Helicobacter pylori除菌非奏効病変の特徴―胃十二指腸潰瘍：難治例

Intractable Peptic Ulcer after Successful Eradication of Helicobacter pylori

要旨　胃潰瘍228例，十二指腸潰瘍239例に除菌療法を行い，内視鏡的に潰瘍治癒を検討した．除菌後も5か月以上治癒しない難治性胃潰瘍例を5例認め，そのうち4例は高位の潰瘍例であった．不整な潰瘍辺縁隆起や固さ，深い潰瘍など，従来からの難治性潰瘍と同様の形態と考えられた．1例は吸収障害のためlansoprazole（LPZ）が無効で，2例はLPZ倍量16週間投与で治癒したが，H₂受容体拮抗剤（H₂-RA）に変更したところH. pylori陰性にもかかわらず，いずれも早期に再発が認められた．残る2例はH₂-RA投与では，むしろ一時悪化したと考えられた．

　We examined endoscopically the healing of gastric and duodenal ulcers after Helicobacter pylori eradication (GU 228 cases and DU 239 cases). In five patients, gastric ulcers were unhealed for more than five months after eradication. Four of those five patients had proximal gastric ulcers. The characteristic appearance of the ulcers was unevenness surrounding elevated mucosa, rigidity, and greater depth. One of those patients had a lansoprazole-refractory ulcer as shown by the absorption disturbance of lansoprazole. Two patients were treated with lansoprazole 60 mg/day for 16 weeks, resulting in the healing of their ulcers, but the ulcers recurred again in a short period despite acid suppressive therapy using histamin2 receptor antagonist (H₂-RA). Another two patients were treated with H₂-RA, and the ulcers became worse temporarily.