胃と腸53巻2号

2018年02月発行

今月の主題 IBDの内視鏡的粘膜治癒─評価法と臨床的意義 主題

Crohn病の内視鏡的重症度評価─カプセル小腸内視鏡による重症度評価

著者： 大森鉄平¹ 細矢さやか¹ 安廣和志¹ 神林玄隆¹ 村杉瞬¹ 柏木宏幸¹ 原敏文¹ 伊藤亜由美¹ 米沢麻利亜¹ 中村真一¹ 徳重克年¹

所属機関： ¹東京女子医科大学消化器内科

ページ範囲：P.211 - P.220

要旨●小腸病変を有するCrohn病（CD）に対するカプセル小腸内視鏡検査（SBCE）は，低侵襲に小腸粘膜の炎症像を視覚化できる検査法でありCDの診断や病状評価・経過観察に有用である．SBCEのスコアリングにはLewis scoreとCECDAIがある．治療介入前後の変化を明瞭化した．一方で，臨床的疾患活動度やbiomarkerとの不一致例の存在や，粘膜治癒後の瘢痕狭窄もスコアに影響を及ぼし，単純に合算した数値では，疾患活動性を十分に評価できない問題がある．重症度の評価のためのスコアは，臨床的疾患活動度と相関し，治療措置および転帰に影響を及ぼすべきである．情報の蓄積により，CDに特徴的なSBCE所見を抽出し，治療介入の機会や病態の把握につながる新規スコアリングの開発も期待したい．

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