急性胃病変の臨床―心窩部痛の面から

Clinics in Acute Gastric Lesions: Epigastric pain caused by them

　近年，胃内視鏡検査も出血の場合を含めてともかく発症の早期から積極的に行なうといった傾向にあるが，それにともない種々の胃粘膜の急性変化がとらえられるようになってきた．以下かなり激しい心窩部痛を訴える急性胃病変のうち，日常の診療にあたって知っておいたほうがよいと思われる3つの場合をとりあげ，述べることにする．

　As acute gastric lesions the following three varieties are described in this paper together with our view of them based on our experienced cases.

　1. Stress ulcer

　So far we havc come across 34 cases of gastric ulcer for which we have enough evidence at hand to demonstrate its close connection with emotional stress. It is characterized by such symptoms as fairly severe epigastric pain, nausea vomiting and at times bleeding (hematemesis and melena). When early seen with the gastrofiberscope, the gastric mucosa may display ulcerous changes with white coat over them. At times multiple bleeding erosions are observed, and even diffuse hemorrhage can be seen over the mucosal surface. Usually those acute lesions would disappear within a short time.

　In addition, some comments are added including those on the mechanism of origin in such acute changes.

　2. Mucosal changes caused by various kinds of medication

　Ingestion of drugs such as acetylsalicylic acid, steroids often gives rise to gastric bleeding, erosion or even ulcer, at times accompanied with considerable pain in the epigastrium. Several illustrative cases are presented here along with problems involved.

　3. Gastric anisakiasis with acute symptoms

　As a special case of acute gastric lesions mention is made of anisakiasis in the stomach. Epigastric pain is caused by anisakis-like larvae penetrating the gastric mucosa.