難治性胃潰瘍―内視鏡所見を中心に

Endoscopic Studies on Intractable Gastric Ulcer

要旨　H₂ブロッカー療法下の胃潰瘍の難治性について検討した．その結果，8週未治癒の潰瘍を難治性潰瘍とすることが妥当と考えられた．難治性を規定する諸因子は，潰瘍の形，潰瘍型，皺襞集中，縮小過程，周辺隆起，硬さなどであり，H₂ブロッカー剤の登場によっても形態的特徴に変化はなかった．次いで，潰瘍の深さ（Ul）別の特徴をみると，Ul-Ⅳの平均治癒期間は16.9週と難治性で，形態的にも上述した難治性潰瘍の所見を呈していた．Ul-Ⅱでは，Ul-Ⅳの形態的特徴は全くみられず，かつ平均治癒期間も4.8週と易治性であった．Ul-Ⅲの内視鏡所見はUl-ⅡとUl-Ⅳの特徴が混在していた．平均治癒期間も10.5週と難治であったが，8週治癒率は約6割と易治のものも多く，両者の性格を併せ持つと考えられた．拡大観察では，易治性潰瘍ほど活動期より柵状や紡錘状の再生粘膜模様が観察された．難治性潰瘍では，結節状粘膜の占める割合が多かった．

　We evaluated the clinical and endoscopic features of gastric ulcers under treatment with H₂-receptor antagonists. Intractable ulcer was defined as unhealed ulcer after 8 weeks' appropriate treatment. Factors influencing intractability were shape of ulcer, type, converging folds, healing process, elevation around the ulcer and rigidity. We focused on the depth of ulcers. Healing time of Ul-Ⅳ ulcers was 16.9 weeks, which was almost identical to that of intractable ulcers. Healing time of Ul-Ⅱ ulcers was 4.8 weeks, but endoscopic finding of Ul-Ⅱ ulcers did not resemble that of Ul-Ⅳ ulcers. Healing time of Ul-Ⅲ ulcers was 10.5 weeks, these ulcers had characteristics of both Ul-Ⅳ and Ul-Ⅱ ulcers. In cases of tractable ulcers, palisading and spindle-like regenerative mucosa could be detected within the active stage of ulcers. On the other hand, in cases of intractable ulcers, nodularity of mucosa was observed from the active stage through to scarring.