再発・再燃性胃潰瘍の内視鏡的特徴とその内科的治療

Endoscopic Characteristics and Medical Management of Recurrent and Recruduescent Gastric Ulcer

　胃潰瘍には無症候性に経過して自然治癒に至る症例も存在するが¹⁾²⁾，愁訴をもって来院する病院症例では治療開始後僅か2週間で治癒するものから5年以上も未治癒のまま経過するものまで，種種の治癒傾向を有する潰瘍症例を対象にしなければならない．そのため患者の既往，胃局所・全身的諸因子を考慮して，まず潰瘍の再発・再燃を含めた治癒傾向を予測し，各症例に適した治療法を設定する必要がある．

　それに先だって，胃潰瘍の内視鏡所見と予後の推定³⁾⁴⁾⁵⁾，あるいは潰瘍の経過に及ぼす心身医学的側面⁶⁾などに関して考察すべきであるが，すでに幾度か報告してきたので省略し，ここではまず治癒後の管理に必要な再発の問題について略記するとともに，胃潰瘍治療に関する基礎的問題ふれてみたい．

　Recurrence of gastric ulcer after its complete healing has been investigated. Emphasis is placed on the necessity of over-all treatment including longterm follow-up of gastric ulcer and evaluation of endoscopic findings. Some basic problems involving the management of gastric ulcer at the present time are also discussed.

　As incidence of recurrence is high in protracted gastric ulcer disease, estimation of its healing tendency is a necessity and appropriate measures against its recurrence must be employed, aiming at its scarification as early as possible.

　Disappearance of white exudate is considered by the authors as a criterion of endoscopic healing of gastric ulcer, but early recurrence within one year after its healing is seen at previous site so often that stress is laid on the necessity of internal management in whatever ways as well as periodic endoscopical follow-up even after disappearance of white exudate with due consideration of engorgement at the site of ulcer scar. The period required for the follow-up varies with each case, but at least six to twelve months are requisite. Investigation on the rate of recurrence on the year-to-year basis show that gastric ulcer patients should remain under medical care for three years after healing of ulcer.

　Study in the effectiveness of medicine in ulcer treatment judged by telemetering by means of radiocapsule shows that antacids are merely of passing efficacy lasting for about only twenty minutes, and anticholinergic agents have no influence on pH of the gastric acid. When combined together, these two agents produce antacid effect continuing for about two hours. Efficacious enough in the daytime when meals are taken at regular intervals, they are insufficient for suppressing higher acidity during the night when pH becomes low. Furthermore, since basic gastric secretion in the active stage of ulcer becomes excessive, while in the chronic and scarring stages it becomes less and less pronounced, appropriate medication with due consideration of each stage of gastric ulcer is required. Efficacy of medical treatment in gastric ulcer must also be strictly evaluated by double blind method because gastric ulcer has a strong tendency to spontaneous healing.