食道炎の診断と経過―病理組織と対比した内視鏡診断基準

Diagnosis and Clinical Course of Esophagitis: Criteria for Endoscopic Diagnosis as Compared with Histological Findings

　食道炎特に原発性食道炎の内視鏡診断は従来の硬性食道鏡による基準が漫然と適用されて来た^1)～11)．

　最近グラスファイバー光学系の進歩と，光源の進歩があり，明るい視野のもとで微細診断が可能なファイバー食道鏡（Fiberesophagoscope，FES）が実用化されたので，過去6年間の症例を中心に癌性随伴性食道炎を除いた原発性食道炎ならびに術後食道炎の内視鏡的診断基準を，組織像と対比して検討した結果を報告する．

　Patients with esophagitis examined by fiberesophagoscope are discussed separately in the first and second stages of examination. In the first period, criteria for esophagitis were established based on the histology of biopsy specimens in conjunction with endoscopic diagnosis. In the second period, surgical specimens were also studied and histological criteria of esophagitis were established. We were thus able to make endoscopic criteria certain. Clinical course and etiology of esophagitis are also discussed.

　For endoscopic diagnosis of primary esophagitis, the following important points of study are described : a) variety of erosions, b) color tone of the mucosa and c) directions of vessels.

　a) Erosion : They were classified as ‘spotty', ‘irregular', ‘protruded', ‘linear' ‘circular with central intact mucosa', linear ‘irregularly coalescent' and ‘belt-shaped' types. Esophagitis itself was also divided into three degrees by the severity of erosions.

　Severe esophagitis : cases showing both ‘irregularly coalescent' and ‘belt-shaped' erosions, affecting more than one third of the esophagus and/or with lesions beyond the bifurcation.

　Mild esophagitis : Cases with only spotty erosions.

　Moderate esophagitis : Cases to be classified between severe and mild degrees.

　b) Color tone of the mucosa : There were three fundamental colors yellow, white and red. Consequently, pink, pale yellow and pale white were regarded as representing normal colors of the mucosa. Therefore, for diagnosis of esophagitis, criterion of ‘atsophy' should be included besides classifying endoscopic findings as normal, mild, moderate and severe esophagitis.

　c) Directions of blood vessels : We have described different modes of running of blood vessels according to each segment of the esophagus. On the basis of this fact, abnormal course and form of vessels have been noticed. In the normal esophageal mucosa blood vessels are transparent. Their disappearance can be related to esophagitis.

　The degree of severity in postoperative reflux esophagitis depends on the extent of resection and also on operative methods. Alkali is important as a detrimental factor in prolongation of cure. Finally etiology of primary esophagitis has been analyzed.