種々のH2受容体拮抗剤に抵抗し，proton pump inhibitorでは再発を繰り返した難治・再発性胃潰瘍の1例

Intractable and Recurrent Ulcer: Resistance to Some H2-receptor Antagonists and Recurrence after Proton Pump Inhibitor Therapy, Report of a Case

要旨　患者は59歳，男性，会社員．1980年より12年にわたり，4種類のH₂受容体拮抗剤に抵抗し，proton pump inhibitor（PPI）で治癒を認めたものの，容易に再発を繰り返した典型的な難治・再発潰瘍の1例である．本症例の内視鏡，X線検査での形態学的特徴は，①活動期での憩室様の深掘れ潰瘍と周辺の不整と隆起，②瘢痕期での線状瘢痕と潰瘍底の隆起，周辺粘膜の一部陥凹を伴う凹凸不整が挙げられる．Helicobacter pyloriの持続感染はなく，血中gastrin値あるいは心身症の立場からも難治性潰瘍の病因は見出せなかった．今後新たな立場からの検討が必要であると共に外科的治療の選択も残された問題である．

　A 59-year-old male who has had an intractable and easily recurrent ulcer for 12 years. The ulcer resisted 4 kinds of H₂-receptor antagonists and recurred easily ever after proton pump inhibitor therapy. The typical picture obtained by endoscopy and x-ray examination is that of a deep punched-out ulcer with irregular randwall appearance like a diverticulum in the active stage, and having linear ulcer scar, protruded lesion and irregular surrounding mucosa in the scar stage. Persistent infection of Helicobacter pylori is not recognized. Psychosomatic tests (CMI, MAS) show no abnormalities, and other tests show that the ulcer is not environmentally induced. Further studies are necessary for discovering the etiology of intractable ulcer.