胃潰瘍の内視鏡的難治所見の解析―8週以内治癒症例と8週未治癒症例の比較

Endoscopic Findings Affecting the Healing Rate of Gastric Ulcer

要旨　初回内視鏡検査時に活動性潰瘍と診断され，H₂拮抗薬で治療された症例のうち8週以内の治癒症例271例および8週での未治癒症例81例を対象とした．その背景因子，潰瘍の形態的性状から潰瘍の治癒を遷延させる因子を判別分析で解析し，初回内視鏡検査時におけるprospectiveな治癒予測の可能性を検討した．その結果，性，年齢，治療環境，合併症，潰瘍歴，喫煙および飲酒習慣，発症の誘因，自覚症状の背景因子は治癒予測の判定因子とはならなかった．初回内視鏡所見では下掘れ，2cm以上の大きさ，線状傾向，胃角部，A₁ stageの順に未治癒要因としての重みがあり，これら要因の8週未治癒判別能は88.3％であった．

　We evaluated patients' profile and endoscopic findings which affected the healing rate by discriminate analysis in 352 patients with gastric ulcers treated with H₂-receptor antagonists. The factors affecting ulcer healing were analyzed between the ulcers that healed within 8 weeks of treatment (tractable ulcers) and those which did not heal within that time (intractable ulcers).

　Two hundred and seventy one patients (77.0%) had tractable ulcers and 81 cases (29.9%) had intractable ones. There was no significant difference between two groups in the following factors: 1) patients' profile; sex, age, therapeutic environment, complication, past history of gastric ulcers, smoking, drinking, inducement, and symptoms, 2) endoscopic findings; number of ulcers, ulcer location on the anterior wall or greater curvature, shape, presence of scar, bleeding, fold convergence, unevenness of the base, and thickness of whitish exudate. The following six endoscopic findings had significant delaying effects on healing: undermining ulcer (p＜0.001), ulcer more than 2 cm in size (p＜0.001), linear-shaped ulcer (p＜0.01), ulcer of active stage 1 (p＜0.05), ulcer location on the lesser curvature (p＜0.05). The discrimination rate of these six factors was 88.3%.

　In conclusion, the prediction of the healing of gastric ulcer based on the discriminate analysis of initial endoscopic findings seemed to be useful for the treatment of gastric ulcers.