慢性胃炎のX線造影像の検討

Radiological Diagnosis for Chronic Gastritis

要旨●当センターで経験した胃癌を，Helicobacter pylori（H. pylori）未感染，現感染（中等度萎縮，高度萎縮），除菌後に分類し，背景胃粘膜のX線造影所見について検討した．X線造影像では，H. pylori未感染は表面平滑で，現感染・除菌後は粗大顆粒〜微細顆粒のX線造影所見が認められ，その組織像は萎縮の程度と領域によって異なり，慢性炎症による経時的な粘膜変化であった．病理組織像では，胃体部の粗大顆粒は慢性炎症細胞浸潤による腺窩の配列の乱れや過形成，前庭部の顆粒は萎縮と腺窩の延長や隆起型の腸上皮化生，胃体部小彎の顆粒は萎縮と幽門腺化生，除菌後では胃体部の萎縮性の腸上皮化生と腺窩の過形成，再生を認めた．胃X線造影像では，胃全体像から萎縮度を診断し，その中の領域性を考慮すれば病理組織学的所見に一致する診断を得ることは可能であり，H. pylori未感染例のX線造影診断能は極めて高率であった．

　Gastric cancer cases examined at this center were categorized as non-Helicobacter pylori（H. pylori）infected, currently infected, and post-H. pylori eradication. Further, X-ray images of background mucosa were assessed. X-ray findings from chronic gastritis cases included granular protrusions of various sizes, linear to reticular networks, and ground glass opacities. Histological changes such as crypt misalignment, atrophy, hyperplasia, fundic gland atrophy, and intestinal metaplasia were observed because of invasion by chronically inflamed cells secondary to H. pylori infection. Because chronic gastritis involves changes over time in mucosal atrophy, the degree of atrophy must be diagnosed by observing the entire stomach using X-ray diagnosis of the background mucosa. Histopathological diagnoses can be performed if the area is considered. With regard to non-H. pylori infected cases, it is very likely that H. pylori-negative can be diagnosed because mucosal changes throughout the entire stomach can be interpreted.