胃潰瘍の再発・再燃について―発見されたopen ulcerの過去の内視鏡像検討を中心に

On Recurrence of Gastric Ulcer

　胃潰瘍患者のとりあつかいにあたって，もっとも重要なことは，胃潰瘍がその患者にとってどれだけのハンディキャップになっているか，そしてこれからの患者の一生を通じてどれだけの肉体的精神的，および社会的なハンディキャップになっていくかを注意深く評価し，それに対する十分な対策をたてていくことである．長期間漫然と薬の投与を続けるのみであったり，あるいは胃潰瘍を発見するとすべて胃切除をおこなったりするのはいずれも適切な配慮を欠除しているといわねばならない．いいかえれば，胃潰瘍の治療は再発・再燃の予測とそれを未然に防ぐための配慮が基礎となるものであるが，これには多くの困難な問題が含まれている．それは，単に投与する薬物の種類・量・投与方法などの問題だけでなく，患者の生活や性格などすべての面を含んでいるからである．

　潰瘍が瘢痕化したのちに，さらに治療を加えているにもかかわらず再発する場合が稀ならずある反面，何ら治療を加えないにもかからず，自然治癒する症例のあることも事実であり，この間の事情を一層複雑なものにしている．

　これらの問題の解明には，胃潰瘍の自然の経過を知ることが必要であると考えられるので，筆者らは，胃集検で発見された胃潰瘍のうち，治療をおこなっていないものをとりあげ，これらの経過を検討することにより，胃潰瘍の再発・再燃の問題への一つのアプローチを試みた．

　Prediction and prevention of recurrence is one of the most important things in dealing with the gastric ulcer patients. As the knowledge on natural history of gastric ulcer is essential for the elucidation of this problem, the incidence and course were studied of gastric ulcer detected by the gastrocamera in an annual gastric mass survey group of 1000 seemingly healthy subjects aged 40 or over(Table 1).

　The incidence of gastric ulcer, including scar, was 11.7% (72/617) (Table 3), in good agreement with that in autopsy materials, e. g. 12.2% (Kino, I. et al). (Table 2).

　On 32 cases of active gastric ulcer, which were detected in 1970 and in which the same site was well visualised on the previous gastrocamera films, the past findings were studied with the following results: The findings of active ulcer or ulcer scar preceded in 30 cases. Ulcer scar was found at some time in the past of 15 cases. Active ulcer was the only previous findings in the other 15. Only 2 cases were free of those findings (Table 4). Those with ulcer scar are apparently recurrent cases, and the other 15 with active ulcer are either recurrent or persistent ulcer cases.

　To supplement those data, the findings after the lapse of one year were studied in active ulcer and ulcer scar cases not included in the series of table 4: Five out of 29 cases of ulcer scar became active in a year, 11 remained as scar and the other 13 became free of ulcer and ulcer scar (Table 7). Among 12 active ulcer cases, 4 remained active in year and 8 showed scarring (Table 8).

　The authors’ study confirms the general belief that gastric ulcer heals easily but also recurs easily. It is, however, surprising that almost all gastric ulcer cases are recurrent or persistent. Newly detected gastric ulcer patients should be regarded, therefore, as recurrent or persistent, at least when they are 40 years old or over.

　Though frequent the recurrence of gastric ulcer is, indiscriminate gastrectomy seems not to be justified, when the high incidence among socially active, symptom-free people is considered.

　Indefinite continuation of the currently employed medical therapy seems also to be a wrong attitude. If a bold statement may be made, the patients should learn to live with gastric ulcer, naturally under careful observation by a gastroenterologist with a psychosomatic insight.

　The high incidence of gastric ulcer (or ulcer scar), the knowledge of which is already a fundamental part of research on ulcer-cancer problem, suggests the possibility of a clinical approach to the problem of malignant transformaion of gastric ulcer.