逆流性食道炎の病理診断

Histological Features for the Diagnosis of Gastroesophageal Reflux Disease

要旨　胃食道逆流症（gastroesophageal reflux disease; GERD）の特徴的病理組織所見については様々な報告があるが，確定的な見解はいまだにない．われわれは臨床的に明らかなGERDの食道生検材料を組織学的に，対照群と比較検討した．炎症性細胞浸潤，特に好中球・好酸球浸潤はGERD群で対照群に比して高頻度であったが，GERDに特徴的とされる上皮内好酸球浸潤，basal cell hyperplasiaおよび上皮内粘膜固有層乳頭の上昇は対照群と有意差はなく，必ずしも特異的組織所見ではなかった．また，そのほかの病理組織所見や増殖能もGERDに特徴的と言える像はなく，病理組織像のみから診断することは困難であった．GERDの診断は病態を把握し，臨床病理的な総合判断を下すことが重要と思われた．

　There have been various reports on the pathohistological characteristics of gastroesophageal reflux disease (GERD), but the diagnostic criterion has not been developed yet. We evaluate esophageal biopsy specimens from GERD patients along with control patients. Infiltration of the inflammatory cells especially neutrophils and eosinophils was more commonly seen in the GERD group than in the control group, however, incidence of the intraepithelial eosinophilic infiltration, basal cell hyperplasia, and invasion of the papillae of mucosa propria into the epithelium, which were regarded as characteristic to the GERD, was not statistically different between two groups. There were no other pathohistological findings and proliferative activity that were specific to GERD; therefore it was very difficult to diagnose GERD by the pathohistological findings alone. The diagnosis of GERD should be based on the pathological understanding and integratdd clinical pathological judgement.