胃と腸45巻10号

2010年09月発行

今月の主題 Crohn病小腸病変に対する診断と治療の進歩 序説

Crohn病小腸病変に対する診断と治療の進歩

著者： 松井敏幸¹

所属機関： ¹福岡大学筑紫病院消化器科

ページ範囲：P.1579 - P.1585

はじめに

　Crohn病（Crohn's disease ; CD）の診断と治療は近年大きく変化した．診断面では，従来のX線検査診断に加え，内視鏡診断が著しく進歩した．2000年以降，カプセル内視鏡（capsule endoscopy ; CE）とバルーン内視鏡が臨床で広く用いられるようになり，小腸疾患の診断と治療は大きく変貌を遂げた^1）2）．その結果，CDにおける小腸の典型病変や微小病変の内視鏡診断も可能となった．また，治療面では生物学的製剤や免疫調節薬の投与が一般的となったため，腸病変の治癒も実感されることが多い．

　しかし，CDの病変のうち，小腸病変は相変わらず診断が容易でない．内視鏡検査は進歩したが，しばしば遭遇する小腸狭窄が十分な検査を妨げることが多い．そのため，CDの小腸病変に関する治癒の実態はほとんど報告がない．

　例えば，インフリキシマブはCDの腸管病変に対して高い治癒効果を有することが明らかとなっているが，その根拠は大腸病変の観察結果によるものであり，小腸病変の治癒の実態に関してはいまだ不明の点が多い．また，治療面では，小腸狭窄性病変に対して内視鏡的拡張術や狭窄形成術も有用と考えられているが，その長期的有効性は明らかではない．そこで本号では，従来の小腸X線検査に加え，最近の小腸内視鏡検査や新しい小腸診断法にも言及することで，小腸病変の望ましい診断・治療における有用な情報などの提供を目指した．

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