疫学からみた消化性潰瘍をめぐる2，3の問題

An Epidemiological Approach to Peptic Ulcer

　消化性潰瘍は現在までは主として内科的または外科的治療といった医療の問題からのみとりあげられてきたが，今後はさらに国民の健康保持または増進といった予防医学的立場からも取り組まれるべき問題である．アメリカでは人口の7～11％が生涯の間に一度はこの病気に悩まされるであろうとSun¹⁾は述べているが，消化性潰瘍の病態生理に対する関心のみでなく，消化性潰瘍のみられない消化管とは何かといった方向も後述する疫学的手法とともに重要な方向といえる．

　潰瘍の発生論に関しては，動物実験または臨床的経験を基礎に数多くの仮説がみられるが，Sun，Shayらをはじめ多くの研究者は潰瘍発生の多因子説をとって，いくつかの因子が生体内でバランスをくずした時に潰瘍が発生するとし²⁾，この考え方が広く一般に認められて現在に至っている．しかし，ここでは単に患者における消化性潰瘍といった問題提起だけでなく，われわれの臨床経験も加えて総説的に消化性潰瘍の成因，地理病理学的検討といった疫学的アプローチから巨視的にその発生論の分析を試みてみたい．

　Peptic ulcer, especially gatric ulcer, is a very common disease among Japanese. But its morbidity rate has a weak point in that it has been collected mainly from the statistics of hospitalized patients and not from general population. Furthermore, due to various factors such as spontaneous healing of ulcer or progress of diagnostic methods, the morbidity rate has shown much larger difference in countries and the times when statistics were taken than it was anticipated essentially. On the other hand, it is now required to deal with peptic ulcer from the standpoint of people's health preservation or preventive medicine, whereas ulcer has been considered until now only from the viewpoint of medical or surgical treatment. Though it is very difficult to compare many epidemiological studies of peptic ulcer presented up to now, it has been tried in this paper to compare the morbidity and mortality rates between Japan and other countries, and to investigate regional difference and age distribution of ulcer incicence in Japan. Finally, the genetic disposition to ulcer which is attracting public attention recently, the frequency rate of familial occurrence and blood groups are discussed.

　It is very important to utilize the methodology to healthy persons which has been applied to patients only. The understanding of etiology of etiology of peptic ulcer would thus becomes much deeper.