健康管理の立場からみた胃潰瘍

Gastric Ulcer Considered from the Standpoint of Health Control

Ⅰ．潰瘍患者対策としての胃集検の意義

　胃集団検診のそもそもの出発点に於ける第一の目標は，胃癌の早期発見，就中早期胃癌の発見にあり，これと関連したその他の良性胃疾患，例えば胃・十二指腸潰瘍，胃ポリープ状隆起性病変の発見はむしろ附随的な意味をもつものであった．しかし，現実的には集検により発見される胃癌患者はたかだか0.1～0.5％程度の頻度にしか過ぎないのである．勿論致命的な疾患である以上，発見数の多寡によってその評価を低くみる考えは毛頭ない．しかし，胃癌の10ないし20倍の頻度の消化性潰瘍が発見されて来た事実は，まさに注目に値するものである，本来，癌に比べ愁訴を有することが多いと考えられていた潰瘍患者が，実は無自覚あるいは一過性のごく軽度の心窩部不快感，圧重感等を感じるのみで，実際には健康だと考えて日常の生活を送っていることの少なくないことが明らかとなった．一方また，消化器症状を訴えつつも器質的変化を証明できず，癌ノイローゼ傾向の強い人達も多い．それでこれらに対する対策が重要視されねばならないのは当然の帰結といってよい．したがって胃癌の発見に重点をおく地域住民を対象とした集検はともかく，職域における胃集検には早期胃癌の発見もさることながら，消化性潰瘍患者の発見とその対策という点に大きな意義をもたせるべきことをかねてより主張して来た．ここに職域集団の健康管理対策の一環としての胃集検の意義を強調するものである．

　In the past we have often emphasized that the aim of gastric mass screening in an occupational group lies in concentrating on the detection of peptic ulcer with subsequent therapeutic measures, although finding out early cancer of the stomach is as important. Peptic ulcer is found at the mass survey ten itmes or more (1-5 percent) as often as gastric cancer, but ulcer patients found thereby usually have few or no subjective complaints, so that they would often lead a normal life as if completely healthy. When these people are placed under health control as was the case in an occupational group where health care is taken seriously,yearly mass screening of the stomach has revealed that the incidence of peptic ulcer would go down to one third in three years.

　We must establish a consistent, systematic setup for health control of peptic ulcer, caring not only for regular examinations on the year-to-year basis, agreement on strict criteria of healing, but also for advice for the way of living after convalescence and the follow-up of ulcer. Above all, we would like to lay stress on the following points : ―

　1. Accurate diagnosis of ulcer with analysis of various factors involved in its healing tendency such as the site of origin, number, shape, size and depth. Whether an ulcer is intractable or not must also be determined.

　2. Establishment of a therapeutic principle effective and pertinent.

　3. More important, strict criteria for healing are essential with subsequent after-care and follow-up. As are shown in our results, fresh peptic ulcer crops up less often than is belived; most of ulcers in our series were old ones remaining not yet healed or relapsed or recurred. Our attention must be centered on the prevention of ulcer recurrence. For this, a consistent health control including systematic examinations of the stomach and after-care is most desirable.