胃と腸44巻13号

2009年12月発行

今月の主題 collagenous colitisの現況と新知見 主題

microscopic colitis（collagenous colitis，lymphocytic colitis）の概念

著者： 平田一郎¹

所属機関： ¹藤田保健衛生大学消化管内科

ページ範囲：P.1947 - P.1953

要旨　CCとLCは類縁疾患で，CCとLCを総称してMCと呼ぶ．MCの年間罹患率（人口10万人対）は8.6～10.0（CC 3.1～4.9，LC 4.4～5.5）である．MCの平均発症年齢は65～68歳，男女比はCC 1：7，LC 1：2.4で，CCにおいて女性優位であるが，LCにその傾向はない．MCの原因として，自己免疫疾患，胆汁代謝異常，腸管感染症，薬剤などが挙げられるが結論は得られていない．MCの患者は対照に比して自己抗体（抗核抗体，抗グリアジン抗体，ASCA）の出現頻度が高く，いくつかの自己免疫疾患との合併が報告されている．MCに関連する薬剤としてNSAIDs，PPI（特にランソプラゾール），SSRI，H₂blocker，チクロピジン，アスピリンなどが挙げられているが，比較対照試験から導き出されたものはNSAIDsとSSRIである．MCの内視鏡所見として大腸粘膜の血管網異常，発赤，浮腫，顆粒状変化，縦走潰瘍などが挙げられるが，MCの約30％（本邦では75％以上）に何らかの内視鏡的異常を認める．顆粒状変化やCB沈着は右側結腸で高頻度に認められる．CCにおける縦走潰瘍は非常に長い線状潰瘍（潰瘍瘢痕）として認めることが多く，潰瘍周辺粘膜に炎症性変化を認めないことが特徴である．この縦走潰瘍とランソプラゾールとの関連性が報告されており，特に本邦ではランソプラゾール服用者の78％に縦走潰瘍を認めるといった報告もある．欧米ではこれほど高い頻度は示されておらず，NSAIDsと縦走潰瘍の関連性を示唆した報告もある．この縦走潰瘍は欧米では横行結腸～右側結腸に多く認めるが，本邦では左側結腸に多く認める．CCと鑑別を要する疾患として，虚血性腸炎，Crohn病，腸管アミロイドーシス，特発性腸間膜静脈硬化症，過敏性腸症候群，感染性腸炎，セリアック病などがある．治療はブデソニドが有効で，予後は総じて良好である．

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