消化性潰瘍のHelicobacter pylori除菌後の再発―わが国における実態

Peptic Ulcer Recurrence with Successful Eradication of Helicobacter pylori : Data from Some Case Studies in Japan

要旨　1996年12月以前にHelicobacter pylori除菌治療を開始し成功した胃潰瘍(GU)89例，十二指腸潰瘍(DU)85例を対象とした．NSAID服用例は除外した．GUでは除菌後潰瘍非再発例は68例(76.4％)，潰瘍再発例は13例(14.6％)，DUではそれぞれ80例(94.1％)，5例(59％)であった．初回潰瘍再発はGU・DUともに1年後までの早期に生じた．GU再発例では線状潰瘍瘢痕・瘢痕帯の存在，除菌前潰瘍歴が長いことや除菌前再発時の内視鏡像がA₁・A₂ stageであった回数が多いという特徴がみられ，約半数が再発を繰り返した．DU再発例では狭窄(球部または球後部)が全例に存在し，4例(80％)が再発を繰り返した．

　Helicobacter pylori eradication therapy started before December 1996 for 144 cases with gastric ulcer (GU) and 137 cases with duodenal ulcer (DU) . Among them, 89 cases with GU and 85 with DU were studied showing successful eradication without the use of NSAID. Thirteen (14.6%) cases had recurrence in GU and five (5.8%) in DU. Most of the first ulcer recurrences occurred within a year. The characteristics of cases with recurrent GU were the presence of a linear ulcer scar or a scarring zone, a longer history of GU and a greater frequency of A₁ and A₂ stage before eradication. About half of the cases had repeated recurrence. All the cases with recurrent DU had duodenal stenosis and four of five cases had repeated recurrence.