難治性多発潰瘍を呈した好酸球性胃炎の1例

Eosinophilic Gastritis, Report of a Case

要旨　患者は20歳代，女性．10歳代から難治性の多発胃潰瘍と診断されていた．近医でプロトンポンプ阻害薬（PPI）の投与，Helicobacter pylori（H. pylori）除菌治療を受けたが潰瘍の瘢痕化がみられず，またPPIの休薬で自覚症状が増悪するため，精査治療目的で当院に紹介となった．胃X線および上部消化管内視鏡検査では，胃体部に3か所の潰瘍性病変を認めた．3病変は，胃体下部小彎にひだの集中を伴う境界明瞭な類円形の潰瘍，胃体中部大彎前壁に多中心性の潰瘍，胃体中部大彎後壁に潰瘍瘢痕として認められた．胃生検では，胃粘膜上皮に好酸球浸潤とCharcot-Leyden結晶を認め，好酸球性胃炎と診断した．プレドニゾロン内服で潰瘍は瘢痕化したが，その後プレドニゾロンの減量に伴い潰瘍は再発し，PPIの継続投与を行っている．

　A 20-year-old woman had been diagnosed with refractory gastric ulcers when she was a teenager. Although she had undergone proton pump inhibitor（PPI）maintenance therapy and Helicobacter pylori eradication therapy at a local clinic, the gastric ulcer recurred. PPI withdrawal caused exacerbation of abdominal symptoms, so she was referred to our hospital. Upper gastrointestinal（GI）series and upper GI endoscopy showed 3 ulcers on the gastric body. The first was a round ulcer with regular margins and converging folds on the lesser curvature of the lower gastric body ; the second was a multicentric gastric ulcer on the anterior wall of the greater curvature of the middle gastric body ; and the third was a gastric ulcer scar on the posterior wall of the greater curvature of the middle gastric body. Gastric biopsy showed marked eosinophil infiltration and Charcot─Leyden crystals in the gastric mucosa, and thus, a diagnosis of eosinophilic gastritis was made. Prednisolone was prescribed, resulting in the fast that the gastric ulcers resolved and scars were formed. However, withdrawal of prednisolone resulted in ulcer recurrence, so PPI maintenance therapy was started.