胃のびまん性炎症性変化を伴った潰瘍性大腸炎の1例

Diffuse Gastritis Complicating Ulcerative Colitis, Report of a Case

要旨　患者は27歳の女性．下血，心窩部痛，悪心，嘔吐があり近医を受診し，4型の胃癌が疑われ当院を紹介された．全大腸炎型，中等症の潰瘍性大腸炎とびまん性の胃粘膜の発赤，びらんを認めた．胃生検では悪性の所見を認めなかったが，内視鏡的には表層拡大型の胃悪性リンパ腫も否定しきれず内視鏡的粘膜切除術を施行した．組織学的に高度の炎症細胞浸潤を伴い腺窩内に膿瘍も認め，潰瘍性大腸炎の組織所見に類似していた．Helicobacter pylori（H. pylori）は培養，尿素呼気試験，血中IgG抗体のすべてが陰性だった．胃炎は制酸剤，抗生剤の投与がなくとも，潰瘍性大腸炎の緩解に伴って改善を認めた．

　A 27-year-old woman with nausea, vomiting, epigastralgia, and hematochezia was admitted to our hospital. The barium enema study showed lead-pipe like appearance and the total colonoscopy revealed diffuse erosions and redness continuously from the rectum to cecum. Biopsy specimens showed the diffuse severe mucin depletion, crypt atrophy, crypt distortion, and crypt abscesses, which were consistent with the ulcerative colitis. On the other hand, upper gastrointestinal endoscopy showed diffuse erosions and redness in the gastric mucosa. Endoscopic mucosal resection was undergone and the specimens revealed the diffuse moderate chronic active gastritis including the abscess in the gastric pit. Helicobacter pylori (H.pylori) was considered to be negative because ¹³C-urea breath test, anti-H. pylori immunoglobulin G antibody, and culture were all negative.

　After taking mesalazine and prednisolone, she underwent colonoscopy. Endoscopic findings showed active inflammation yet, then betamethasone was added topically. Though she never took proton pump inhibitor or histamine receptor antagonist, upper gastrointestinal endoscopy showed almost normal gastric mucosa after the remission of ulcerative colitis.