Takada Y, Fujita Y, Igarashi M, Katsumata T, Okabe H, Saigenji K, Takahashi T, Atari E
Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
J Gastroenterol. 1997 Oct;32(5):598-604. doi: 10.1007/BF02934108.
To clarify the pathognomonic changes of intestinal lesions of Behçet's disease and to determine effective therapeutic measures, we recruited 13 patients with the intestinal form of this disease for study. We performed pathology studies on the resected specimens of 7 patients and treated 5 of the other 6 patients with a low-residue diet. Pathology examination revealed that 6 of 7 had inflammatory ulcerations in the ileocecal region. The ileal ulcers were mainly on the antimesenteric side. We observed remnants of Peyer's patches at the margins of the major ulcerative lesions in 2 of 2 patients examined. There were aggregations of lymphocytes resembling destroyed lymph follicles in the superficial layer at the mouths of small fissuring lesions, and ulcer scars were also noted in Peyer's patches in 4 of 5 other patients. X-ray and endoscopic examinations revealed the disappearance of intestinal lesions in 5 patients within 1 month during, or following the low-residue diet treatment. We found the intestinal lesions of Behçet's disease at sites coinciding with intramucosal lymphoid tissue. The "rest cure" for the affected bowel was effective, i.e., there was significant alleviation of gastrointestinal symptoms and the intestinal lesions disappeared. We speculated that acute exudative inflammation, abscess formation, and consequent ulceration may occur in these tissues by the same mechanisms as those that operate in the positive needle-prick reactions seen in patients with Behçet's disease.
为明确白塞病肠道病变的特征性改变并确定有效的治疗措施，我们招募了13例肠道型白塞病患者进行研究。我们对7例患者的切除标本进行了病理研究，并对另外6例中的5例采用低渣饮食治疗。病理检查显示，7例中有6例在回盲部有炎性溃疡。回肠溃疡主要位于系膜对侧。在检查的2例患者中，我们在主要溃疡性病变边缘观察到派尔集合淋巴结残余。在小裂隙性病变开口处的表层有类似被破坏淋巴滤泡的淋巴细胞聚集，另外5例患者中有4例在派尔集合淋巴结中也观察到溃疡瘢痕。X线和内镜检查显示，5例患者在低渣饮食治疗期间或之后1个月内肠道病变消失。我们发现白塞病的肠道病变位于与黏膜内淋巴组织相符的部位。对受累肠道的“静卧疗养”有效，即胃肠道症状明显缓解，肠道病变消失。我们推测，这些组织中可能通过与白塞病患者阳性针刺反应相同的机制发生急性渗出性炎症、脓肿形成及随后的溃疡。
