Helicobacter pylori除菌と萎縮性胃炎

Improvement of Atrophic Gastritis after Helicobacter pylori Eradication Therapy

要旨　萎縮性胃炎がH. pylori除菌で改善するのか，しないのか，まだ結論が出ていない．その最大の原因は萎縮性胃炎の定量的診断が定まっていないことである．そこで，共同研究による前検討で，萎縮は生検標本全体に占める固有腺の量で評価すること，胃体部小彎が最も鋭敏に萎縮改善を評価できる部位であることを確認した．今回は，除菌治療後3年以上経過を観察したH. pylori陰性化（n）群33例と陽性持続（p）群13例で萎縮性胃炎所見の変化を検討したので，個々の症例提示を中心に報告する．数値化して評価した生検組織学的な検討では，n群の胃体下部小彎では39.4％で，前庭部小彎では15.2％で萎縮が改善した．腸上皮化生は変化に乏しかった．萎縮パターンで評価した内視鏡的萎縮の改善はn群では33.3％であった．p群では改善例はなく，一部で萎縮の進展を認めた．今回の検討では胃体部小彎粘膜を中心に観察してH. pylori除菌で胃粘膜萎縮が改善する症例があることを示した．しかし，腸上皮化生も含めて萎縮性胃炎が改善するか否かの結論を出すためには，さらに長期間検討していく必要があると思われた．

　Improvement of atrophic gastritis after Helicobacter pylori (H. pylori) eradication therapy was investigated by endoscopic follow-up study with histological assessment, using biopsy specimens. From our preliminary analysis, it was revealed that the atrophy is able to be assessed by the area which the proper glands occupy in the total biopsy sample, and the lesser curvature of the gastric corpus is the most sensitive biopsy point to assess the improvement of atrophy. In this study, improvement of atrophic gastritis is observed in 33 H. pylori-negative patients and 13-positive patients who had over 3 years of follow-up after eradication therapy at Tokyo Metropolitan Komagome Hospital. The improvement of mucosal atrophy assessed by the Updated Sydney System was observed histologically in 39.4％ of the patients at the lesser curvature of the lower corpus and in 15.2％ at the lesser curvature of the antrum in H. pylori-negative patients. The endoscopic atrophic change was observed in 33.3％ of the H. pylori-negative patients. As a result, a possibility of improvement of atrophy was demonstrated. However, more long-time follow-up study with many eradicated patients will be needed to prove the possibility of improvement of atrophic gastritis including intestinal metaplasia.