高齢者の胃病変―剖検例を中心に

Gastric Lesions in the Aged: Review of autopsy cases

　老年者の胃病変が，若年者と対比された場合の特徴については，過去多数の業績からその一般的傾向についてはすでに定説化しているものも少なくない．しかし老年者層の中で各疾患がどのような条件下で発生し分布するかについては，いまだ明確な数値が出されていないものが多い．その原因の1つには，いわゆる老年者層における「正常胃」の実態についての追求が不十分な面が多いことがあげられよう．

　われわれは1966年4月以来，60歳以上の老年者を中心に，入院死亡者の90％以上の剖検を実施しており，その際胃病変について肉眼的，組織学的に検索を行なってきた．今回は，主として胃粘膜病変について検討した．

　Characteristic features of the gastric lesions in the aged were studied in 1,456 cases of autopsy over 60 years old. This report is not a comparative study with the lesions of younger persons but is focussed on the features of age, sex difference and atrophic changes of the gastric mucosa in comparison with “stomachs without specific lesion”, or the so-called normal stomach.

　1) It was first examined whether or not autopsy cases as controls showed a general tendency of the aged. The conclusion was obtained that cases classified as “stomachs without lesion” are representative of the so-called normal stomachs of the aged.

　The mucosal atrophy was seen in about similar grade in each decade of life. Wide distribution ranging from little to extensive atrophy was confirmed. However, males revealed more marked atrophy than females.

　2) Gastric carcinoma of Borrmann 4 type was unexpectedly frequent even in the aged as compared with that of resected cases. In histological typing of early gastric cancer, however, well-differentiated tubular adenocarcinoma was predominant.

　3) Ninety-five per cent of gastric polyps developed on the atrophic mucosa. Atypical epithelial lesion and adenomatous polyp were seen in approximately the same ratio. The ratio of coexistence of carcinoma in atypical epithelial lesion ranged 6.4 to 14.3％.

　4) We attempted to know the time elapsed of scar formation in gastric ulcer. The distance between the location of the scar and the intermediate zone appeared to express the passage of time, but it was also related to the progress of the mucosal atrophy.

　5) Cases of duodenal ulcer showed the gastric mucosa of common type in more than 90 per cent as the initial features in the aged. In duodenal ulcer scar, about half of the cases revealed atrophic gastric mucosa.