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犬の慢性下痢と炎症性腸疾患 犬の慢性下痢と炎症性腸疾患
・犬の炎症性腸疾患の病態
・犬の炎症性腸疾患の診断
・炎症性腸疾患の治療方針
・予後
犬の慢性腸症は、輸液や薬剤などの対症療法に抵抗性または再発性の慢性の消化器症状を示し、一般的な血液検査や画像検査などで原因の特定に至らない原因不明の消化器疾患とされています。慢性腸症は治療反応性により「食事反応性腸症」「抗菌薬反応性腸症」「炎症性腸疾患」に分類されます。
長期間お腹が緩かったり回復と再発を繰り返す場合様々な検討がされますが、「下痢」という非常に広範囲な理由で発生する症状のためになかなか診断に至らず、数ヶ月単位の経過をもつ犬も珍しくありません。
犬の炎症性腸疾患の病態
炎症性腸疾患は治療薬への反応により免疫抑制薬反応性腸症または治療抵抗性腸症に大別されます。病態はいまだ不明な点が多くありますが、腸粘膜における持続的な炎症や腸を内張りする絨毛(ヒダ)の障害が関与していると言われています。
発症年齢は若齢では少なく中年齢以上が多いとされており、比較的多くの犬種で見られる疾患です。
炎症性腸疾患の症状
主な症状としては、下痢、嘔吐、食欲不振、体重減少、腹鳴、腹痛などが認められます。それぞれの症状の強さによって障害の強い部位がある程度予測できる場合もあります。
また、重度の場合は胸水や腹水の貯留が見られることもあります。
犬の炎症性腸疾患の診断
診断には血液検査、糞便検査、X 線検査、超音波検査などを実施し、消化器症状の原因となる他の疾患を除外していきます。
さらに食事療法および抗菌薬を投与し、食事反応性腸症および抗菌薬反応性腸症の除外(改善されないことの確認)を行います。炎症性腸疾患の診断のためには消化管内視鏡検査を実施し、組織生検と病理組織学的検査を行います。もっとも多い病理組織診断は「リンパ球形質細胞性腸炎」で、消化器型リンパ腫との鑑別も重要です。
治療方針
内視鏡下生検で腸粘膜に炎症が認められた場合には、免疫抑制薬の投与を行います。また、状況に応じて低脂肪食などの食事療法を行う場合もあります。
治療効果の判定は、臨床症状と蛋白喪失(総蛋白やアルブミン)の程度を指標に、重症度を評価する指標である「CCECAI」を用いて行います。
予後
ステロイドのみや他の免疫抑制薬との組み合わせで良好にコントロールできることが多いです。しかしながら、ほとんどの症例で長期間あるいは一生にかけてなんらかの薬が必要となります。一方、治療抵抗性腸症となり徐々に消耗したり安楽死を選択することもあります。このように、ある程度確実な診断をつけるためには内視鏡検査が必要であるものの、栄養不良が長期に続いたために体力が著しく低下しているケースもあります。試験投薬であっても回復できるかどうかの判断や対症療法にもなりますので、なかなか治らない下痢や嘔吐がある場合は早めに相談することをお勧めいたします。
※参考文献:犬の治療ガイド2020. 2020,8,1.p351-353
記事執筆者
長江嶺(金乃時アニマルクリニック・獣医師)
略歴:東京都内の動物病院、神奈川県内の動物病院の勤務医を経て、現在は横浜市を診療エリアとする往診専門の動物病院を運営しています。
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