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要旨 治りにくい食道炎を,①PPI 8週投与でも治癒しない症例,または,②H2拮抗剤の維持療法中に再発しPPIによる維持療法が必要であった症例と定義し,Savary-Miller分類における頻度を検討したところstage Ⅳで高頻度で認められた.変形・狭窄・Barrett食道を有する症例でロサンゼルス(LA)分類のgrade A~Dにおける①の頻度は50,50,78,100%,②の頻度は100,100,78,100%と高値であった.変形の有無別に食道内圧を検討したところ,変形(+)群で下部食道括約部圧が低下していた.よって,LA分類を使用するときは変形の所見を正確に確認することが予後や食道機能を予測するうえで重要であり,また治りにくい食道炎とは食道壁の変形所見を伴うものと結論した.
To detect the characteristic endoscopic features of intractable reflux esophagitis, we defined intractable reflux esophagitis as 1) failure to respond to treatment with a proton pump inhibitor (PPI) for eight weeks and 2) the need for PPI maintenance therapy. In patients with esophageal mucosal deformity of LA grade A-D, there was a significantly higher incidence of intractable reflux esophagitis than in patients without mucosal deformity. The lower esophageal sphincter pressure was also significantly lower in patients with esophageal mucosal deformity than in patients without deformity. We concluded that esophageal mucosal deformity along with esophageal manometry findings could be an indicator of whether the reflux esophagitis would be intractable or not.
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