胃と腸49巻9号

2014年08月発行

今月の主題 小腸潰瘍の鑑別診断 主題研究

分類困難な小腸潰瘍・びらんの現状

著者： 藤森俊二¹ 秋元直彦¹ 大森順¹ 遠坂由紀子¹ 小杉友紀¹ 鈴木将大¹ 馬來康太郎¹ 春日祐介¹ 杉浦陽子¹ 江原彰仁¹ 三井啓吾¹ 米澤真興¹ 田中周¹ 辰口篤志¹ 坂本長逸¹

所属機関： ¹日本医科大学消化器内科学

ページ範囲：P.1303 - P.1308

要旨　本邦において，原因不明消化管出血に対してカプセル内視鏡を施行した場合，およそ30％の対象に潰瘍性病変が指摘される．NSAIDsを服用している場合においてはNSAIDs起因性と診断されることが多いが，正確な診断は簡単ではない．さらに，健常者においても10％程度は無症候性の小腸潰瘍性病変を有しており，原因疾患の診断は困難を極めている．近年，腸内細菌叢が小腸潰瘍性病変に深く関与している可能性が指摘されており，今後の解明が望まれている．

参考文献

1）Boydstun JS Jr, Gaffey TA, Bartholomew LG. Clinicopathologic study of nonspecific ulcers of the small intestine. Dig Dis Sci 26 : 911-916, 1981

2）Karnam US, Rosen CM, Raskin JB. Small bowel ulcers. Curr Treat Options Gastroenterol 4 : 15-21, 2001

3）Capurso G, Lahner E, Pallotta N, et al. Iron deficiency anemia caused by nonspecific（idiopathic）small bowel ulceration : an uncommon presentation of an uncommon disease. Can J Gastroenterol 16 : 855-859, 2002

4）Matsumoto T, Iida M, Matsui T, et al. Non-specific multiple ulcers of the small intestine unrelated to non-steroidal anti-inflammatory drugs. J Clin Pathol 57 : 1145-1150, 2004

5）Matsumoto T, Iida M, Matsui T, et al. Chronic nonspecific multiple ulcers of the small intestine : a proposal of the entity from Japanese gastroenterologists to Western enteroscopists. Gastrointest Endosc 66 : S99-107, 2007

6）Matsumoto T, Kubokura N, Matsui T, et al. Chronic nonspecific multiple ulcer of the small intestine segregates in offspring from consanguinity. J Crohns Colitis 5 : 559-565, 2011

7）Wang W, Wang Z, Yang Y, et al. Long-term follow-up of nonspecific small bowel ulcers with a benign course and no requirement for surgery : is this a distinct group ? BMC Gastroenterol 11 : 51, 2011

8）Hao WL, Lee YK. Microflora of the gastrointestinal tract : a review. Methods Mol Biol 268 : 491-502, 2004

9）Whittle BJ. Mechanisms underlying intestinal injury induced by anti-inflammatory COX inhibitors. Eur J Pharmacol 500 : 427-439, 2004

10）Bjarnason I, Hayllar J, Smethurst P, et al. Metronidazole reduces intestinal inflammation and blood loss in non-steroidal anti-inflammatory drug induced enteropathy. Gut 33 : 1204-1208, 1992

11）Wallace JL, Syer S, Denou E, et al. Proton pump inhibitors exacerbate NSAID-induced small intestinal injury by inducing dysbiosis. Gastroenterology 141 : 1314-1322, 2011

12）Fujimori S, Takahashi Y, Tatsuguchi A, et al. Omeprazole increased small intestinal mucosal injury in two of six disease-free cases evaluated by capsule endoscopy. Dig Endosc 2013 in press