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<meta name="description" content="好評の第2版から5年ぶりの改訂．クローン病では，多くの有効な薬剤が臨床で用いられるようになり，患者のQOL向上のために外科治療を含めた治療選択が重要となる．第3版では臨床現場の第一線で活躍している各専門家によって全面改訂．より臨床現場で役立つ実践的な内容のガイドブックとなった．クローン病の診療に携わる全ての医師，コメディカルスタッフだけでなく，患者さんにも身近に置いて活用していただきたい．">

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		<h1 class="catchCopy">クローン病の診療に携わる全ての医師に役立つ，ポイントと最新情報がわかりやすくまとめられた実践的なガイドブック！</h1>
		

		<h1 class="title titleWidth">クローン病の診療ガイド<span class="version">第3版</span></h1>
		

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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2版から5年ぶりの改訂．クローン病では，多くの有効な薬剤が臨床で用いられるようになり，患者のQOL向上のために外科治療を含めた治療選択が重要となる．第3版では臨床現場の第一線で活躍している各専門家によって全面改訂．より臨床現場で役立つ実践的な内容のガイドブックとなった．クローン病の診療に携わる全ての医師，コメディカルスタッフだけでなく，患者さんにも身近に置いて活用していただきたい．</section><section class="preface">第3版刊行にあたって<br><br>　クローン病はわが国で増加し，2016年には6万人を超えたとされています．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，改訂されており，新しい診断法や治療法の開発に伴って本症に対する新しい知見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2011年に本症の診断，治療の実践に役立てていただくことを目的に初版が刊行され，その後の変遷に伴って2016年に第2版が刊行されて実臨床のガイドブックとして利用していただいてきたと思います．<br>　近年，診断に関しては本症の病態の解明，長期経過例に合併する大腸肛門管癌を中心とする悪性腫瘍の診断，本症を合併する高齢者の特徴など，診断面での進歩があり，治療に関しては治療目標の設定に基づいて，内科治療では多くの有効な新規薬剤が使用され，外科治療では手術適応の変遷，手術術式の選択の変化などがみられています．これらの新しい診断法，治療法はその有効性と問題点の検証を行いながら，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3版はこれらの観点から，従来の項目を多くの点で改訂，追記によりページ数を増や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3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．ぜひ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2月吉日<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　クローン病の診断<br>　　❶診断基準<br>　　❷診断のポイント<br>　　❸鑑別診断<br>　2　クローン病の分類<br>　　❶病型分類<br>　　❷活動度分類<br>　3　肛門病変の診断基準<br>　　❶クローン病における肛門病変<br>　　❷クローン病における肛門病変の分類<br>　　❸肛門病変の特徴<br>　　❹クローン病診断基準としての肛門病変<br><br>第2章　検査法<br>　1　上部・下部内視鏡検査1<br>　　❶下部内視鏡所見<br>　　❷上部内視鏡所見<br>　　❸内視鏡的活動指数<br>　　❹内視鏡検査における注意事項<br>　2　消化管造影検査（X線検査）<br>　　❶クローン病に用いるX線検査法<br>　　❷クローン病のX線所見<br>　3　小腸内視鏡・カプセル内視鏡<br>　　❶BAE<br>　　❷CE<br>　4　横断的画像診断<br>　　❶MRI<br>　　❷超音波検査<br>　　❸CT<br><br>第3章　病　理<br>　1　腸管病変の組織像の特徴<br>　2　組織像と肉眼像の対応<br>　3　クローン病診断における生検診断<br>　4　クローン病の胃病変<br><br>第4章　内科治療<br>　1　基本的な考え方<br>　2　5-ASA製剤<br>　　❶薬剤の種類<br>　　❷作用機序<br>　　❸クローン病に対する適応<br>　　❹副作用・相互作用<br>　3　ステロイド薬<br>　　❶適応および投与方法<br>　　❷寛解導入<br>　　❸副作用<br>　4　免疫調節薬<br>　　❶適応および投与方法<br>　　❷寛解導入<br>　　❸寛解維持<br>　　❹瘻孔に対する効果<br>　　❺術後再発予防<br>　　❻抗TNF-α抗体製剤との併用の有用性<br>　　❼副作用<br>　5　抗菌薬<br>　　❶適応および投与方法<br>　　❷寛解導入<br>　　❸術後再発予防<br>　　❹肛門病変<br>　　❺副作用<br>　6　栄養療法（経腸栄養療法）<br>　　❶栄養療法の位置づけ<br>　　❷栄養療法の特徴と適応<br>　　❸使用する栄養剤の種類<br>　　❹投与の仕方<br>　　❺活動期の投与法<br>　　❻寛解期の栄養療法<br>　7　GMA<br>　　❶GMAの適応と効果<br>　　❷GMA実施方法<br>　　❸GMA実施に際して<br>　8　抗TNF-α抗体製剤<br>　　❶TNF-αとは<br>　　❷作用機序<br>　　❸製剤の種類<br>　　❹適　応<br>　　❺治療戦略<br>　　❻投与する前の注意事項<br>　　❼効果減弱<br>　　❽術後治療<br>　　❾副作用<br>　　➓その他の留意点<br>　9　抗interleukin-12/23p40抗体製剤<br>　　❶Interleukin-12/23p40とは<br>　　❷ウステキヌマブとは<br>　　❸適応と投与方法<br>　　❹特　徴<br>　　❺副作用<br>　　❻注意点<br>　10　抗インテグリン抗体製剤<br>　　❶インテグリンとは<br>　　❷ベドリズマブとは<br>　　❸適応と投与方法<br>　　❹特　徴<br>　　❺副作用<br>　　❻注意点<br>　11　内視鏡的拡張術<br>　　❶クローン病狭窄病変への考え方とEBDの適応<br>　　❷EBDの方法<br>　　❸EBDの治療成績と合併症<br>　［Topics］新しい治療法─漢方薬<br><br>第5章　外科治療<br>　1　腸管病変　<br>　　❶手術適応と手術のタイミング<br>　　❷術前検査<br>　　❸手術術式<br>　　❹術後経過<br>　2　肛門病変<br>　　❶外科治療の選択<br>　　❷外科治療の実際<br>　　❸クローン病肛門病変に対する治療指針<br>　　❹クローン病痔瘻に対するその他の治療<br><br>第6章　長期予後<br>　1　クローン病の自然史<br>　2　disease behavior<br>　　❶クローン病におけるdisease behavior<br>　　❷disease behaviorと遺伝子マーカー<br>　3　累積手術からみる長期予後<br>　　❶クローン病における外科手術<br>　　❷年代による手術率の変化<br>　　❸術後の再発予防<br><br>第7章　癌　化<br>　1　クローン病に合併する悪性腫瘍<br>　　❶消化管悪性腫瘍<br>　　❷消化管外悪性腫瘍<br>　2　クローン病に合併する小腸癌<br>　3　クローン病に合併する大腸癌<br><br>第8章　小　児<br>　1　小児IBDの診断<br>　2　小児IBDの治療<br>　　❶栄養療法<br>　　❷5-アミノサリチル酸（5-ASA）製剤<br>　　❸抗菌薬<br>　　❹ステロイド<br>　　❺免疫調節薬<br>　　❻生物学的製剤<br>　　❼顆粒球吸着療法<br>　　❽肛門病変に対する診療<br>　　❾外科療法<br>　　➓monogenic IBDの治療<br>　3　その他の小児クローン病診療における重要なポイント<br>　　❶予防接種<br>　　❷心理社会的側面<br>　　❸トランジション（移行期医療）<br>　　❹成長障害<br><br>第9章　妊　娠<br>　1　IBD合併妊娠管理の基本的な考え方<br>　2　疾患の遺伝性<br>　3　クローン病による受胎・妊娠・出産・授乳への影響<br>　　❶受胎への影響<br>　　❷妊娠・出産・分娩への影響<br>　　❸授乳への影響<br>　4　妊娠・出産によるクローン病への影響<br>　5　クローン病治療薬の妊娠・児に対する影響<br>　　❶女性患者の妊娠，胎児に対する影響<br>　　❷男性患者に対する影響<br>　　❸授乳に対する影響<br><br>第10章　高齢者<br>　1　疫　学<br>　　❶高齢者の定義<br>　　❷高齢発症クローン病の頻度<br>　2　診断と臨床的特徴<br>　　❶高齢発症クローン病の診断<br>　　❷高齢発症クローン病の病型と治療経過<br>　3　内科治療<br>　　❶副腎皮質ステロイド<br>　　❷チオプリン製剤<br>　　❸抗TNF-α抗体製剤<br>　4　外科治療<br>　5　合併症<br>　　❶感染症<br>　　❷悪性腫瘍<br>　　❸血栓性合併症と抗凝固療法，抗血小板療法<br><br>第11章　食事および生活指導<br>　1　食事および生活指導の必要性<br>　2　食事指導<br>　　❶活動期（重症）<br>　　❷活動期（軽症～中等症）<br>　　❸寛解期<br>　3　生活指導<br>　　❶増悪因子を避ける指導<br>　　❷講演会や患者会を通じた情報提供による支援<br>　　❸社会制度による支援<br><br>第12章　社会支援<br>　1　社会支援の必要性と支援体制<br>　　❶社会支援の必要性<br>　　❷支援体制<br>　2　社会保障制度<br>　　❶難病医療費助成制度<br>　　❷身体障害者認定<br>　　❸所得補償<br>　　❹障害福祉サービス<br>　　❺合理的配慮の提供について<br>　3　患者支援組織<br>　　❶患者会<br>　　❷保健所<br>　　❸難病相談・支援センター<br>　　❹ハローワーク<br>　　❺その他<br>　4　間接的な支援活動<br>　　❶難治性炎症性腸管障害に関する調査研究班<br>　　❷希少疾病用医薬品の開発促進制度<br>　5　生命保険への加入<br>　［column］クローン病患者の就労支援</section></article>
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