胃・十二指腸潰瘍の治療法の評価―心身医学的治療法の効果とその限界

An Evaluation of Psychosomatic Therapeutic Approach to Gastroduodenal Ulcer

　胃・十二指腸潰瘍の病因論については，古くから論じられているが，その原因は多元的であり，発生機序も複雑で，今日なお未解決のところがある．しかし，近年では本症は心身症の代表的な疾患であることを，誰もが認めてきている．

　これは，本症の心身医学的病因論が説く，Fig.1のような発生機序が，塩酸，ペプシンなどの攻撃因子と，粘液の分泌量，胃壁血流量などの防禦因子との間にアンバランスが生じた時に潰瘍が発生するという，現在誰もが認めている本症の終極的な発生機序のバックグランドとして，もっとも妥当性の高いものであると考えられるからである^1)～3)．

　Gastroduodenal ulcer is one of the most important psychosomtic diseases of the digestive tract. There are some troublesome problems in this disease ; about 30% of ulcers healed by medical treatment will relapse, and psychosomatic factors are most important causes of the relapse.

　However, there is few clinical study from psychosomatic medical point of view to prevent the relapsing.

　We treated some of our inpatients with peptic ulcer with autogenic training (AT) in addition to the routine medical treatment. And, furthermore, to prevent the ulcer from relapsing, we instructed the patients to continue AT at home after discharge from hospital. The relapse rate in these patients was 16%. The relapse rate in patients who did not learn AT was 28%, and in those who gave up AT because they had no symptoms, it was greater than 38%.

　Thus, the regular practice of AT at home seemed to be very effective in preventing the relapse of gastroduodenal ulcer.