胃潰瘍の内科療法とその評価

Medical Treatment of Gastric Ulcer and its Evaluation

　胃潰瘍の治療とは活動性潰瘍を治癒させるとともに，患者を潰瘍より離脱させること，すなわち永久に治癒せしめることを目的としている．今日まで行われてきた治療法でこれを満足するものは，いわば手術療法のみであった．しかし本来良性疾患であるべき消化性潰瘍の治療法として，これはあまりに犠牲が大きく，なるべく保存的に治療したいと願うのが内科医としての立場である．今日までの内科療法をふり返るとともに，複雑な胃潰瘍の経過を述べ，内科療法がこれにどのようにかかわってきたかを明らかにするのが本稿の目的である．

胃潰瘍の治療法の評価

　胃潰瘍の治療の目的は，①疹痛など自覚症状の消失，②潰瘍の治癒促進，③再発の予防と潰瘍の永久治癒の3つにあることはすでに述べた．今日の治療法により，①はほぼ満足すべき結果が得られているが，③についてはまだほとんど手つかずの状態といってよい．今日まで発表されてきた数多くの報告は，主として②に関してである．従来より有効とされてきた潰瘍の治療法は次のように要約できる．

　（1）精神的および肉体的安静（入院）

　（2）食餌療法

　（3）タバコ，コーヒーなど嗜好品の禁止

　（4）薬物療法

　Rest, diet, stop-smoking and drug therapy have been used as the medical treatments of peptic ulcer. This study was done to know influence of smoking as well as effect of drug therapy on the peptic ulcer.

　1. Rate of smoking habit among the patients with gastric ulcer was 83.8% in men, 37.4% in women. This figure was significantly higher than those in controlled groups.

　2. Following the standard drug therapy for two weeks, the ambulant patients were divided into two group:. Inactive placebos were given to one group and the standard drug therapy was continued in the other. Between those two groups, there were no significant difference of healing rates after three months.

　3. Among 1,058 ambulant patients who were under medical treatment for peptic ulcer, 55.4% healed by 3 months, 71.5% by 6 months, and 81.3% during the whole follow-up term.

　4. Among 368 cases with gastric ulcer who had been followed up more than three years, ulcer recurred in 89 cases (24%) during the follow-up term. Not a few among the 89 cases were under the drug therapy when ulcer recurred.

　In conclusion, the presently available medical therapy could heal ulcer, but can not prevent the healed ulcer from recurring.