H2受容体拮抗薬抵抗性潰瘍

H2-Receptor Antagonist-Resistant Ulcers

要旨　H₂受容体拮抗薬で治療した胃潰瘍219例，延べ262回，十二指腸潰瘍134例，延べ161回の中で，H₂拮抗薬に反応して順調に治癒した潰瘍と，治療に抵抗し難治であった潰瘍の間で，種々の臨床的背景因子と環境因子の差を比較検討した．胃潰瘍では，3か月以内に治癒しなかった潰瘍を，十二指腸潰瘍では2か月以内に治癒しなかった潰瘍をそれぞれH₂-antagonist-resistant ulcerと定義すると，胃潰瘍では十二指腸潰瘍に比しresistant ulcerの頻度が高く（それぞれ32％，20％），胃潰瘍の中では，H₂拮抗薬の治療開始時に活動期にあった潰瘍より，既に治癒期にあった潰瘍でH₂拮抗薬抵抗性潰瘍の頻度が高かった．これは，後者の多くが，H₂拮抗薬使用以前に既成の抗潰瘍薬（antacidを主とする）による治療で完治するに至らない難治例であったためである．このような潰瘍は胃体部より胃角部潰瘍に多く見出された．患者の職業上の精神的ストレスの有無，潰瘍発症の誘因，喫煙量，食事習慣，睡眠などの環境因子と，潰瘍治癒の難易との間には，明らかな差は見出せなかった，同一症例で再発のため，時期を異にして2回以上H₂拮抗薬を使用した胃潰瘍の中には，ある時期には容易に治癒したが，異なる時期には難治を示す症例も少なくなかった．H₂拮抗薬による治療に抵抗性を示す要因は一元的なものでなく，個々の症例で異なるほか，同一例でも，時期によって異なる可能性がある．cimetidine抵抗性胃潰瘍26例に対し，ranitidineに切り換えて治療したが，ranitidineが有効であったと推定されるものは8例，無効と推定されるもの8例で，ほかは判定困難であった．

　Two groups of ulcer patients, the one favorably reacted to and the other resisted to H₂-antagonist, were compared with respect to various clinical backgrounds and environmental factors.

　The subjects were all treated by H₂-antagonist, 219 gastric and 134 duodenal ulcer cases with total episodes of recurrence being 262 and 161, respectively. Based on the definition of the H₂-antagonist-resistant ulcers, i.e., the one which failed to heal within three months for gastric ulcer and within two months for duodenal ulcer, the frequency of resistance was higher for gastric ulcers than for duodenal ulcers (32% and 20%, respectively). Among the gastric ulcer cases, the resistance to H₂-antagonist was more frequently observed when the treatment was started in the healing stage than when it was started in active stage of ulcers. This was due to the fact that most of the former cases had been found refractory to other anti-ulcer drugs (mostly antacid) before H₂-antagonist was started. This type of ulcer was more often located at the gastric angle than in the gastric body.

　No apparent relationship was found between the degree of difficulty in healing the ulcer and the environmental factors such as mental stress, ulcer inducing cause, amount of smoking, eating habit and sleeping conditions, etc. Some of the cases of gastric ulcer in which H₂-antagonist was used on more than two occasions because of the recurrence, responded easily at a certain time, while resisted at another time. The factors related to resistance to H₂-antagonist treatment are not of an unitary nature, but differ in each case of ulcers as well as according to the period the treatment was applied in the same case.

　Ranitidine was used in 26 cases of cimetidineresistant gastric ulcers. It was considered effective in eight cases, and ineffective in eight cases. Effectiveness of ranitidine was not clearly judged in the remainder.