クローン病診療ガイドライン - JCQHC

1 23 . 2011 10 .. 2009 .. 2006 .. 2010 4 .. QOL .. 5 .. 2 .. 2 .. 1.. 4.. 4.. 5.. 5.. 5.. 6.. 7.. 7.. 8.. 8.. 8.. 9.. 10.. 11. CQ .. 12.. -1.. 16. -2.. 16. -3.. 17. -4.. 17. -5.. 18.. 19.. -1.. 20. -2.. 21. -3.. 22. -4.. 23. -5. X .. 25. -6.. 26. -7.. 26. -8.. 27. -9.. 29.. 30.. -1.. 31. -2.. 31. -3.. 32. -4.. 32. -5.. 33. -6.. 34. -7.. 34.. 35.. -1.. 36. -2.. 37. 2. -3. 5-ASA .. 37. -4.. 38. -5. TNF .. 38. -6.. 39. -7.. 40. -8.. 41. -9.. 41. - .. 42. - .. 42.. 43.. -1.. 45. -2.. 46. -3.. 46. -4.. 47. -5.. 48. -6.. 48. -7.. 49. -8.. 49. -9.. 50. - .. 50. - .. 51.. 51.. -1.. 53. -2.. 54. -3.. 55.. 56.. -1.. 57. -2.. 58. -3.. 58. -4.. 59. -5.. 59.. 61.. -1.. 62. -2.. 62. -3.. 63.. 64.. -1.. 65. -2.. 66.. 67.. 68. 3.. QOL .. 2011 10 . CD . CD .. CD .. CD .. 4.. CD CD.. CD .. Clinical Question CQ .. CQ 2007 . MEDLINE Cochrane Library . 2008 . 1 .. 5. 1.. / . 1 .. a . b .. Minds 2007 . CQ .. 4 . 3 7 . 9 1 9 3 .. 2 . C1 B B.

2 3 . 6 . C2 D . 6. 2.. 8 7 6 4 3 . A A C2 D. A B C2 D. B B C2 D. B C1 C2 D. C1 B C1 C2 D. C1 B C1 C2 D. 3.. A .. B .. C1 . C2 . D . Minds 2007 .. 2 .. 68 .. 7.. CD .. CQ .. CD .. 3 .. 8.. 1.. CD 4 2011 6 . 2011 2011 .. 4.. LTT .. EN . MSD gsk . JIMRO .. EN MSD . gsk . JIMRO J & J .. 2.. COGS Ann Intern Med 2003 139 493-498 . 9.. CQ .. CQ.. CQ . CQ 2 . 4-8 . A 8 . C1. 8 . 5-ASA A 8 .. 1970 80 . 4 5 . CDAI150 450 5-ASA 4 . TNF- .. 6 5-ASA . 1, 2, 6, 7 . 9mg/ 2, 3, 8 . 10.. ASA aminosalicylic acid . 5-ASA 5-ASA .. AZA azathioprine . CD Crohn's disease .. CDAI Crohn's disease activity index .. ECCO European Crohn's and colitis organisation . GMA Granulocyte-monocyte apheresis . IBD inflammatory bowel disease .. IC indeterminate colitis .. IOIBD international organization for the study of inflammatory bowel disease .. 6-MP 6-mercaptopurine . MTX methotrexate . NSAIDs nonsteroidal anti-inflammatory drugs . PSC primary sclerosing cholangitis.

3 QOL quality of life .. SASP salazosulfapyridine .. TNF . TNF tumor necrosis factor .. TPN total parenteral nutrition . UC ulcerative colitis . 11. CQ .. -1.. CQ1. CD . -2.. CQ2. CD . -3.. CQ3. CD . -4.. CQ4. CD . -5.. CQ5. CD .. -1.. CQ1. CD . CQ2. CD . CQ3. CD . -2.. CQ4. CD . -3.. CQ5. CD . CQ6. CD . CQ7. CD . -4.. CQ8. CD . CQ9. CD . CQ10. CD . -5. X . CQ11. CD X . CQ12. CD X . -6.. CQ13. CD CT US . -7.. CQ14. CD . -8.. CQ15. CD . CQ16. CD . -9.. CQ17.. 12.. -1.. CQ1. CD . -2.. CQ2. CD . -3.. CQ3.. -4.. CQ4.. -5.. CQ5. CD . CQ6.. -6.. CQ7. CD . -7.. CQ8. CD .. -1.. CQ1. CD . -2.. CQ2.. -3. 5-ASA . CQ3. 5-ASA . -4.. CQ4.. -5. TNF . CQ5. TNF . CQ6. TNF . -6.. CQ7.. -7.. CQ8.. CQ9.. CQ10.. -8.. CQ11.. -9.. CQ12.. - .. CQ13. CD . - .. CQ14.. 13.. -1.. CQ1. CD . -2.. CQ2. CD . -3.. CQ3. CD . -4.. CQ4.. CQ5. CD . -5.. CQ6. CD . -6.. CQ7.. -7.. CQ8. CD . -8.. CQ9. CD . -9.. CQ10. CD . - .. CQ11. CD . - 1.. CQ12. CD.

4 -1.. CQ1.. CQ2. CD . -2.. CQ3.. CQ4.. -3.. CQ5.. CQ6.. CQ7. HPN . 14.. -1.. CQ1.. CQ2.. -2.. CQ3.. -3.. CQ4.. -4.. CQ5.. CQ6.. -5.. CQ7.. CQ8.. CQ9.. -1.. CQ1.. -2.. CQ2. X . -3.. CQ3. CD . CQ4.. CQ5.. -1.. CQ1. CD . CQ2. CD . CQ3.. CQ4.. -2.. CQ5.. 15.. - 1.. CQ 1 . CD 1 . CD C1 . VI VI 8 .. CD . 1 .. QOL . IBD .. - 2.. CQ2. CD . 1- 6 . CD 3 . B 9 . CD 10 30 B . 9 . CD C1 8 .. 1991 10 .. 2 .. 3 2009 3 .. CD 20 10 1-3 . 20 30 10 20 4 . 10 10 . CD 5 . 6 . 3 . 16. - 3.. CQ 3 . CD 7-18 . CD C1 8 . CD B a 8 . CD B . b b 8 . CD B 8 .. NSAIDs . CD C1 b 7 .. CD . 7-9 . CD 10, 11 .. CD . 12, 13 . 14 CD .. CD CD . 15 . 16 . NSAIDs CD . 17, 18 . - 4.. CQ4 . CD 19 . CD . B 9 .. CD .. 3 19 .. CDAI . IOIBD . CD .. 17. - 5.. CQ 5 . CD 20-28 . CD C1 9 . CD C1 8 . CD B b 8 . CD C1 b 7 .. CD . 5 10 15 % 20 1 . CD 30 % 21 CD ADL . 22 . CD 23 .. 24, 25 . 7 6 1 40 26 . 2 27, 28 CD .. 18.. 1. Jewell DP. Crohn's disease. In Warrell DA, Cox TM, Firth JD, Benz EJ, eds.

5 Oxford textbook of medicine, 4th ed. Oxford Oxford University Press, 2005. 2. Morita N, Toki S, Hirohashi T, et al. Incidence and prevalence of inflammatory bowel disease in Japan nationwide epidemiological survey during the year 1991. J Gastroenterol 1995 30 Suppl VIII 1-4. 3. Yao T, Matsui T, Hiwatashi N. Crohn's disease in Japan diagnostic criteria and epidemiology. Dis Colon Rectum. 2000 43 Suppl S85-93. 4. 54 3-14, 2007. 5. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease. Incidence, prevalence and environmental influences. Gastroenterology 2004 126 1504-17. 6. Loftus EV Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn's disease in population- based cohort from North America a systematic review. Aliment Pharmacol Ther 2002 16 51-60. 7. Isaac KL, Lewis JD, Sandborn WJ, et al. State of art IBD therapy and clinical trials in IBD. Inflamm Bowel Dis 2005 . 11 Suppl 1 S3-S12.

6 8. Hibi T, Ogata H. Novel pathophysiological concepts of inflammatory bowel disease. J Gastroenterol 2006 41 10-16. 9. Sands BE. Inflammatory bowel disease past, present, and future. J Gastroenterol 2007 42 16-25. 10. Orholm M, Munkholm P, Langholz E, et al. Familial occurrence of inflammatory bowel disease. N Engl J Med 1991 . 324 84-88. 11. Peeters M, Nevens H, Baert F, et al. Familial aggregation in Crohn's disease increased age-adjusted risk and concordance in clinical characteristics. Gastroenterology 1996 111 597-603. 12. Jamerot G, Jammark I, Nilsson K. Consumption of refined sugar by patients with Crohn's disease, ulcerative colitis, or irritable bowel syndrome. Scand J Gastroenterol 1983 18 999-1002. 13. Tragnone A, Valpiani D, Miglio F, et al. Dietary habits as risk factors for inflammatory bowel disease. Europ J. Gastroenterol Hepatol 1995 7 47-51. 14. Sakamoto N, Kono S, Wakai K, et al. Epidemiology Group of the Research Committee on Inflammatory Bowel Disease in Japan.

7 Dietary risk factors for inflammatory bowel disease a multicenter case-control study in Japan. Inflamm Bowel Dis 2005 11 154-63. 15. Ryan WR, Allan RN, Yamamoto T, Keighley MRB. Crohn's disease patients who quit smoking have a reduced risk of reoperation for recurrence. Am J Surg 2004 187 219-225. 16. Parzi MA, Achkar JP, Richardson S, et al. Predictors of response to infliximab in patients with Crohn's disease. Gastroenterology 2002 123 707-13. 17. Felder JB, Korelitz BI, Rajapakse R, et al. Effects of nonsteroidal anti-inflammatory drugs on inflammatory bowel disease a case-control study. Am J Gastroenterol 2000 95 1859-61. 18. Boyko EJ, Thesis MK, Vaughan TL, Nicho-Biades B. Increased risk of inflammatory bowel disease associated with oral contraceptive use. Am J Epidemiol 1994 140 268-78. 19. Gasche C, Scholmerich J, Brynskov J, et al. A simple classification of Crohn's disease report of the Working Party for the World Congress of Gastroenterology, Vienna 1998.

8 Inflamm Bowel Dis 2000 6 8-15. 20. Carter MJ, Lob AJ, Travis SPL. Guidelines for the management for inflammatory bowel disease in adults. Gut 2004 53. Suppl V v1-v16. 21.. QOL 9 1998. 22.. 18 2007. 23. von Roon AC, Reese G, Teare J, et al. The risk of cancer in patients with Crohn's disease. Dis Colon Rectum 2007 . 50 839-55. 24. Crohn 2006 103 797-804. 25. Yano Y, Matsui T, Uno H, et al. Risks and clinical features of colorectal cancer complicating Crohn's disease in Japanese patients. J Gastroenterol Hepatol. 2008 23 1683-1688. 26. Wolters FL, Russel MG, Stockburgger RW. Systematic review has disease outcome in Crohn's disease changed in the last four decades? Aliment Pharmacol Ther 2004 20 483-496. 27. Oriuchi T, Hiwatashi N, Kinouchi Y, et al. Clinical course and longterm prognosis of Japanese patients with Crohn's disease predictive factors, rates of operation and mortality. J Gastroenterol 2003 38 942-953. 28.

9 Uno H, Yao T, Matsui T, et al. Mortality and cause of death in Japanese patients with Crohn's disease. Dis Colon Rectum 2003 46 Suppl S15-S21. 19.. -1.. CQ1 . CD 1 . C1 8 .. C1 8 .. 70% . 80% 30% . CD . 15% 1 . 40 70% . CD . 1 2 10% 1 . CQ2 . CD 1- 6 .. B 9 .. Sweet . PSC C1 8 . C1 . 7 .. 2 disabling type . 2 QOL CD 5% . 1 . 1 5 . 2 3 30% . 1 6% 2 4% axial 3 . Sweet IBD. % 4, 5 3 UC CD . Sweet 30 6 CD .. IBD 1 2% 5 PSC CD 1 3% UC . CD . 1 IBD . 35% 1, 3, 5 . 20. CQ3 . CD 7- 9 . anal fissure anal ulcer . skin tag anal fistula . perianal abscess . anovaginal fistula .. cavitating ulcer . pile . C1 8 .. CD 36 . 81% CD 7-9 . Hughes 3 CD . primary lesion .. 2 secondary lesion CD incidental lesion 8 .. -2.. CQ4 . CD 10 . CD . C1 8 . CD . CD C1 7 . CD C1 7 .. CD 2002 1 .. 10 . 21. -3.. CQ5 . CD . 11,17 . C1 . 8 . CD C1 8 . C1 . V 8 . C1 8 .. CRP .. X X CD. CD . 11, 17 .. CT MRI .. CQ6 . CD 11,17 . X X X . B 9 .. CD X . X.

10 X .. CD X .. 22. CQ7 . CD 12-14 . CRP C1 8 . RBP C1 . 7 . C1 . 9 .. CD Crohn's disease activity index CDAI IOIBD . CDAI 12 CD . CRP .. Endoscopic Index of Severity of Crohn's Disease CDEIS . 13, 14 S 5 .. -4.. CQ8 . CD 10,11,13 -16 . CD . C1 . 8 .. C1 . 8 .. CD CD .. 11, 13-16 .. CD 17 75% . CD . 10 CD .. 23. CQ9 . CD 16,18 . skip lesion . B .. 9 .. C1 8 .. IBD 89 % CD UC . 16 CD UC . 18 . CD .. CQ . CD 11,17,18 . X B . VI 9 . X . C1 8 .. CD . X .. 11, 17, 18 . CD X . CD . CD .. 24. -5. X . CQ . CD X 18 -20 . CD . X C1 8 . X . X C1 8 .. X X . X 85 95% 89 94%. CD 18 - 20 . CQ . CD X 20-23 .. B 9 .. 5cm .. CD 84% 20-23 .. 23 . 25. -6.. CQ . CD CT US . 24 . C1 8 .. CT US CT MRI . CT colonography . 24 . -7.. CQ . CD 23,25 .. 4 C1 8 .. IBD basal cell plasma cytosis UC . focal . CD . 40 60% 15% 36% 25 .. 23 .. disproportional inflammation . 26. -8.. CQ . CD 10 . C1 . 9 . 1 C1 8 .. 1. Crohn 2011 2 10 . 1 . A. 1 . B.. C.