H. pylori除菌後の胃潰瘍

Gastric Ulcers after Helicobacter pylori Eradication

要旨●Helicobacter pylori（H. pylori）除菌は明らかな消化性潰瘍再発予防効果を認めるものの，除菌成功後にもわずかながら潰瘍の発生，再発を認める．その原因はH. pylori再陽性化によるH. pylori潰瘍とH. pyloriに起因しない非H. pylori潰瘍の2つに分かれ，後者は薬剤性潰瘍とりわけアスピリンを含む非ステロイド性抗炎症薬（NSAIDs）潰瘍が大部分を占める．また，原因を特定できない特発性潰瘍もまれながら存在し，その再発率は高い．再発潰瘍への対応としては，酸分泌抑制薬の投与に加え，H. pyloriの再検査，服用薬の確認など潰瘍の誘因を調べることが大切である．

　Eradication of Helicobacter pylori（H. pylori）can prevent recurrence of ulcer ; however, peptic ulcers rarely occur after successful eradication. The causes of occurrence of ulcers after eradication are classified into re-positive for H. pylori and non-H. pylori ulcer. A major risk factor of non-H. pylori ulcer is non-steroidal anti-inflammatory drug, including aspirin, and unidentifiable idiopathic ulcers are very rare. For ulcers after H. pylori eradication, Antacids would be prescribed and the status of H. pylori and history of drugs would be checked.