十二指腸潰瘍の背景としての胃粘膜―内視鏡的立場より

The Gastric Mucosa as a Background of Duodenal Ulcer: from the standpoint of endoscopy

　十二指腸潰瘍に関する研究は多方面から行なわれており，十二指腸潰瘍の際の胃粘膜に関する報告も，Konjetznyを始めとして諸家によりなされてきた．いずれも幽門前庭部と胃体部との胃炎の病型について述べられている．幽門前庭部ではビランの検出率は高く，古谷は組織学的に確かめて23.7％に，筆者は内視鏡的に52％に，そして梅津らは内視鏡的に50％の症例にみられるとし，しかも年代とは特に相関がみられない．すなわち胃ビランは，十二指腸潰瘍の胃粘膜にあらわれやすい病変であることは既に諸家によっても明らかにされたことである．他方，胃体部領域の粘膜に関する報告は少ないが，梅津らは十二指腸潰瘍症例の胃腺の萎縮の程度について，高齢者の胃体小彎でも萎縮は非常に軽いと述べ，Urbanは幽門腺領域，胃底腺領域の高さについて104例十二指腸潰瘍手術症例をもとに計測を行なって，同様の結果を報告している．

　さらに十二指腸潰瘍症例における胃粘膜の記載に関してSchindlerが内視鏡的にとらえ報告した肥厚性胃炎がある．これはその後も多くの学者によって，その存否に関しても議論のあるところである．すなわちWood，Henning，Palmerらによると，むしろ否定的な報告が多く，原らによれば組織学的検索により肥厚性胃炎像をみたものは1例もないと述べている．しかし現在までにはっきりいえることは，内視鏡的にSchindlerが述べた所見をわれわれが日常検査の所見として観察しうることは確かで，ことに十二指腸潰瘍症例にそのような所見があらわれる頻度が高いことも，諸家の報告によって明らかにされている．

　An attempt has been made to clarify the true state of the gastric mucosa that can possibly undergoes changes in the presence of duodenal ulcer and especially of endoscopic picture of so called hypertrophy in the gastric body that is said often to accompany dudenal ulcer. From the endoscopic point of view, we have picked out, in strict accordance with Schindler's descriptions, 136 cases of endoscopic picture of so called hypertrophy out of many cases filmed with gastrocamera. Their courses have been followed up, and their behaviors have been dynamically recorded in both 16 mm movies and Ⅳ videotapes. Analysis of the results led us to the following conclusions: ―

1. Erosive gastritis was recognized in the mucosa of the pyloric antrum in 40 per cent of 136 cases with endoscopic picture of so called hypertrophy. Atrophic gastritis was seen only in a small number.

2. Observations of the same period in these cases showed that endoscopic picture of so called hypertrophy would most often comes out on the posterior wall of the body, but it was seen to appear in other segments of the body as well.

3. Endoscopic picture of so called hypertrophy was constantly seen in 15 cases out of 18 whose courses had been followed up.

4. Study of the relationship between various physiological aspects of the stomach and the picture of so called hypertrophy in endoscopy showed that typical view of so called hypertrophy would become less manifest with the administration of blocking agents such as Buscopan and as the gastric wall was distended with increasing amount of introduced air.

　Finally it would become hard to recognize, but yet the small units of the gastric mucosa surrounded with fine sulci remained clearly visible. These situations were dynamically confirmed in both 16 mm movies and endoscopic TV.

5. Histopathologic study of direct vision biopsy and surgical specimens revealed that in our cases there was no striking picture of hyperplasia in the mucosa of the fundic glands that was unaccompanied with atrophic changes.