胃MALTリンパ腫のHelicobacter pylori除菌後の経過と治療効果―主に臨床の立場から

Endoscopic Evaluation of Helicobacter pylori Eradication Therapy Against Low-grade Gastric MALT Lymphoma

要旨　低悪性度胃MALTリンパ腫（以下L-MALT）におけるHelicobacter pylori除菌療法後の内視鏡的評価について検討した．L-MALTは発赤・びらん，粘膜腫脹・浮腫，Ⅱc様陥凹，潰瘍，敷石状粘膜，隆起，白斑などの多彩な所見を呈するが，その中で隆起所見は内視鏡的に除菌非奏効を予測しうる因子と考えられた．また，白斑以外の各所見はいずれも内視鏡的に評価しうる有用な所見であり，特に除菌後の萎縮様褪色所見の出現は，内視鏡的寛解を示唆する所見である可能性が高いものと考えられた．

　The histological cure of low-grade gastric MALT (mucosa-associated lymphoid tissue) lymphoma by Helicobacter pylori (H. pylori) eradication therapy has been demonstrated. However, the existence of relapsed cases within relative short periods indicates the necessity for other useful and accurate methods of evaluation of this therapy. The aim of this study was to investigate the endoscopic mucosal change after treatment as compared with “histological evaluation”.

　Out of 30 H. pylori-positive patients with low-grade gastric MALT lymphoma treated by H. pylori eradication and followed-up for more than one year, 24 cases showed histological regression (CR: 15, PR: 9, response rate = 80%). Dividing the endoscopic findings into seven groups such as white spot, redness/erosion, edema, Ⅱc-like depression, ulceration, cobblestone appearance and protrusion, protrusion indicated the tendency of no-response to treatment and the white spot was not changed despite histological improvement. On the other hand, the other findings had a tendency to regress easily after treatment and changed to discolored mucosa like atrophy, which corresponded well with histological cure. These results suggest that “endoscopic evaluation” may be useful in the treatment of low-grade gastric MALT lymphoma.