胃潰瘍のX線診断―潰瘍瘢痕，胃潰瘍の経過，多発性潰瘍

X-ray Diagnosis on the Gastric Ulcer: Ulcer-scar; Healing process and Multiple ulcer

　胃潰瘍のX線診断はすでに20世紀初頭のReiche（1909），Haudek（1910）のニッシェの発見にさかのぼるといわれており，そのX線的特徴については内外の数多くの成書に記載されているところである．更にX線所見と病理組織学的所見の対比についてもEschbach”，熊倉^2,3)の報告に詳しく，改めてこれに追加するほど新しい知見はもち合わせていない．臨床的にはもはやX線検査による胃潰瘍の診断能などを問題にするより，潰瘍の性状，即ち良悪性の判定または病期の判定，深さの診断，治癒の判定などに興味を残しているといえよう．

　したがって本文の目的は，こと改まって新しい胃潰瘍のX線診断法を述べるものでない．たまたま昨年11月広島での，第6回目本内視鏡学会秋期大会で，芦沢教授・白壁博士司会のシンポジウム「微細病変」において，私にX線診断の立場からの発言をもとめられたが，この時のシンポジウムの内容および著者の発言を紹介し，私の責めを果たしたい．

　We have a lot of textbook about the diagnosis of the gastric ulcer but nowdays the evaluation of the stage, healing course and differentiation from the malignant ulcer has become the main problem radiologically.

　In regard to the diagnosis of the gastric ulcer-scar, we standardize the disappearance of the niche as the healing of the ulcer. But it is often very defficult to visualize the small and shallow niche using the compression technique or changing the position radiologically. From double contrast study.

　Dr. Igarashi investigated the scar of gastric ulcer and reported that the disappearance of the barium fleck with radiating folds or specific irregular mucosal pattern at the central portion of ulcer-scar are the most important findings in its diagnosis especially in posterior lesion. I agree with his opinion that when we can take the photograph up to the fine gastric mucosal area, the diagnosis of the ulcer-scar should be radiologically available. But Hauser reported 88% of the gastric ulcer-scar originated in the lesser curvature or the posterior wall and 41.5% of the gastric ulcer originated in the lesser curvature. From only double contrast study, there remain some failure to diagnose the lesion of lesser curvature or anterior wall. So, we should like to emphasize that the combination of the barium filling picture and double contrast study are indispensable to the diagnosis of the ulcer-scar.

　We have already reported from the long standing endoscopical observation that the acute gastric ulcer, chronic round ulcer, multiple ulcer or the kissing ulcer are the same quality and reversible patho- genetically even if they are different morphologically (table 3). And we have divided the healing process of the gastric round ulcer into four Cathegories endoscopically (Fig. 9～22), that is α-course (ordinary reduction of the size), β-course (through short linear scar), γ-course (splitting) and δ-course (longitudinal linear scar). The same classification is adapted to the radiological diagnosis of the gastric ulcer and is useful for the evaluation of the stage of the ulcer and it's prognosis.

　Otherwise, Dr. Shirakabe and Dr. Kumakura tried to diagnose the multiple gastric ulcer from the deformity of the barium filling picture and this consideration is very interesting and logical. Dr. Tsukasa developped this suggestion from the statistical analysis on the investigation of the operated stomach, and reported and that the deformity of the stomach is very reliable to diagnose the multiple gastric ulcer But it is obvious that the most important point is to diagnose them correctly by the endoscopic visualization.

　It is essential to detect the smaller lesion and to investigate the kinetic study of the ulcer, for the further development of the diagnosis of the gastric ulcer.