逆流性食道炎の治癒過程－色素内視鏡によるstaging

Chromoendoscopic Observation and Staging of Reflux Esophagitis

要旨　逆流性食道炎は臨床の場でよく遭遇する疾患であるが，ヨード染色やトルイジンブルー染色による色素内視鏡検査を行って詳細を検討する向きは少ない．ヨード染色による再生上皮の診断，食道びらん・潰瘍の良悪性の鑑別診断，食道炎の既往診断，トルイジンブルー染色による深達度診断，びらんと再生上皮の鑑別診断，トルイジンブルー・ヨード二重染色による逆流性食道炎の内視鏡所見について述べた．更に，逆流性食道炎の病期分類について崎田・三輪の胃潰瘍の病期分類に準じて作成した私案を呈示した．また，その病期分類の臨床応用上の問題点につき検討し，逆流性食道炎の記載基準についても言及した．

　Although reflux esophagitis is a widespread disease, there have been few reports in which endoscopic findings with iodine and toluidine blue staining have been described in detail. In this paper, we reveal the usefulness of iodine staining for identification of regenerative epithelium and previous esophagitis, and differentiation of benign and malignant erosions or ulcers. We also demonstrated the beneficial role of toluidine blue staining for estimatlon of the depth of inflammation and differentiation of erosion and regeneration. Chromoendoscopic findings of reflux esophagitis using iodine together with toluidine blue are presented as well. Furthermore, we present our system for showing the stage of reflux esophagitis according to the stage of gastric ulcers as defined by Sakita and Miwa. We discuss the problems for the clinical application of this system. We also discuss the criteria for description of reflux esophagitis.