Helicobacter pylori除菌後の背景胃粘膜の性状と潰瘍の再発

Change of Histological Gastritis and Frequency of Ulcer Recurrence after Eradication of Helicobacter pylori

要旨　Helicobacter pylori(H. pylori)の除菌治療に成功し，3年以上経過を観察しえた胃潰瘍63例と十二指腸潰瘍65例を対象とし，除菌前後の胃粘膜の組織学的変化と潰瘍再発の頻度について検討した．炎症細胞浸潤，好中球浸潤，および表層上皮の変性は除菌治療後早期より改善し，以後胃炎のない状態が維持された．萎縮と腸上皮化生については，胃体部では除菌治療後に徐々に改善した．除菌治療成功後の潰瘍の再発は，十二指腸潰瘍では65例中1例(1.5％)，胃潰瘍では63例中4例(6.3％)であり，その頻度は低率であった．潰瘍が再発した5例中4例は非ステロイド系抗炎症剤(non-steroidal anti-nflammatory drug ; NSAID)服用の既往があり，うち1例は除菌1か月後に胃潰瘍の再発を来し，酸分泌抑制剤治療に対して難治性かつ易再発性であった．潰瘍の再発を来した5例とも，除菌後に胃炎は消失した状態にあった．H. Pyloriの除菌は胃粘膜の炎症を改善し潰瘍の再発を抑制するが，背景に炎症のない状態でも潰瘍は再発し，NSAIDは除菌治療成功後の潰瘍再発における重要な危険因子と考えられる．

　To determine the long-term effect on Helicobacter pylori (H. pylori) eradication, we examined change of histological gastritis and frequency of ulcer recurrence after successful H. pylori eradication. The subjects were 63 gastric ulcer (GU) patients and 65 duodenal ulcer (DU) patients who were followed up more than three years after successful H. pylori eradication. The histological gastritis before and after eradication of H. pylori was assessed according to the Updated Sydney System.

　The degree of neutrophil infiltration and degenerative epithelium of the antrum and fundus improved one month after eradication of H. pylori. The degree of inflammation of the antrum and fundus improved one year after eradication of H. pylori. The degree of atrophy and intestinal metaplasia of the fundus improved slowly after eradication of H. pylori. One of 65 (1.5%) patients with DU, four of 63 (6.3%) patients with GU had an ulcer relapse after successful H. pylori eradication. Four of five patients with ulcer recurrence took non-steroidal anti-inflammatory drugs.