急性胃潰瘍の病理

Pathology of Acute Ulcer of the Stomach

　「急性胃潰瘍」という言葉をきいてどのような想念をもつかは，内科の先生と外科の先生とでは随分食い違うのではなかろうか？切除胃の検索に当たる病理医のそれは，大体において外科医のイメージに近いものと思われるが，それは「手術適応」という前提に立ったこの診断名のつけられる疾患の氷山の一角であって，急性胃潰瘍の病理を論ずる際には，外科の先生のみならず内科の先生にも，ある程度納得のゆくものでなくてはならないであろう．

　しかし内科的に治癒の見込みのある急性胃潰瘍については，たとえ内視鏡と生検組織診によってその実際の姿をうかがい知ることができるようになったとはいえ，系統的に論ずることは難しい．

　On the basis of macroscopical and histological findings of the resected stomach, acute gastric ulcers are classified into those in narrow and broad senses. The former fulfilled the strict criteria of the acute uler indicated by “punched out ulcer” without any convergency of the mucosal folds, while the latter is accompanied by slight convergency focusing on the center or periphery of the acute ulcer, thus indicating acute exacerbation of the pre-existed ulcer.

　By statistical analysis of the cases with gastric ulcer, it was found that relative frequency of acute ulcer increased in recent years.

　Comparing with the statistics done 20 years ago by authors on whole gastric ulcers resected, we have extracted the following points as characteristic of acute gastric ulcer.

　1. High frequency in aged people.

　2. High frequency in the body, especially in its posterior wall.

　3. High frequency of large ulcer and low frequency of ulcer which completely disrupted the muscularis propria.

　4. Frequent accompaniment of multiple erosions caused by acute gastritis in the antral mucosa.

　Macroscopical features of the acute gastric ulcer are also presented.