腺領域からみた良性病変の診断（胃炎，潰瘍，ポリープ，カルチノイド）―内視鏡的コンゴーレッド法による成績を中心に

Diagnosis of Gastroduodenal Diseases in Relation to Glandular Areas Using Endoscopic Congo-red Test

要旨　胃の良性病変は各腺領域の分布と発生部位に密接に関連している．われわれは内視鏡的コンゴーレッド法により酸分泌領域の拡がりと，各種胃疾患の関係を検討した．胃炎の拡がりは，年齢と強く関連しており，経過観察15例中5例（33％）に，平均観察期間14年6か月で胃炎の拡大を認めた．胃潰瘍は酸分泌境界近傍，特に遠位側に好発し，胃炎の拡がりとともに発生部位は噴門側に移動する．胃底腺ポリープは萎縮のない胃底腺領域内に存在し，ポリープ表面からも酸分泌がみられる．胃腺腫は萎縮の強い胃の非酸分泌領域内に発生し，表面の色素が褪色する．A型胃炎に合併した，高ガストリン血症を伴うカルチノイドは予後良好であった．

　Distribution of glandular areas of the stomach and extent of fundal gastritis closely relate to the location and incidence of gastroduodenal diseases. Previously, we had developed endoscopic Congo-red method (ECRM). Using this method we demonstrated that the discolored areas were histologically normal fundic mucosa and the non-discolored areas indicated the extension of fundal gastritis. We showed usefulness of ECRM to diagnose gastroduodenal diseases in relation to extent of the acid-secreting area, based on the data of 284 patients with this method. The extent of gastritis correlated with patient's age, which was proved by the cross-sectional analysis and retrospective cohort study. The gastric ulcer was usually located in discolored area. The wider non-acid secreting area was, the more likely a gastric ulcer was located in the gastric body. A fundic gland polyp existed in the discolored area of gastric body mucosa without atrophy, and secreted acid from the surface. A gastric adenoma was located in the non-discolored area of severely atrophic gastric mucosa and bleached Congo-red dye on its surface. A case with multiple small gastric carcinoid tumors with type A gastritis resected endoscopically seemed to have good prognosis.