H. pylori関連性胃潰瘍

Clinicopathological Study of Gastric Ulcer Caused by Helicobacter pylori

要旨●今回H. pylori関連性胃潰瘍207例を対象に臨床病理学的に検討を行った．結果は男性が全体の69.1%（143人），症状としては無症状が88人（42.5%）を占めた．潰瘍の中で単発潰瘍が全体の75.8%（157例）を占め，類円形を呈し，好発部位は胃角部小彎と胃体上部後壁であった．背景粘膜としては，内視鏡的萎縮境界近傍と萎縮領域ですべての潰瘍が発生していた．また萎縮の進展に伴い発生部位は異なり，萎縮の進展と潰瘍の発生部位に密接な関係が認められた．実臨床では萎縮境界の把握と大井らが注目した潰瘍発生論を理解しておくことが肝要である．また出血リスク評価についてはスコアを用いることでリスクの評価，治療の適応を的確に判断できることが示唆された．

　In the present study, 207 patients with gastric ulcer associated with Helicobacter pylori were clinicopathologically examined（male：female ratio, 69：31 ; males, 143 ; and females, 64） ; 88 patients（42.5％）had no symptoms. Single ulcers, which were nearly circular lesions, were present in 75.8％（157 patients）cases. The frequent ulcer sites were the incisura angularis on the lesser curvature and the upper posterior gastric wall. Notably, the gastric ulcers in all patients were found around the atrophic border or within the atrophic territory, which were recognized endoscopically. Therefore, clinical attention should be paid to the progress of the atrophy, which was closely associated with the ulcer sites, as originally suggested by Oi et al. In the present report, we also demonstrated that examining the risk of bleeding using the scoring system resulted in an appropriate risk management and a preferable treatment.