十二指腸の非腫瘍性びまん性病変の診断―非特異性十二指腸炎

Diagnosis of Non-specific Duodenitis

要旨　非特異性十二指腸炎の診断基準は確立されておらず，その診断は混迷をきわめ実に多くの内視鏡分類が報告されてきた．本稿では従来の病理組織診断，内視鏡診断の問題点について詳述し，筆者らが提唱する新たな十二指腸炎の内視鏡分類を紹介した．また十二指腸における胃上皮化生とH. pyloriの関連性を意識した拡大内視鏡観察の重要性についても述べた．今後は共通の内視鏡分類診断に基づき長期的な多数例によるprospective studyが展開され非特異性十二指腸炎の病態が解明されるものと期待する．

　“Non-specific duodenitis (NSD)”remains a controversial area in clinical medicine. There have been many reports on endoscopic classification for NSD. However, it has been established that diagnosis of NSD. We have pointed out the problems of these histopathological criteria and endoscopic classification hitherto reported, and we proposed a new classification for the duodenitis into three types: hyperemic, erosive and roughsurfaced types baced on the endoscopic appearances. A new way of viewing the magnifying endoscopic diagnosis of NSD is necessary to define the role of H. pylori and gastric epithelial metaplasia in NSD. Prospective studies should be required including longterm clinical follow up of a large number of patients with NSD, accurately diagnosed by our endoscopic classification for duodenitis.