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<meta name="description" content="好評の第3版から5年ぶりの改訂．潰瘍性大腸炎の診断面では，病態の解明，長期経過例に合併する悪性腫瘍の早期診断，高齢者での特徴などが注目されている．内科治療では多くの有効な薬剤が臨床で使用できるようになり，外科治療では治療成績の安定化や生活の質の改善などがみられている．第4版ではこれら最新情報を盛り込み全面改訂．潰瘍性大腸炎の診療・ケアに携わる全ての医師・スタッフ，患者さんの身近に置いて活用していた">

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		<h1 class="catchCopy">潰瘍性大腸炎診療に携わる全ての医師に役立つ診療の基本と最新情報を，わかりやすくまとめた実践的なガイドブック！</h1>
		

		<h1 class="title titleWidth">潰瘍性大腸炎の診療ガイド<span class="version">第4版</span></h1>
		

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					編集：NPO法人日本炎症性腸疾患協会（CCFJ）
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				<ul class="property"><li class="disc">B5判・112頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-2108-6</li><li class="disc">2021年1月22日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">好評の第3版から5年ぶりの改訂．潰瘍性大腸炎の診断面では，病態の解明，長期経過例に合併する悪性腫瘍の早期診断，高齢者での特徴などが注目されている．内科治療では多くの有効な薬剤が臨床で使用できるようになり，外科治療では治療成績の安定化や生活の質の改善などがみられている．第4版ではこれら最新情報を盛り込み全面改訂．潰瘍性大腸炎の診療・ケアに携わる全ての医師・スタッフ，患者さんの身近に置いて活用していただきたい．</section><section class="preface">第4版　刊行にあたって<br><br>　潰瘍性大腸炎はわが国で増加し，患者数は現在30万人に及ぶといわれています．厚生労働省難治性炎症性腸管障害に関する調査研究班の指針や欧米の各種ガイドラインが定期的に追記，改訂され，本症に対する知見の実臨床，臨床研究による更新が患者さんの診療には必須と考えられます．<br>　本診療ガイドはまだ症例数が少なかった2007年に本症の診断，治療を実臨床で普遍的に行うことを目的に初版が刊行され，その後臨床面での進歩に伴って2011年に第2版，2016年に第3版が刊行されて実臨床のガイドブックとしてご利用いただいてきました．近年は診断に関して本症の病態の解明，長期経過例に合併する悪性腫瘍の早期診断，高齢者に発生する本症の特徴などが注目されて診断面でのさらなる進歩と詳細化があり，治療に関して内科治療では多くの新規の有効な薬剤が臨床で使用できるようになるとともに，外科治療では治療成績の安定化や生活の質の改善などがみられています．これらの新しい診断，治療はその有効性と問題点を検証し，そのうえで診断，治療を確立して実臨床で患者さんの診療に役立てる必要があります．本診療ガイド第4版はこれらの観点から従来の項目を多くの点で改訂，追記して，現在の診療に役立てることのできる最新の内容を読者の皆さんにお届けすることを目的に刊行されました．<br>　本第4版を刊行するにあたり，ご尽力いただきました執筆者の先生方，本書の刊行にご支援をいただきました多くの関係者の皆さんにお礼を申し上げます．是非，本書の内容を皆さんの日々の実臨床に役立てていただきたいと思います．<br><br>2021年新春<br>NPO法人 日本炎症性腸疾患協会（CCFJ）理事長<br>杉田　昭</section><section class="indexes">第1章　診断と分類<br>　1．概念・疫学<br>　2．診断へのアプローチ<br>　　○症状・問診<br>　3．診断確定と鑑別疾患<br>　4．病態（病型，病期，重症度）の分類<br>　（1）病変の拡がりによる病型分類<br>　（2）臨床経過による分類<br>　（3）病期の分類<br>　（4）臨床的重症度による分類<br>　（5）臨床的活動性指標<br>　（6）治療反応性に基づく難治性潰瘍性大腸炎の定義<br><br>第2章　内視鏡<br>　1．潰瘍性大腸炎の内視鏡分類<br>　2．潰瘍性大腸炎の内視鏡像<br>　（1）活動期<br>　（2）寛解期<br>　（3）粘膜治癒とは<br>　3．大腸内視鏡検査を実施する際の注意点<br>　（1）前処置<br>　（2）前投薬<br>　（3）内視鏡操作および挿入時の注意<br>　（4）非典型的な内視鏡所見<br><br>第3章　病　理<br>　1．UCでみられる主な組織所見<br>　2．組織所見で除外することが期待される主な疾患<br>　3．UCにおけるCACとCAD<br><br>第4章　内科治療<br>【総　論】<br>　1．一般原則<br>　2．難治例の治療<br>【各　論】<br>　1．アミノサリチル酸（ASA）製剤<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　2．副腎皮質ステロイド薬<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　3．免疫調節薬（アザニン<sup>Ⓡ</sup>およびロイケリン<sup>Ⓡ</sup>）<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　4．抗TNF-α抗体製剤<br>　 A　インフリキシマブ（レミケード<sup>Ⓡ</sup>）<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　 B　アダリムマブ（ヒュミラ<sup>Ⓡ</sup>）<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　 C　ゴリムマブ（シンポニー<sup>Ⓡ</sup>）<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　5．カルシニューリン阻害薬<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　6．血球成分吸着除去療法<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　7．トファシチニブ（ゼルヤンツ<sup>Ⓡ</sup>）<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　8．ベドリズマブ（エンタイビオ<sup>Ⓡ</sup>）<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　9．ウステキヌマブ（ステラーラ<sup>Ⓡ</sup>）<br>　（1）作用機序<br>　（2）適応と投与方法<br>　（3）副作用<br>　10．漢方薬─青黛について<br><br>第5章　外科治療<br>　1．手術適応と手術のタイミング<br>　（1）重症，劇症例<br>　（2）難治例<br>　（3）癌/dysplasia症例<br>　2．手術率<br>　3．潰瘍性大腸炎に対する術式<br>　（1）大腸全摘，J 型回腸囊肛門吻合術（ileal J-pouch anal anastomosis：IPAA）<br>　（2）大腸全摘，J 型回腸囊肛門管吻合術（ileal J-pouch anal canal anastomosis：IACA）<br>　（3）大腸全摘，回腸永久人工肛門造設術<br>　（4）結腸（亜）全摘，回腸人工肛門造設術<br>　（5）結腸全摘，回腸直腸吻合術<br>　（6）分割手術<br>　（7）腹腔鏡手術<br>　4．手術成績<br>　（1）術後合併症<br>　（2）術後排便機能<br>　（3）術後長期予後<br>　5．小児に対する外科治療<br>　6．分類不能腸炎に対する回腸囊肛門（管）吻合の成績<br>　7．回腸囊炎の治療<br>　8．術後のストーマケア<br><br>第6章　長期経過<br>　（1）初発時症状，経過<br>　（2）発　症<br>　（3）罹患範囲と症状<br>　（4）合併症・経過<br>　（5）UCの自然寛解<br>　（6）ステロイド薬の有効率とその長期的な効果<br>　（7）抗TNF-α抗体の有効率とその長期的な効果<br>　（8）寛解率<br>　（9）UCの病型<br>　（10）UCの長期予後<br>　（11）活動性の推移<br>　（12）長期予後に関係する因子<br>　（13）発症時年齢<br>　（14）再発，増悪因子としての感染性腸炎<br>　（15）生命予後<br><br>第7章　癌化・サーベイランス<br>　1．長期予後と癌化<br>　2．リスクファクター<br>　3．癌の特徴<br>　4．サーベイランス法とその問題点<br>　5．Dysplasiaの分類と生検でdysplasiaが認められなかったときの対応<br>　6．Dysplasiaが認められたときの対応<br>　7．術後のサーベイランス<br>　8．大腸癌の予防<br><br>第8章　小　児<br>　1．小児の潰瘍性大腸炎の特徴<br>　2．潰瘍性大腸炎患児の成長評価<br>　3．薬物療法<br>　（1）5-アミノサリチル酸（5-ASA）製剤（メサラジン，サラゾスルファピリジン）<br>　（2）ステロイド薬<br>　（3）免疫調節薬〔チオプリン製剤；アザチオプリン（AZA）/ メルカプトプリン（6-MP），カルシニューリン阻害薬；シクロスポリン（CsA）タクロリムス（Tac）〕<br>　（4）生物学的製剤（抗TNF-α抗体；インフリキシマブ，アダリムマブ，ゴリムマブ）<br>　4．血球成分除去療法<br>　5．外科治療<br>　6．メンタルケア<br><br>第9章　妊　娠<br>　1．潰瘍性大腸炎患者での妊娠に関する基本的な考え方<br>　2．疾患の遺伝性<br>　3．潰瘍性大腸炎による妊娠への影響<br>　4．妊娠による潰瘍性大腸炎への影響<br>　5．潰瘍性大腸炎治療薬の影響<br>　6．潰瘍性大腸炎による妊娠・出産の転帰への影響<br>　7．新生児への生ワクチン投与<br><br>第10章　高齢者<br>　1．高齢発症潰瘍性大腸炎の疫学<br>　2．高齢発症潰瘍性大腸炎の経過<br>　3．高齢発症潰瘍性大腸炎の重症度，罹患範囲<br>　4．高齢潰瘍性大腸炎患者の手術率，入院率<br>　5．高齢潰瘍性大腸炎患者の併存症<br>　6．高齢潰瘍性大腸炎患者に対する内科治療<br>　7．高齢潰瘍性大腸炎患者に対する外科治療<br><br>第11章　食事および生活指導<br>　1．食事・生活指導の必要性<br>　2．食事指導<br>　（1）活動期<br>　（2）寛解期<br>　3．生活指導<br>　（1）病状に応じた生活指導の内容<br>　（2）喫　煙<br>　（3）進学や就職における留意点<br>　（4）公的支援の活用<br>　（5）生命保険<br>　4．心理面での支援<br>　（1）支援の必要性<br>　（2）病状説明における留意点<br>　（3）講演会や患者会の活用<br>　（4）支援の到達目標<br><br>第12章　社会支援<br>　1．炎症性腸疾患の公的支援体制<br>　（1）「難病の患者に対する医療等に関する法律（難病法）: 平成26年法律第50号」制定の背景<br>　（2）「難病医療費助成制度」における重要なポイント<br>　2．その他の社会支援<br>　（1）NPO法人 日本炎症性腸疾患協会（CCFJ：Crohn’s & Colitis Foundation of Japan）<br>　（2）日本炎症性腸疾患学会（Japanese Society for Inflammatory Bowel Disease：JSIBD）<br>　（3）患者会<br>　（4）各保健所の取り組み<br>　3．社会支援実施に向けた対応<br>　（1）医療や支援の均一化<br>　（2）恒常的な支援体制の構築<br>　4．新たな社会支援体制<br>　（1）新規ツールの開発：webサイトやスマホアプリ<br>　（2）難病指定医，指定医療機関の検索<br>　（3）セカンドオピニオン，病診連携<br>　（4）生命保険加入</section></article>
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