5.急性胃十二指腸粘膜病変

Acute Gastric Mucosal Lesion Related to Gastrointestinal Bleeding

要旨　acute gastric mucosal lesion（AGML）では，軽度の出血は発生していると考えられるが，吐・下血といった顕性出血の頻度は低く，われわれの早期上部消化管内視鏡患者での検討では頻度は5.4％であった．AGML患者の大部分は軽症であるので，原因除去とプロトンポンプ拮抗剤またはH2受容体拮抗剤の投与により数日で軽快する．しかし，重篤な合併症を有する大量出血患者では厳重管理が必要である．AGML発生要因は不明（40.5％），薬剤服用（32.4％），飲酒（16.2％），ストレス（10.9％）の順であった．AGMLの内視鏡所見から，①出血性胃炎型，②多発びらん・潰瘍型，③出血性びらん型，④発赤胃炎型の4型に分け，特に，観察時に出血を認める①～③の内視鏡所見を図説した．これらの型は単一でみられることもあればいくつかの組み合わせでみられることもあった．

　The incidence of overt upper gastrointestinal bleeding such as hematemesis or melena in AGML is low, according to our investigation, 5.4 ％ of cases in early esophago-gastro-duodenoscopy although minor bleeding is presumed to occur. More often most patients with AGML are mild, so they can recover in several days by elimination of causes and administration of proton pump inhibitors or H2 receptor antagonists. However, patients with massive bleeding associated with severe complications require intense management. Etiologies, in descending order, are : unknown origin (40.5 ％), medicine (32.4 ％) and alcohol (16.2 ％) and stress (10.9 ％). We describe the endoscopic features of AGML, dividing them into four types : ① Hemorrhagic gastritis (40.5 ％ in AGML) ② Multiple erosions and/or ulcers (35.1 ％) ③ Hemorrhagic erosins (16.2 ％) and ④ Reddened gastritis (8.2 ％). Especially, endoscopic type ①② and ③ which are shown are illustrated with observation of the bleeding involved. These endoscopic types present either alone or occasionally in various combinations.