臨床の立場からみたAGMLの概念

Concept of Acute Gastric Mucosal Lesion: An Endoscopist's Point of View

要旨　AGMLに関して，内視鏡医の立場から，歴史的な展開，現状，今後の方向について，意見を述べた．もともとAGMLの概念は，内視鏡所見を中心に概念づけがされており，病理学的な裏づけが少ないなど基盤の弱い点がある．しかし，今日対象とする疾患が増加し，多用される事態となり，この概念に混乱が生じている．この時点で，概念，定義を論じることは極めて重要なことと考え，1つの定義を提唱した．現状では，緊急内視鏡を前提とし，臨床症状を加味し，かなり厳しく病変の程度と時間的な経過を限定した．しかし，今後，AGMLの病態生理学的な研究が進めば，この概念も変わっていくことが予測される．

　I here expressed my opinion on the historical development, present status and possible future development of a concept of acute gastric mucosal lesions (AGML).

　Originally, the concept of AGML was developed based on the findings of urgent endoscopy, leaving some weak points in pathological f indings. At present, the frequency of AGML diagnosed has been increasing in many clinics. However, current diagnositc criteria of AGML is far from satisfactory, creating confusion in the concept itself. It is, therefore, important now to discuss about the concept and definition of AGML. I forwarded my definition of AGML based on our experiences and review of literature published up to now, that is, one or any combination of the findings compatible with hemorrhagic gastritis, hemorrhagic gastric erosion or acute gastric ulcer on urgent endoscopy performed in patients with acute gastrointestinal symptoms.

　Under the current circumstances, I consider that the definition should be first of all based on the urgent endoscopic findings supplemented by clinical symptoms. My definition has also strict criteria with respect to the grading and time course of the lesions.

　It is very likely the concept itself will change according to the progress of pathophysiological studies on AGML in the future.