腺境界と胃病変―老年者剖検例の検索より

Intermediate Zone and Gastric Ulcer: A study on autopsy cases of the aged

　消化性潰瘍の発生や慢性胃炎の進展に関与して腺境界部の実態を知ることは極めて重要な課題の1つである．このため，従来より数多くの研究が成されており，明らかにされていることも少なくない．しかし，病理形態学的な研究は，そのほとんどが手術材料によるものであり，既にその対象自体に多くの問題が含まれているように思われる．そこで剖検材料を通じての検索を行い，腺境界と消化性潰瘍のかかわりについて若干の対比検討を試みた．

　Relationship between intermediate zone and peptic gastric ulcer was histopathologically studied on stomachs obtained from autopsy cases of the aged people. There composed of; (1) 58 Cases of gastric ulcer (Ul-Ⅳ), among which 18 cases were open ulcers (average age, 73 yrs old) and 40, scarring ulcers (average age, 78 yrs old) and (2) 128 control cases, which were composed of 8 groups and each group was composed of 16 cases randomly selected from 70, 80, 90 and 100 decade of male and female, respectively.

　In this study, the upper boder of intermediate zone was defined as the most oral point where fundic glands became continuous, and the lower border was defined as the most oral point where nest-like group of fundic glands started to appear.

　In the control cases without circumscribed lesions, there was age-related increase in frequency of intestinal metaplasia and atrophy of fundic glands. However, this increase was much less than that expected from the observation on materials obtained at operation as well as biopsy. The upper border of intermediate zone did not move upwards in association with age, and the lower border changed greatly by individual, giving no apparent age-related changes of the borders.

　Peptic gastric ulcers including healed ones were always observed within the intermediate zone. In highlocated ulcers, the intermediate zones were also highlocated, while in low-located ones the intermediate zones were observed still in the lower area of stomach.

　Considering the above-mentioned findings, age-related movement of the intermediate zone was different by individual although there was a trend of slight upward movement in association with age, and therefore the position of peptic ulcer in the stomach was different by individual and there was no apparant age-reiated upward movement of it. Moreover there was no definite relationship between the age of individual and size of the ulcer. It could be concluded that there was not such a gastric ulcer which was characteristic to the aged people.

　As an additional finding, in the cardiac region isolated foci of intestinal metaplasia were present 18% in frequency in control groups and 45% in ulcer groups. This may indicate the fact that there is another process of intestinal metaplasia beginning from the cardiac region.