胃と腸54巻4号

2019年04月発行

今月の主題 知っておきたい小腸疾患

主題

小腸の非腫瘍性疾患—セリアック病

著者： 武田輝之¹ 平井郁仁¹ 高津典孝¹ 岸昌廣² 別府剛志² 久部高司² 宮岡正喜³ 八尾建史³ 金城健⁴ 太田敦子⁴ 田邉寛⁴ 原岡誠司⁴ 岩下明德⁴ 長浜孝⁵ 植木敏晴²

所属機関： ¹福岡大学筑紫病院炎症性腸疾患センター ²福岡大学筑紫病院消化器内科 ³福岡大学筑紫病院内視鏡部 ⁴福岡大学筑紫病院病理部 ⁵長浜クリニック

ページ範囲：P.515 - P.525

文献概要

要旨●セリアック病は，グルテンの経口摂取を契機に発症する自己免疫疾患で，本邦では非常にまれであるものの，絨毛の萎縮を来す疾患を鑑別する際に知っておくべき疾病である．特徴的な内視鏡所見として，十二指腸や小腸にモザイクパターン，溝状の陥凹，貝柱状外観（scalloping），顆粒状・結節状粘膜，Kerckring皺襞の減少・消失，血管透見像の出現，多発びらんなどを認める．病理組織学的所見が確定診断に必須であり，絨毛の萎縮と表層上皮内へのリンパ球浸潤などの特徴的所見により診断する．絨毛の萎縮の程度は平坦化・鈍化・消失などの段階があり，Marsh分類で評価される．本稿では，セリアック病の血清学的検査所見，特徴的な画像所見や病理組織学的所見について，絨毛の萎縮を来す他の鑑別疾患を交え概説する．

参考文献

1）Choung RS, Larson SA, Khaleghi S, et al. Prevalence and morbidity of undiagnosed celiac disease from a community-based study. Gastroenterology　152：830-839, 2017

2）Husby S, Koletzko S, Korponay-SzabóIR, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr　54：136-160, 2012

3）Green PH. The many faces of celiac disease：clinical presentation of celiac disease in the adult population. Gastroenterology　128：S74-78, 2005

4）Rondonotti E, de Franchis R. Diagnosing coeliac disease：is the videocapsule a suitable tool? Dig Liver Dis　39：145-147, 2007

5）Bhagat G, Chan JKC, Jaffe ES, et al. Enteropathy-associated T-cell lymphoma. In Swerdlow SH, Campo E, Harris NL, et al（eds）. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th ed. IARC, Lyon, pp 372-380, 2017

6）Gregor J, Sey MSL. Celiac disease：diagnosis, treatment and prognosis. In Mcdorald JWD, Burroughs AK, Feagan BG, et al（eds）. Evidence-based Gastroenterology & Hepatology, 3rd ed. Wiley, New Jersey, pp 200-210, 2011

7）Hopper AD, Hadjivassiliou M, Hurlstone DP, et al. What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis. Clin Gastroenterol Hepatol　6：314-320, 2008

8）Lebwohl B, Sanders DS, Green PHR, et al. Coeliac disease. Lancet　391：70-81, 2018

9）Leffler DA, Schuppan D. Update on serologic testing in celiac disease. Am J Gastroenterol　105：2520-2524, 2010

10）岸昌廣，松井敏幸，八尾建史，他．知ってそうで知らない消化器疾患（15回）Celiac病．G.I.Research　23：437-443, 2015

11）Dickey W. Endoscopic markers for celiac disease. Nat Clin Pract Gastroenterol Hepatol　10：546-551, 2006

12）Dickey W, Hughes D. Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy. Am J Gastroenterol　94：2182-2186, 1999

13）Oxentenko AS, Grisolano SW, Murray JA, et al. The insensitivity of endoscopic markers in celiac disease. Am J Gastroenterol　97：933-938, 2002

14）Niveloni S, Fiorini A, Dezi R, et al. Usefulness of videoduodenoscopy and vital dye staining as indicators of mucosal atrophy of celiac disease：assessment of interobserver agreement. Gastrointest Endosc　47：223-229, 1998

15）Culliford A, Markowitz D, Rotterdam H, et al. Scalloping of duodenal mucosa in Crohn's disease. Inflamm Bowel Dis　10：270-273, 2004

16）Shah VH, Rotterdam H, Kotler DP, et al. All that scallops is not celiac disease. Gastrointest Endosc　51：717-720, 2000

17）Kasirer Y, Turner D, Lerman L, et al. Scalloping is a reliable endoscopic marker for celiac disease. Dig Endosc　26：232-235, 2014

18）Oxentenko AS, Murray JA. Celiac disease：ten things that every gastroenterologist should know. Clin Gastroenterol Hepatol　13：1396-1404, 2015

19）Cammarota G, Cesaro P, Martino A, et al. High accuracy and cost-effectiveness of a biopsy-avoiding endoscopic approach in diagnosing coeliac disease. Aliment Pharmacol Ther　23：61-69, 2006

20）Cammarota G, Cazzato A, Genovese O, et al. Water-immersion technique during standard upper endoscopy may be useful to drive the biopsy sampling of duodenal mucosa in children with celiac disease. J Pediatr Gastroenterol Nutr　49：411-416, 2009

21）Gasbarrini A, Ojetti V, Cuoco L, et al. Lack of endoscopic visualization of intestinal villi with the “immersion technique” in overt atrophic celiac disease. Gastrointest Endosc　57：348-351, 2003

22）Siegel LM, Stevens PD, Lightdale CJ, et al. Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption. Gastrointest Endosc　46：226-230, 1997

23）岸昌廣，八尾建史，平井郁仁，他．拡大内視鏡が診断に有用であったceliac病の1例．胃と腸　49：395-404, 2014

24）Rewers M：Epidemiology of celiac disease：what are the prevalence, incidence and progression of celiac disease? Gastroenterology　128：S47-51, 2005

25）Yao K, Nagahama T, Hirai F, et al. Clinical Application of Magnification Endoscopy with NBI in the Stomach and the Duodenum. In Cohen J（ed）. Comprehensive Atlas of High Resolution Endoscopy and Narrow Band Imaging. Wiley-Blackwell, New York, pp 81-103, 2008

26）Badreldin R, Barrett P, Wooff DA, et al. How good is zoom endoscopy for assessment of villous atrophy in coeliac disease? Endoscopy　37：994-998, 2005

27）馬場由紀子，松田彰郎，西俣伸亮，他．グルテン制限食で臨床症状，画像所見が改善したセリアック病の1例．胃と腸　50：950-956, 2015

28）Rondonotti E, Spada C, Cave D, et al. Video capsule enteroscopy in the diagnosis of celiac disease：a multicenter study. Am J Gastroenterol　102：1624-1631, 2007

29）Kurien M, Evans KE, Aziz I, et al. Capsule endoscopy in adult celiac disease：a potential role in equivocal cases of celiac disease? Gastrointest Endosc　77：227-232, 2013

30）Murray JA, Rubio-Tapia A, Van Dyke CT, et al. Mucosal atrophy in celiac disease：extent of involvement, correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol　6：186-193, 2008

31）Enns RA, Hookey L, Armstrong D, et al. Clinical Practice Guidelines for the use of video capsule endoscopy. Gastroenterology　152：497-514, 2017

32）Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders：European Society of Gastrointestinal Endoscopy（ESGE）Clinical Guideline. Endoscopy　47：352-376, 2015

33）Rokkas T, Niv Y. The role of video capsule endoscopy in the diagnosis of celiac disease：a meta-analysis. Eur J Gastroenterol Hepatol　24：303-308, 2012

34）Perez-Cuadrado-Robles E, Lujan-Sanchis M, Elli L, et al. Role of capsule endoscopy in alarm features and non-responsive celiac disease：a European multicenter study. Dig Endosc　30：461-466, 2018

35）Luján-Sanchis M, Pérez-Cuadrado-Robles E, García-LledóJ, et al. Role of capsule endoscopy in suspected celiac disease：a European multi-centre study. World J Gastroenterol　23：703-711, 2017

36）Tennyson CA, Semrad CE. Small bowel imaging in celiac disease. Gastrointest Endosc Clin N Am　22：735-746, 2012

37）Van Weyenberg SJ, Mulder CJ, Van Waesberghe JH. Small bowel imaging in celiac disease. Dig Dis　33：252-259, 2015

38）Catassi C, Fasano A. Celiac disease diagnosis：simple rules are better than complicated algorithms. Am J Med　123：691-693, 2010

39）Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders：consensus on new nomenclature and classification. BMC Med　10：13, 2012

40）Thijs WJ, van Baarlen J, Kleibeuker JH, et al. Duodenal versus jejunal biopsies in suspected celiac disease. Endoscopy　36：993-996, 2004

41）Ludvigsson JF, Bai JC, Biagi F, et al. Diagnosis and management of adult coeliac disease：guidelines from the British Society of Gastroenterology. Gut　63：1210-1228, 2014

42）Rubio-Tapia A, Hill ID, Kelly CP, et al. ACG clinical guidelines：diagnosis and management of celiac disease. Am J Gastroenterol　108：656-676, 2013

43）Kurien M, Evans KE, Hopper AD, et al. Duodenal bulb biopsies for diagnosing adult celiac disease：is there an optimal biopsy site? Gastrointest Endosc　75：1190-1196, 2012

44）Shamban L, Sorser S, Naydin S, et al. Factors associated with number of duodenal samples obtained in suspected celiac disease. Endosc Int Open　5：E1220-1228, 2017

45）Glickman JN. The Nonneoplastic Small Intestine. In Noffsinger AE（ed）. Fenoglio-Preiser's Gastrointestinal Pathology. 4th ed. Wolters Kluner, Philadelphia, pp 371-379, 2017．

46）二村聡，石橋英樹．IEL．胃と腸　52：698, 2017

47）Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity（‘celiac sprue'）. Gastroenterology　102：330-354, 1992

48）Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease：time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol　11：1185-1194, 1999

49）Dickson BC, Streutker CJ, Chetty R. Coeliac disease：an update for pathologists. J Clin Pathol　59：1008-1016, 2006

50）Corazza GR, Villanacci V. Coeliac disease. J Clin Pathol　58：573-574, 2005

51）Weinstein WM, Saunders DR, Tytgat GN, et al. Collagenous sprue—an unrecognized type of malabsorption. N Engl J Med　283：1297-1301, 1970

52）坪内直子，沼田政嗣，大野香苗，他．経時的に内視鏡で観察したcollagenous sprueの1例．胃と腸　49：1355-1361, 2014

53）Yamamoto Y, Yamada T, Akutsu D, et al. Collagenous sprue diagnosed by double balloon endoscopy. Dig Endosc　6：108-112, 2014

54）Zhao X, Johnson RL. Collagenous sprue：a rare, severe small-bowel malabsorptive disorder. Arch Pathol Lab Med　135：803-809, 2011

55）Satoyoshi E. A syndrome of progressive muscle spasms, alopecia and diarrhea. Neurology　28：458-471, 1978

56）Nagahama T, Yao K, Oishi T, et al. GI manifestation of Satoyoshi's syndrome. Gastrointest Endosc　64：143-145, 2006

57）長浜孝，松井敏幸，田辺寛，他．著しい消化管病変を主徴とした里吉症候群の2例—特徴的な消化管病変とその臨床経過，病理組織学的所見を中心に．胃と腸　41：1683-1697, 2006

58）長浜孝，松井敏幸，岩下明德．里吉症候群．胃と腸　43：713-718, 2008