胃診断学20年の歩みと展望―胃潰瘍を中心に

Progress in the Diagnosis of Gastric Ulcer in the Last Twenty Years

要旨　戦後，わが国ではニッシェおよび胃の変形の研究によって，胃潰瘍のX線診断学は進歩した．20年以上前のことである．そして，過去20年の歩みは，次のようである．(1)瘢痕区域の検索により，胃潰瘍の治癒経過，治癒判定，再発などについてのX線診断学が登場した．(2)線状潰瘍や多発性潰瘍による胃の変形についての知見が一層詳しくなった．(3)急性胃潰瘍のX線診断学が始まった．(4)胃潰瘍の良・悪性の鑑別診断が明確になった．(5)胃体部，幽門部，幽門前部，大彎側，胃高位（胃上部）など，部位別にみた胃潰瘍のX線診断が検討された．(6)その他．その間，日本人の消化性潰瘍による死亡率は漸減している．そして近年，ulcus callosumの症例はほとんどなくなった．また，線状潰瘍の症例は減少し，特に著しく長い線状潰瘍の症例は激減している．なお，X線写真を一段と鮮明にするような，X線装置その他の開発は全くなかった．

　The radiographic diagnosis of gastric ulcer had made its progress through investigation of niche and deformity sign of stomach for the 20 years since the last war. The following developments have been made in the last 20 years.

　1) The radiographic diagnosis of gastric ulcer has been discussed in correlation with process of healing, assessment of healing and recurrence.

　2) Gastric deformities causing linear ulcer and multiple ulcer has been analyzed in detail.

　3) Radiographic diagnosis of acute gastric ulcer has been started.

　4) Malignant ulcer has become to be more definitely distinguished from benign ulcer.

　5) Radiographic diagnosis of gastric ulcer has been considered according to its location such as body, antrum, prepyloric region, greater curvature and upper portion of the stomach.

　The mortality of gastric ulcer has markedly decreased in Japan for the last two decades. Recently ulcus callosum has no longer been observed, and the number of linear ulcer has also markedly decreased. Especially, an extensively long linear ulcer has rarely been encountered.