Helicobacter pyloriに起因しないとされる胃粘膜病変の形態―全身疾患に伴う胃粘膜病変：Crohn病と結節性多発動脈炎を中心に

Helicobacter pylori-Independent Gastric Mucosal Lesions Associated with Systemic Disorders―Crohn's Disease, Polyarteritis Nodosa, Schoonlein-Henoch Purpura, Tuberous Sclerosis, and Graft-Versus-Host Disease

要旨　消化管病変を伴う全身疾患は決してまれではないが，下部消化管に好発することが多く，上部消化管，特に胃に良性粘膜病変を合併する疾患は限定される．Crohn病と結節性多発動脈炎について多数の自験例を集計したところ，Crohn病では前庭部アフタ様病変が多く，胃潰瘍は頻度こそ少ないものの非定型的な形態を呈していた．噴門部の竹の節状外観はCrohn病患者の79％に認められ，病的意義は不明であるが診断的価値の高い胃粘膜変化であった．結節性多発動脈炎では，20％程度に胃病変が観察され，その多くは多発性胃潰瘍であった．さらに，Schoonlein-Henoch紫斑病，結節性硬化症，慢性移植片対宿主病に伴う特徴的胃病変の画像所見も呈示した．

　Various systemic disorders are known to involve the gastrointestinal tract. Gastrointestinal lesions often develop in the small or large intestine, and gastric mucosal lesions independent of Helicobacter pylori infection are rarely identified. Therefore, we reviewed gastric involvement in the following five disorders : Crohn's disease, polyarteritis nodosa,Schoonlein-Henoch purpura, tuberous sclerosis, and graft-versus-host disease.

　In Crohn's disease, aphthoid lesions at the antrum were seen in one third of the patients examined. Gastric ulcers were rare and their clinical courses were atypical. A bamboo joint-like appearance of the cardia, which may be only a morphological change in the gastric mucosa, was observed in 79％ of the patients and seems to be suitable as an indication for screening the condition because of high sensitivity and high specificity.

　In arteritis nodosa, gastric lesions, which were mostly multiple gastric ulcers refractory to medication, were seen in approximately 20％ of the patients.

　Schoonlein-Henoch purpura mainly develops in children. We presented a case of Schoonlein-Henoch purpura in an elderly subject. Recently, there have been some reports suggesting a causal relationship between Helicobacter pylori and Schoonlein-Henoch purpura. We also presented a case of Schoonlein-Henoch purpura in which Schoonlein-Henoch purpura gastritis was superimposed on Helicobacter pylori-associated nodular gastritis.

　As a rare gastrointestinal manifestation in tuberous sclerosis, hamartomatous polyposis of the stomach was demonstrated in our case.

　Although patients with graft-versus-host disease frequently complain of gastrointestinal symptoms from the early stage, gastric involvement in chronic graft-versus-host disease remains unclear. We presented interesting images of gastric lesions in a patient with chronic graft-versus-host disease.