胃集検で発見された胃潰瘍―頻度と経過

Gastric Ulcer Detected in Mass Survey of the Stomach: Its incidence and courses

　胃癌による死亡率の著明な低下を来たすまでにはいたらないが，胃集検の普及により全国で数多くの早期胃癌が発見され胃集検は次第にその初期の目的を達成してきている．同一集団を対象とした逐年検診では胃癌の発見率すら減少し，これ以上は間接フィルム読影の限界であるというところまでになってきた．

　このような状況になってくると，胃集検においては胃癌の早期発見という第一目的以外に，他の胃疾患の発見やその動態を知るということも大きな目的と役割の一つになってくる．ことに，職域胃集検では同一集団を継続して検診することが多いため，集団内の胃潰瘍の動態を知り，さらに一歩進んでこれを管理することは健康管理のうえからも重要な責務の一つである．

　A study has been made of vicissitude of gastric ulcer in an occupational group based on the results of gastric mass survey done on a year-to-year basis. In 1971 gastric cancer was seen in 0.04 per cent of the examinees, while ulcer of the stomach was seen 30 times as frequent, or in 1.2 per cent. This is due to the decrease of cancer in yearly gastric mass survey. In earlier stages of our investigation gastric cancer was seen in 0.5 per cent, with gastric ulcer 5.7 per cent.

　In our series not a case of ulcer was found in the upper segment of the stomach including cardia. Mostly it was seen at the level of the angle, and observations in indirect exposures were variegated.

　Special care must be taken in picking up lesions in the lower corpus and antrum. In order to detect gastric ulcer accurately, we need false negative cases four times as many, and often diseases other than ulcer have been detected. Gastric ulcer found at the mass survey was most often seen in men, especially among superintendants, safety guards and chauffeurs. Many (38.5 per cent) had a previous history of ulcer history. Multiple ulcers were found in 18.3 per cent, and in 22.1 per cent coexistent ulcer was seen in the neighborhood of the original ulcer.

　Gastric ulcer should be followed preferably by coemployment of radiography and endoscopy. Accurate rate of healing or recurrence can be obtained through observations of ulcer courses. Naturally this rate differs greatly according to the interval and length of observations. In 37 patients examined by x-ray and endoscopy every three months the rate of scarring in that period was 35.0 per cent. The rate of recurrence was also very high; it was observed in 76.8 per cent from the selfsame ulcer scar after it had completely healed. From 60 to 75 per cent of it seem to heal when observed on yearly basis, but within a much shorter period alternating phases of healing and flaring-up are repeatedly observed. Gastric ulcer heals easily and recurs as easily.