噴門部領域の良性狭窄性病変に対する最近の治療法―狭窄性食道炎，アカラシアなど

Recent Therapeutic Modalities for Benign Stenotic Diseases of the Esophagogastric Junction

要旨　噴門部に狭窄を呈す良性疾患としては，食道アカラシアや逆流性食道炎，粘膜下腫瘍，静脈瘤硬化療法や粘膜切除後の瘢痕化などが挙げられる．発生機序を考慮して個別に対応する必要があるが，代表的な前2者について最近の治療法を示した．食道アカラシアの保存的療法は内服薬とバルーンによる強制拡張術とが中心で，最近ではボツリヌストキシンの局所注入が注目されている．狭窄を来した逆流性食道炎では強制拡張術とプロトンポンプインヒビターの適応となるが，胃食道逆流防止手術がより適している場合も多い．最近導入された鏡視下手術はその低侵襲性が特徴で，これらの疾患では，現時点でも従来の外科治療と同等の効果が期待できるため，外科治療の適応範囲は拡がりつつある．

　Dysphagia is the most important symptom in patients with esophageal achalasia or severe stenotic reflux esophagitis. In these diseases, therapeutic strategy is determined by consideration of pathogenesis and severity in each patient, and the therapeutic modality should be selected according to each patient's condition.

　The main conservative treatments for esophageal achalasia are balloon dilatation and medication, and now local botulinum-toxin injection is likely to be used. In patients with stenotic reflux esophagitis, mandatory dilatation with low compliance balloon dilator followed by medication using proton-pump inhibitor are needed. Recently, a laparoscopic Heller-Dor operation for achalasia and a laparoscopic anti-reflux operation for gastroesophageal reflux diseases have been introduced in this field, and such treatment will probably become used more widely because only minimally invasive surgery is required. This treatment is less invasive than conventional surgical procedures, but it is equally effective.