アレルギー性胃炎の4症例

Allergic Gastritis: with special references to its roentgenologic, endoscopic and histologic findings

　アレルギー性胃炎は，急性胃炎の分類上，Bockus¹⁾のacute simple exogenous gastritis，Henning¹⁾のakute alimentäre Gastritisの一分型に属するものと考えられる．一般に食餌の不摂生と関係があるため，急性胃カタルとして処理され，その経過も短時日で良好なため，胃X線，胃内視鏡，胃生検が行なわれる機会が少なかった．

　胃X線検査にっいては，最近，第一線で活躍している諸家により，その機会が多くなったが，その特異な所見は，進行癌と誤診される場合がある．

　Because of advances in their technics of examination, home doctors can now observe early stage of acute gastric diseases both by roentgenography and endoscopy. As such we have experienced 4 cases diagnosed as acute allergic gastritis.

　Case 1: ― a 23-year-old man, sufftering from epigastralgia and diarrhoea shortly after eating raw mackerel. Two days later x-ray revealed a transient, soft filling defect suspected to be due to marked swelling of the mucosa and to spasm in the antrum. Seven days later, the mucosa showed almost normal x-ray findings.

　Case 2: ― a 28-year-old man, having eaten “sushi” with raw mackerel at night. Next morning he had epigastralgia with subsequent vomiting. X-ray picture taken three days later showed edematous swelling of the folds and a transient, soft filling defect. Biopsy disclosed only mild edema in the superficial zone of the lamina propria with no inflammatory cell infiltration.

　Case 3: ― a 38-year -old man, complaining of epigastralgia shortly after eating raw sardine pickled with vinegar. Next morning x-ray revealed transient filling defect in the lesser curvature of the antrum. Gastrofiberscopy two days later demonstrated edema spread from the corpus to the antrum along the lesser curvature. Biopsy carried out at that time showed degeneration of mucosal cells, mild edema and marked eosinophilic infiltration in the laimina propria.

　Case 4: ― a 65-year-old woman, suffering from epigastralgia and vomiting after eating meuniére of sardine. X-ray examination done four days later showed hypersecretion, swollen mucosal folds, transient filling defects from the corpus to antrum together with an irregular niche in the antrum on the posterior wall. Five days later, gastroscopy revealed typical hemorrhagic erosions at the angle and in the antrum. They disappeared when seen ten days later, leaving an irregular-shaped ulcer in their wake, covered with white coat. However, biopsy done at that time exhibited still remaining hemorrhagic erosions as well as acute shallow ulcerations.

　In general, allergic gastritis most often occurs after eating fish and/or shellfish. While roentgenography would demonstrates transient, soft filling defect, endoscopy would occasionally reveal hemorrhagic erosion. Its histologic findings include changes in the lamina propria and submucosa such as edema, degeneration of mucosal cells, inflammatory cellular, especially eosinophilic, infiltration, at times with hemorrhagic erosion and acute shallow ulceration.