proton pump inhibitor投与にて治癒したHelicobacter pylori陰性肉芽腫性胃炎の1例

Helicobacter pylori-Negative Granulomatous Gastritis Treated by Proton Pump Inhibitor, Report of a Case

要旨●患者は59歳，女性．心窩部不快感を主訴に上部消化管内視鏡検査を受けたところ，胃体中部大彎に40mm大の急峻な立ち上がりの辺縁隆起を伴う潰瘍性病変を認め，悪性リンパ腫が疑われた．潰瘍辺縁からの生検組織には非乾酪性類上皮細胞肉芽腫が多数認められた．全身検索を行ったが，肺や眼などにはサルコイドーシスを疑う所見を認めず，結核，梅毒，Crohn病の所見も認めなかった．以上から特発性肉芽腫性胃炎と診断したが，Helicobacter pyloriは陰性であった．前医より開始されたPPIの投与のみで病変は治癒，瘢痕化し，病理組織学的にも肉芽腫は消退した．

　A 59-year-old female presented to our hospital because of epigastralgia and abdominal discomfort. A precipitous protrusion with an irregularly shaped ulcer on top of the lesion was identified at the middle part of the stomach by esophagogastroduodenoscopy. Non-caseous epithelioid cell granulomas were histologically identified at the ulcerated gastric lesion. After performing various differential diagnoses such as that for Crohn's disease, tuberculosis, lues, and sarcoidosis, the patient was finally diagnosed with idiopathic granulomatous gastritis. Helicobacter pylori infection was ruled out by several examinations. Administration of proton pump inhibitor for 3 months reduced the size of the epithelioid cell granulomas and improved the patient's symptoms. This was a case of H. pylori-negative granulomatous gastritis with an atypical macroscopic appearance improved by proton pump inhibitor therapy.