健康管理の立場からみた胃潰瘍

Gastric Ulcer Considered from the Standpoint of Health Control: for more effective mass screening

　胃癌の早期発見を目的として実施している胃集検において，胃潰瘍はかなり高い頻度で発見されている．筆者らの施行してきた成績では，集検対象および年度によって差はあるものの，瘢痕を含めて3.0～6.0％の頻度で発見されている．今回はこれらの胃潰瘍例についてどのように処理し，管理しているかという面から検討してみた．

対象

　筆者らの実施している胃集検の対象は，その集団と集検方式（精検を含めて）で分けてみると3つの形に大別される．

　The present state of control for gastric ulcer is evaluated separately in general population, people in a model area and in occupational groups. Advice and guidance for control of gastric cancer are sufficiently given to people in general by public health nurses, but ulcer of the stomach is of such a common occurrence that there is shortage of personnel for its control. Increase of staff together with introduction of electric computer is urgently needed to meet the demand. On the other hand, patients with gastric ulcer in a model area are favored with guidance and control for it by public health nurses. And yet persons with gastric. ulcer accidentally detected at a mass screening of the stomach are generally free from any subjective symptom. Soon after ulcer dete ction they may undergo examination and treatment, but mostly they are lost to the follow-up. Consequently, observation of ulcer courses is put off unit the examination one year later. We believe that persons under control for gastric ulcer should undergo ‘straight thorough examination¹⁾ at the next screening. Considered from the standpoint of ulcer control, even this is not sufficient.

　¹⁾Thorough examination of the stomach to be done without preliminary indirect radiography to those that are in need of ulcer control because lesions confirmed at the minute examination or treatment one year before, and to those that are unsuitable for indirect x-ray examination owing to deformed stomach considered as lasting or to excised stomach.

　Patients with detected gastric ulcer in occupational groups are as a rule under consistent control for it because of convenience and facilities they are provided with, but even here people are sometimes indifferent to the guidance for ulcer control. Often our expectations for a better result fall far short of the mark.

　Management of gastric ulcer after its detection should be done with meticulous care, for even from strictly controlled ulcer patients gastric cancer may sometimes develop.