脊椎後彎症の患者にみられた広範なBarrett食道とBarrett食道潰瘍の1例

Wide-spread Barrett's Esophagus and Ulcers Associated with Kyphosis, Report of a Case

要旨　脊椎後彎の女性に認められた18cmに及ぶ広範なBarrett食道とそれに伴ったBarrett食道潰瘍の1例を報告した．患者は64歳，女性．脊椎後彎症のため5年前から矮軀となった．食欲不振と食後の嘔吐を主訴として来院した．X線検査で胸部上部食道に潰瘍と狭窄，胸部下部食道に潰瘍を認め，食道裂孔ヘルニアを伴っていた．内視鏡的には上切歯列から20cmの部位に狭窄と潰瘍，35cmの部位に潰瘍を認めた．生検では胸部上部食道の潰瘍辺縁からの生検でいわゆるspecialized columnar epitheliumが採取され，以下胸部食道全域で円柱上皮が認められた．脊椎後彎に伴う食道胃逆流がBarrett食道の発生と進展に関与したことが疑われた．

　A 64-year-old woman with kyphosis was admitted to our hospital with complains of anorexia and vomiting. Radiologic examination revealed a stenosis with an ulcer in the upper thoracic esophagus and another ulcer in the lower thoracic esophagus. Endoscopic examination showed a stenosis with an ulcer at the level of 20 cm from the incisors and another ulcer at 35 cm. The endoscopical biopsy specimen demonstrated so called specialized columnar epithelium (Paul) around the ulcer in the upper thoracic esophagus and columnar epithelium in the middle and lower thoracic esophagus. The patient was diagnosed as having wide-spread Barrett's esophagus and Barrett's ulcers caused by reflux esophagitis due to kyphosis.