Helicobacter pylori除菌療法にて改善した胃巨大皺襞症の1例

Enlarged Fold Gastritis Improved by Eradication of Helicobacter pylori, Report of a Case

要旨　症例は72歳，男性．人間ドックの上部消化管造影で胃体部小彎に巨大皺襞が認められ，精査目的に当科紹介受診となった．上部消化管造影では胃体部大彎側に皺襞の肥厚はみられないが，胃体部小彎に周堤様の皺襞の肥厚とNische様の所見がみられた．内視鏡像では胃体部小彎を中心に3条の肥厚した粘膜ひだが縦走し，胃体上部ではひだの屈曲により周堤様を呈していたが，びらん，潰瘍はみられなかった．超音波内視鏡では同部位の粘膜層の肥厚が認められた．組織学的には腺窩上皮のcorkscrew様の過形成と問質の炎症細胞浸潤，粘膜筋板の索状の走行がみられた．迅速ウレアーゼテスト，免疫染色にてHelicobacter pylor（H.pylori）陽性であった．発生部位が胃体部小彎側で非典型的であったが，H.pylori感染に伴う胃巨大皺襞症と診断し，除菌療法を施行した．除菌は成功し，上部消化管造影，内視鏡検査にて巨大皺襞は消失し，組織学的にも改善がみられた．胃巨大皺襞症の成因にH.pylori感染が関連していることを強く示唆する結果と考えられた．

　A Randwall-like appearance with barium-poolings on the lesser curvature of the corpus was detected in a 72-year-old man during a barium meal examination. Laboratory tests revealed normal proteinemia. Gastroendoscopy revealed enlarged folds without erosion and an ulcerative lesion on the lesser curvature of the corpus. Endoscopic ultrasonography revealed a remarkably thickened mucosal layer. To make an accurate diagnosis histologically, endoscopic mucosal resection for an enlarged gastric fold was performed. Histological findings showed corkscrew-like hyperplasia in the surface epithelium and mucosal infiltration by inflammatory cells. He was then diagnosed as having enlargedfold gastritis. Since Helicobacter pylori infection was detected, eradication therapy was performed (lansoplazole 60 mg, amoxicillin 1,500 mg and clarithromycin 400 mg for 7 days) . As a result, Helicobacter pylori was eradicated. After this treatment, the enlarged gastric folds and histological findings of the gastric mucosa were normalized.

　This case suggests Helicobacter pylori infection plays some etiological role in enlarged fold gastritis. This was shown by the improvement of the disease by eradication of Helicobacter pylori.