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Stomach and Intestine(Tokyo) Volume 24, Issue 4 （April 1989）

胃と腸 24巻4号（1989年4月発行）

Japanese English

研究

食道mucosal bridgeの成因，形成機序を中心とした自験6例の解析と文献的考察 Esophageal Mucosal Bridge, Report of Six Clinical Cases and a Review of the Literature 粉川隆文 ¹ , 市川寛 ¹ , 北住清治 ¹ , 岸泰三 ¹ , 田井中憲三 ² , 竹村俊樹 ² , 森田豊 ² , 伊谷賢次 ² , 吉川敏一 ² , 福本圭志 ² , 近藤元治 ² Tukafami Kogawa ¹ , Hiroshi Ichikawa ¹ , Toshiki Takemura ² , Keiji Fukumoto ² , Motoharu Kondo ² ¹舞鶴赤十字病院内科 ²京都府立医科大学第1内科 ¹Internal Medicine, Maizuru Red Cross Hospital ²The First Department of Internul Medicine, Kyoto Prefecturul University of Medicine pp.423-432

発行日 1989年4月25日 Published Date 1989/4/25

DOI https://doi.org/10.11477/mf.1403106434

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要旨　6例の食道mucosal bridgeを経験し，うち3例で，その形成過程を内視鏡的に経過観察しえた。原因は内視鏡的食道静脈瘤硬化療法2例，食道カンジダ症，Barrett食道，逆流性食道炎および原因不明各1例であった．食道mucosal bridgeは極めてまれな病態で，過去15例の文献報告があるにすぎず，自験6例を加え臨床的検討を行った．原因は後天例が14例と多く，すべて炎症ないし潰瘍病変に続発して形成されていた．形成機序としては，壁在性のmucosal bridgeでは，潰瘍底が粘膜下で交通し，取り残された粘膜がmucosal bridgeを形成する説，また食道壁の前後方向のmucosal bridgeでは，炎症による肉芽がこの方向に癒合する説が有力であり，pseudopolypが関与する炎症性腸疾患におけるmucosal bridgeの形成機序と若干の相違があるものと思われた．

　Esophageal mucosal bridge (EMB) is a rare condition. To date (1986), only 15 cases have been reported in world medical literature, 9 cases in English and 6 in Japanese.

　Six cases of EMB are presented. Twenty-one cases including 6 of the author's are reviewed. Conclusions are as follows : 　1) Two cases are extremely rare ones, including EMB observed in a case of Barrett-esophageal ulcer accompanying congenital broncho-esophageal fistula. No such cases have been reported in medical literature.

　2) The etiology of EMB is not yet known. Inflammation and/or ulcer of the esophagus are seen in most cases, suggesting that the etiology of EMB is acquired(Table 1).

　3) The location of EMB is mainly the middle and lower esophagus. EMB can be single or double. Intramucosal form of EMB is the one mainly recognized. In 7 cases, EMB formed in an anteroposterior direction was seen. This form is supposedly another characteristics of EMB (Table 2).

　4) Pathological conditions seen in the esophagus with EMB are varied, these are, ulcer, moniliasis, hiatal hernia, stenosis, etc (Table 2).

　5) Histological findings of EMB are normal in congenital cases. In acquired case, esophagitis, fibrosis and granulomatous tissue are demonstrated. These varied findings are presumably due to the difference in grade of inflammation and period of examination in each case.

　6) In inflammatory bowel disease, the fusion of pseudopolyposis is thought to be the main cause of mucosal bridge formation. In the esophagus, however, communication of two ulcers in the submucosa and fusion of granulomatous tissue in an anteroposterior direction are considered to be the main mechanisms for the formation of EMB (Fig. 11) . The authors consider that the follow-up studies in 3 cases support these two theories (Figs. 1, 4 and 7)