胃潰瘍の病理学的温故知新

The Histological Features of Gastric Ulcers Resected Cases in the Past and New Causes of Ulcers

要旨●当院で経験した胃潰瘍切除15例の検討により，次のような結果を得た．①30年間で切除症例は明らかに減少した．②高年齢層の男性に多く，深さはUl-IVの潰瘍が77.8％を占めた．③背景粘膜の組織所見でHelicobacter pylori（H. pylori）胃炎を疑う症例が多く，菌体は40％の症例で確認した．④除菌後の2例では萎縮や好中球浸潤はなく，軽度の慢性炎症細胞浸潤を認めた．また，近年非ステロイド性抗炎症薬（NSAIDs）潰瘍をはじめ，薬剤による潰瘍や粘膜の変化が増加しており，特にNSAIDs潰瘍の組織像とプロトンポンプ阻害薬（PPI）による胃粘膜の変化について述べた．

　We analyzed 15 cases of resected gastric ulcers in our hospital and obtained the following results：（1）The number of resected gastric ulcer cases has clearly decreased in the last 30 years ; （2）Gastric ulcers mainly occurred in older men, and patients with deep ulcers, graded as Ul-IV, accounted for 77.8％ of all cases ; （3）According to the histological findings of the background gastric mucosa, it was suspected that most cases demonstrating chronic active gastritis were associated with Helicobacter pylori（H. pylori）infection, but only 40％ of all the cases showed the presence of H. pylori ; and（4）On histological examination, two cases who received eradication therapies revealed no neutrophilic infiltration without atrophy and only a mild chronic inflammatory cell infiltration. The number of patients with drug-induced gastrointestinal ulcers, such as those induced by NSAIDs（nonsteroidal anti-inflammatory drugs）, has been increasing in recent years. We described the histology of NSAID-induced ulcers and the histological changes in gastric mucosa due to proton pump inhibitor treatment.