7.胃潰瘍・十二指腸潰瘍

Gastrointestinal Bleeding―Gastric Ulcer and Duodenal Ulcer

要旨　胃潰瘍・十二指腸潰瘍からの顕出血に対する診断，病態，治療について述べた．診断，治療ともに内視鏡検査が有力である．診断では内視鏡検査にて露出血管を見い出しForrest分類のIa，Ib，IIaでは直ちに治療を行う必要がある．内視鏡的治療を行うには露出血管を適切な視野にもってくることが重要であり，時には先端フード装着が有効なことがある．内視鏡治療の方法には種々あるが自身の得意な方法を修得することが肝要である．胃潰瘍・十二指腸潰瘍に対する内視鏡的止血率は高い．しかし数％ではあるが止血困難例があり，出血死も存在する．内視鏡的止血に固執することなく次の治療法を選択すべきである．

　We discuss here the diagnosis, disease condition, and treatment of bleeding gastric ulcer and duodenal ulcer which cause bright red hematochezia (the passage of stools coated with/containing bright red blood).

　Endoscopic procedures are useful for both the diagnosis and the treatment of such conditions. In diagnostic endoscopy, visible vessels should be searched for, and treatment should be given without delay to patients who have been found to have peptic ulcer bleeding falling under the categories of Forrest Ia, Ib and IIa in accordance with the Forrest's classification. In endoscopic treatment, it is important to keep a visible vessel in an appropriate position in the field of view, and, for this purpose, the attachment of a hood to the tip of the endoscope may be helpful.

　While various techniques can be adopted in endoscopic treatment of gastrointestinal bleeding, it is significant for a doctor to find and master a technique matching his/her own skills.

　The success rate of endoscopic hemostasis for gastric ulcer and duodenal ulcer is high. However, intractable bleeding does occur, though in only a low percentage of patients with gastric ulcer and duodenal ulcer, and death from loss of blood may sometimes occur. In patients whose bleeding is uncontrollable by endoscopic hemostatic procedures, these procedures should be abandoned and another treatment method should be employed without delay.