Helicobacter pylori除菌治療後に興味ある臨床経過をとった胃潰瘍の1症例

An Interesting Case which Showed Frequent Gastric Ulcer Relapses after Helicobacter pylori Eradication Therapy

要旨　H. pyloriの除菌治療が成功すると，胃潰瘍の再発する患者は数％と激減することは知られている．H. pyloriの除菌治療後，3種類の侵襲的検査でH. pyloriが陰性と判定されていたにもかかわらず，胃体中部小彎の胃潰瘍の再発を繰り返した61歳男性患者を供覧する．その後，除菌5年後に施行した¹³C尿素呼気試験のみが陽性であったので，H. pyloriの存在の有無は保留とするが，血清・尿中抗体検査は陰性のままであった．潰瘍は同部位再発で小さく，プロトンポンプ阻害薬で通常の治癒経過を示したが，5年間で少なくとも4回の再発を認めた．うち3回はH₂受容体拮抗薬投与中の再発であった．

　It is well-known that gastric ulcer relapses are rare after successful H. pylori eradication therapy. In this case report, a 61-year-old male patient with a gastric ulcer on the lesser curvature of the lower corpus presented frequent ulcer-relapses, in spite of negative results of 3 invasive tests for H. pylori. ¹³C-urea breath test peformed 5 years after eradication therapy showed positive data. However, anti-H. pylori antibody tests using serum and urine still showed negative results.

　The small relapsed ulcers occurred in the same area and healed easily after treatment with a proton pump inhibitor. However, the ulcer relapses occurred 4 times during a 5-year follow-up period, even during maintenace therapy using a regular-dose of H₂-receptor antagonist.