	Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital / Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
Author	Airi Hoshimoto	Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
Author	Fumihiko Hashino	Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
Author	Hiroaki Kataoka	Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
Author	Takamitsu Umeda	Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
Author	Shinsuke Takagi	Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
Author	Takayoshi Nishimoto	Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital / Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
Author	Jun Omori	Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
Author	Katsuhiko Iwakiri	Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
[ Summary ]	Patients with liver cirrhosis are more likely to develop complications such as angioectasias, small intestinal varices, and/or a bleeding tendency. Therefore, small intestinal bleeding is strongly associated with liver cirrhosis. The occurrence of small intestinal angioectasias is 6-fold higher in patients with liver cirrhosis than in patients without liver cirrhosis. Notably, angioectasias are commonly detected in patients with liver cirrhosis. Moreover, patients with liver cirrhosis show an increased bleeding tendency. Reportedly, the rebleeding rate is 4-fold higher in patients with liver cirrhosis than in patients without liver cirrhosis. An association has been observed between portal hypertension and small intestinal edema. The prognosis of small intestinal bleeding in patients with liver cirrhosis is strongly associated with the severity of liver dysfunction.

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