腺境界と胃病変―噴門側萎縮境界も含めて，内視鏡の立場から

Fundic-Pyloric Border and Gastric Diseases: Gastroscopic studies with endoscopic proximal atrophic border

　「腺境界と胃病変」というテーマに，内視鏡の立場のみから概説を加えることは大変難しい．これは腺境界の内視鏡的認知と病変の診断とは，内視鏡的立場からすればそれぞれ別個の観察対象となってしまい，結果的には腺境界と病変とは極めて密接なものであるという認識はあっても，これを内視鏡という概念の中で結びつけることが難しくなってしまうからである．そこで著者は，この問題を，腺境界と各胃病変がどのような位置的関係にあるか，そしてそれは内視鏡観察とどのような関連性を持つかということを中心に述べてみようと思う．

　It is very difficult to explain endoscopically a relationship between the fundic-pyloric border and gastric diseases. Therefore, this relation is discussed by dividing them into 3 mucosal lesions; intestinal metaplasia, gastric ulcer (erosion) and gastric cancer. Furthermore, a relation between an endoscopic proximal atrophic border and cardiac lesions is finally described.

　Intestinal metaplasia of the gastric mucosa has been easily diagnosed with endoscopic methylene blue staining method and this distribution has also been easily observed. Usually, the stained intestinal metaplasia is most abundantly distributed on the antrum and gradually slight on the lesser curvature of the corpus, but is rarely observed on the fundic gland area beyond the border. This metaplastic change of the gastric mucosa may come out at first on the process of the regeneration of erosions and may develop to the elevated type of intestinal metaplasia from the depressed or flat type. Epithelium of the intestinal metaplasia has an absorptive function as stained with methylene blue but the absorbed materials may be difficult to be transported out of the epithelial cells.

　This unbalanced condition in the intestinal metaplasia may produce a differentiated type of adenocarcinorna.

　Gastric ulcer was Closely related with the fundicpyloric border and localized on the border or on its pyloric side, but in about 5 per cent of the gastric ulcers, no relation with this border was found.

　Pathogenesis of these ulcers which had no relation should be much studied in future.

　In gastric cancer, a marked relationship with this border was observed in the histological types of gastric cancer. It was the fact that differentiated type seemed to be found in the pyloric gland territory and undifferentiated type in the fundic gland territory. And then the differentiated type of the gastric cancer was accompanied with intestinal metaplasia in a high frequency of more than 90 per cent. From this fact, a gastric cancer of the differentiated type may also be considered to arise from the background of intestinal metaplasia as mentioned above.

　Another border at the cardia of the stomach has been observed endoscopically with Congo-red method as described by Suzuki et al (1972), and this border has been understood as a boundary between atrophic and non-atrophic area (endoscopic proximal atrophic border) rather than a boundary between glands. Gastric ulcer on the upper part of the stomach and differentiated type of gastric cancer near the esophagogastric junction were much related with this proximal atrophic border.