高齢者に経験した薬物初発胃潰瘍

Drug-induced Ulcer of the Stomach in the Aged

　高齢者に発生する疾患はより若年者層のものと本質的には変るものではないと言えるが，ただ加齢による機能的・器質的変化に多分に修飾され，それ故にその老化の変遷と疾患像の推移とを追求することは本質の解明に大きく役立つと考えられ，重要である．例えば，萎縮性胃炎の程度の増強と慢性胃炎の位置の問題，びらん性胃炎，ポリープあるいは早期胃癌の発生状況等は検索を要するにたる素材である．

　この意味において薬物性潰瘍が高齢者に発生することを探求することは，その発生機構の解明にかなりの比重をもちうると考えうるので，今度われわれが経験した薬物初発の潰瘍を内視鏡並びに一部病理学的に検討し報告したい．

　Drug-induced gastric ulcer was encountered in 11 elderly persons. This paper describes its endoscopic and pathologic findings with some reference to its pathogenesis. The drugs administered include steroid hormones and various antiinflammatory medicines.

　The age of the patients varied from 69 to 91 years, and the average was 79 years. In 7 patients the underlying disorder for medication was painful skeletal disease. Six persons were bed-ridden.

　Within one month of medical management gastric ulcer developed in 8 persons, and sudden gastrointestinal bleeding was seen at the beginning of the disease.

　The initial endoscopy revealed in all the patients ulcer in the antral portion, accompanied in 2 persons with duodenal ulcer, in 1 with ulcer up to the corpus on the lesser curvature and in another with erosion in the body. Subsequent endoscopy showed shallow ulcer of irregular type in 4 persons, punched-out type in 2 and multiple small ulcers in 5. Of 8 patients followed up, exacerbation was seen in 2. Pathological findings obtained in 7 persons showed that active from of ulcer was seen in 5. Pathologically it belonged either to acute or subacute ulcer. Atrophic pattern of the gastric mucoua was investigated in survived patients with endoscopic biopsy. Open type was seen in 4 cases (36%) and closed type in 7 (64%).

　When we take into account the facts that, in addition to the pharmacological effects of antiinflammatory drugs, ulcer was seen in the antral portion and the fundic gland remained mostly active despite old age of the patients, we think it pertinent that mucous disturbance was primarily responsible for ulcer. Reduced mucosal resistance associated with aggravating influence of acid-pepsin must have induced ulcer.