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Stomach and Intestine(Tokyo) Volume 49, Issue 13 （December 2014）

胃と腸 49巻13号（2014年12月発行）

Japanese English

今月の主題胃の腺腫─診断と治療方針

主題

胃腺腫に対するHelicobacter pylori除菌の影響 Endoscopic and Histological Changes of Gastric Adenoma after Helicobacter pylori Eradication 鈴木翔 ¹ , 後藤田卓志 ¹ , 鈴木晴久 ² , 阿部正和 ¹ , 勝呂麻弥 ¹ , 古賀幹教 ¹ , 河野真 ¹ , 八木直子 ¹ , 草野央 ¹ , 福澤誠克 ³ , 小田一郎 ² , 関根茂樹 ⁴ , 河合隆 ³ , 森安史典 ¹ Sho Suzuki ¹ , Takuji Gotoda ¹ , Haruhisa Suzuki ² , Masakazu Abe ¹ , Maya Suguro ¹ , Mikinori Koga ¹ , Shin Kono ¹ , Naoko Yagi ¹ , Chika Kusano ¹ , Masakatsu Fukuzawa ³ , Ichiro Oda ² , Shigeki Sekine ⁴ , Takashi Kawai ³ , Fuminori Moriyasu ¹ ¹東京医科大学消化器内科 ²国立がん研究センター中央病院内視鏡科 ³東京医科大学病院内視鏡センター ⁴国立がん研究センター中央病院病理科 ¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo ²Endoscopy Division, National Cancer Center Hospital, Tokyo ³Endoscopy Center, Tokyo Medical University Hospital, Tokyo ⁴Pathology Division, National Cancer Center Hospital, Tokyo キーワード：胃腺腫 , Helicobacter pylori , 除菌治療 , 除菌後経過 Keyword: 胃腺腫 , Helicobacter pylori , 除菌治療 , 除菌後経過 pp.1871-1878

発行日 2014年12月25日 Published Date 2014/12/25

DOI https://doi.org/10.11477/mf.1403200113

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要旨　胃腺腫に対するHelicobacter pylori（H. pylori）除菌の影響，効果についてはいまだ明らかになってはいない．そこで，H. pylori除菌後に3年以上の長期の経過観察が可能であった胃腺腫27症例の内視鏡的および組織学的変化について検討した．除菌後平均91.9か月の観察期間内に12例（44.4％）の胃腺腫が内視鏡上消失し，7例（25.9％）で組織学的消失を確認した．消失群と非消失群との比較では，消失例は女性に多く（p＝0.009），腫瘍径が小さく（p＝0.025），除菌前血清ペプシノゲン（PG）II値が高値（p＝0.041）であった．以上の結果から，H. pylori除菌が一部の胃腺腫の形態および組織に何らかの影響を与える可能性が示唆された．

　Backgrounds and Aims : Helicobacter pylori infection causes gastric adenoma and gastric cancer through the development of chronic atrophic gastritis and intestinal metaplasia. The effect of H. pylori eradication on existing gastric neoplasia is unknown. This study investigated the efficacy of H. pylori eradication therapy on existing gastric adenoma.

　Material and Methods : We prospectively reviewed 27 patients with gastric adenoma who underwent H. pylori eradication therapy between April and December 1997. We evaluated the endoscopic and histological changes of gastric adenoma cases for≧3 years and analyzed the relationship between endoscopic and histological changes and clinicopathological factors, including follow-up periods, age, gender, serum pepsinogen level, serum H. pylori antibody level, lesion size and location, and phenotypic expression, using univariate analysis.

　Result : The total mean follow-up period was 91.9 months. Twelve lesions（44.4％）were not visible by endoscopy, and seven lesions（25.9％）disappeared in both endoscopy and histological examination. The mean period of endoscopic disappearance was 21.8 months after H. pylori eradication therapy. Fourteen（51.9％）lesions remained unchanged by endoscopy. Of these, six（22.2％）were diagnosed as intramucosal cancer at follow-up and were endoscopically treated. Univariate analysis revealed that gender（p＝0.009）, lesion size（p＝0.025）, and serum pepsinogen II level（p＝0.0041）before H. pylori eradication therapy were significantly associated with the disappearance of lesions, both endoscopically and histologically.

　Conclusions : H. pylori eradication therapy may contribute to the improvement or disappearance of gastric adenoma. Therefore, H. pylori eradication therapy could be the initial therapy for gastric adenoma.