アルコールによる急性胃病変症例

Acute Gastric Lesions Due to Alcohol Intake

　急性胃病変，殊に出血性胃炎をおこす代表的なものとして，アスピリンと共に挙げられるのがアルコール性飲料である．欧米諸国でアルコール性飲料といえば，ウィスキー等の高張液が好まれ，アルコール摂取後の急性胃炎，急性潰瘍の頻度が高く，それらにっいての報告も多い．日本では，酒，ビール等の比較的低濃度のものが従来多用され，大出血をおこすような症例に遭遇することは稀であった．しかし，最近生活が益々洋式化するにっれ，外国製のウィスキー等の輸入が盛んとなり，一方，国産でも高級洋酒の販路はますます拡大されっっあり，日本人とても高濃度アルコール性飲料を大量摂取する機会が多くなってきた．さて，急性消化管出血に対する内視鏡検査は，米国ではEmergent endoscopyとして早くから積極的に実施されている．この面では，私共の経験は彼らに比して乏しいと思う．近年，内視鏡器械の改良により安全性が強調され，出血巣の早期診断の必要性から多くの施設でEmergent endoscopyが応用されるようになった．

　私共に与えられたテーマは，アルコールによる急性病変であり，各Stageの代表例をあげてみよう．

　Alcoholic gastric lesions have been frequently reported in English literature and rarely in Japan. As an use of hypertonic alcoholic solutions becomes popular in our country, our experience of seeing gastric mucosal damage represented by hemorrhagic erosive gastritis and acute ulcer developing after a large amount of alcohol intake is increasing in frequency.

　We here in present representative three such cases.

Case 1: A 42-year-old man, heavy drinker, presenting with tarry stools after alcohol intake more than usual in amount. Gastroscopy three days later revealed multiple hemorrhagic erosions scattered throughout the body of the stomach.

Case 2: A 32-year-old man presenting with tarry stools after a large amount of alcohol intake. Gastroscopic observation one week later revealed multiple hyperemic spots suggestive of subsiding erosive gastritis.

Case 3: A 42-year-old man developed severe epigastric pain after alcohol intake without associated gastrointestinal bleeding. Gastroscopy taken a half month later demonstrated four shallow ulcers with irregular shape in the middle antrum. Conservative treatment was successful in the three patients. Erosive changes seen in Case 1 and 2 healed rapidly and ulcerative lesions in Case 3 more slowly, taking over one month. With regard to diagnosis, a barium swallow study can detect ulcerative changes, but is not helpful in detecting such erosive lesions as seen in Case 1 and 2. On the contrary, endoscopic approaches are of more help in establishing the diagnosis of erosive changes commonly seen among acute alcoholic lesions.