胃潰瘍の時代的変貌

Historical Transfiguration of Peptic Ulcer

　世につれ，時代につれ，変遷の跡の明らかな疾患があり，そうでない疾患がある．前者は，たとえば伝染病であり，後者は癌や動脈硬化症などである．潰瘍はそのどちらであろうか．一般には，消化性潰瘍の有病率や発生率は，時代時代の社会的状況を反映しながら消長してきたとするのが通念のようにみえる．しかも，このような前提に立って，面白いことには，いつも，日本人の消化性潰瘍が増加していることが強調され，その背景として文明や戦争，社会生活や食生活の変遷などとの関連が論じられてきた．とすれば，日本人の消化性潰瘍は時代とともに増加の一途を辿ってきたということになる．

　しかし，これを読む者がいつも隔靴掻痒の思いを強いられるのは，これらの記述がきまって，「最近，潰瘍が増加していることは誰しも異論のないところ……」，「最近，潰瘍が増加しているという声がしきり聞かれる……」というふうで，一向に，具体的な根拠が示されていないことである．また，そうでなければ，臨床において患者が増加したという数字が，いつのまにか，潰瘍の発生が増加したという話にすり変わってしまうという，論証の展開の曖昧さのためである．

　Upon examination of the incidence of gastric ulcer among Japanese people over the past eighty years with the use of autopsy data, macroscopically, there have been no great changes in the frequency of autopsy of gastric ulcer, and therefore in the frequency of occurence of gastric ulcer of which is a background. The present views that the prevalence rate and occurence rate of ulcer reflect the historical situation and thus rose and fall accordingly is questionable. Even during the period of the Second World War when there was a notably high ulcer death rate from ulcer, there were no sign that the frequency of autopsy of ulcer increased. This observation shows not that the war increase the occurence rate of ulcer but that it aggravated prognosis. Yet presently, the death rate from gastric ulcer falls below that of the pre-war level and is continuing to decrease. This is assumed as the result of the popularization of surgical operation. Moreover, it can be assumed that the current increase in the aged population is leading to a rise in the prevalence rate of gastric ulcer.

　Examination of the operation cases of the stomach over the past 15 years shows that the percentage of round ulcer is on the decrease, but this is due to the changes in views on operational indications. On the other hand, there is no definite historical transfiguration noted in the number of cases and length of linear ulcer. Recently, attention is drawn toward the fact that cases with erosion is increasing notably but its epidemologic meaning is unknown.