内視鏡ルーチン検査の中での十二指腸炎―日本人の十二指腸炎のスペクトラム

Duodenitis Observed in Routine Panendoscopy: Spectrum of Duodenitis in Japanese

要旨　49,452件のパンエンドスコピーで1,232件（2.50％）の十二指腸炎があった．男性1,038件，女性194件，検査件数に対する頻度の男女比は2.8：1である．発赤型（29.9％），びらん型（45.5％），タコイボ型（13.1％），化生型（9.2％），AGML合併型（2.9％）に分類するのが適当であった．発赤型・びらん型・AGML合併型は若年者に，タコイボ型・化生型は高齢者で多い．AGML合併型を除き90％以上が球部内に限局した．十二指腸潰瘍は発赤型17.9％，びらん型31.4％，タコイボ型11.7％で併存し，十二指腸潰瘍⇔潰瘍瘢痕⇔びらん型十二指腸炎を行き来している例がある．胃びらん，胃潰瘍も高頻度で併存する．十二指腸炎が十二指腸潰瘍に進展することはまれで，十二指腸炎が腹痛や不定愁訴の原因とはなることも少ないように思われた．肝炎・黄疸・重篤な疾患・肝動注・TAEは十二指腸炎の原因となることがある．

　Utilizing the computerized data-base, we have found 1,232 (2.50％) cases of duodenitis among 49,452 cases in which panendoscopy was performed from 1976 to 1988 in Kanto-Teishin Hospital. This figure is much less than 20％ of the frequency of gastric erosion. Reviewing the endoscopic photos of these cases and dividing them into 5 types as shown in Figs. 1 and 2, there were 359 (29.9％) cases of reddening, 562 (45.55％) cases of erosive, 162 (13.1％) cases of verrucous, 113 (9.2％) cases of metaplastic and 36 (2.9％) cases of the type complicated with acute gastric mucosal lesion (AGML). Frequency of duodenitis of reddening and erosive type was higher in younger ages, and, in verrucous and metaplastic type, it increased with age (Fig. 3). Gastric metaplasia is not infrequently observed in biopsy of duodenitis of verrucous type. These data suggest the sequence of reddening→erosive→verrucous→metaplastic type. Except for metaplastic type, duodenitis was observed much more in male than female patients (Fig. 4). Site of duodenitis was limited to the duodenal bulb in over 90％ of the cases, but in 1/3 of the cases complicated with AGML, it was extended to the 2nd portion (Fig. 5).

　As shown in Fig. 6, 1/3 of the cases of duodenitis of reddening or erosive type complained of epigastric pain. 1/6 of the cases complained of dyspeptic symptoms. However, it is questionable if duodenitis brought about all of these complaints, because the frequency is the same as that in cases without any pathologic changes in panendoscopy. Duodenitis is often associated with gastric and duodenal ulcer (Table 1, Fig. 7). As is shown in Fig. 8, coexistence of gastric erosion and verrucous gastritis was as frequent in duodenitis as in duodenal ulcer (DU), and of higher frequency than in cases of gastric ulcer (GU). These results suggest that duodenitis is a disease in the same line as peptic ulcer, especially of DU. However, the course of duodenitis wasn't parallel to that of DU or GU.

　Often duodenitis is considered as the pre-stage of DU, but we could confirm it only in 6.4％ of cases. On the contrary, duodenitis, DU and its scar seem to alternate with other (Table 2). Duodenal lesions associated with AGML usually recovered more quickly than gastric ones. Duodenitis was observed in patients suffering from various diseases (Figs. 10, 11). We encountered it in 24 cases of acute hepatitis in the icteric stage (Fig. 1 c). It was also experienced after chemotherapy for cancer and TAE (Fig. 12). Duodenitis was observed in every 4 cases of Schönlein-Henoch disease and 4 out of 8 cases of Crohn's disease (Fig. 13).