Helicobacter pylori除菌治療後に増悪した逆流性食道炎の2例

Reflux Esophagitis Aggravated after Helicobacter pylori Eradication Therapy, Report of Two Cases

要旨　Helicobacter pylori除菌治療後に増悪した逆流性食道炎の2例を経験した．〔症例1〕は48歳，男性，逆流性食道炎grade A．併存する胃潰瘍の再発抑止の目的で除菌したところ，1年後に胸やけが出現，内視鏡ではgrade Bへ進展していた．背景胃粘膜は，除菌前のopen typeからclosed typeに変化していた．〔症例2〕は61歳，女性，逆流性食道炎grade A．広範囲の腸上皮化生を有する萎縮性胃炎であった．除菌後3年6か月で胸やけが出現，内視鏡ではgrade Cへ進展していた．腸上皮化生の胃内分布に変化はなかった．除菌による逆流性食道炎の発症あるいは増悪には，酸分泌の回復と食道胃協調運動の変化の関与が示唆された．

　We report two cases of reflux esophagitis aggravated after Helicobacter pylori (H. pylori) eradication therapy.

　〔Case 1〕A 48-year-old man presented with heartburn and was endoscopically diagnosed as having reflux esophagitis and gastric ulcer scar. The presence of H. pylori was confirmed by histology and culture. H. pylori eradication therapy was performed by lansoprazole (30 mg) and clarithromycin (600 mg) for two weeks. Although treatment with H₂-blocker had been continued after the completion of eradication therapy, the patient complained again of heartburn one year later. Reflux esophagitis had recurred and was detected endoscopically as grade B.

　〔Case 2〕A 61-year-old woman presented with a 2-year history of dyspepsia and one-month of heartburn. She was diagnosed endoscopically as having grade A reflux esophagitis and atrophic gastritis with an extended intestinal metaplasia. She was treated with the same regimen as 〔Case 1〕. Because she complained of heartburn 3.5 years after the completion of H. pylori eradication therapy, an endoscopic examination was carried out. Although the grade of atrophic gastritis remained as it had been, reflux esophagitis was detected as grade C.