非H. pylori・非薬剤性胃潰瘍

Gastric Ulcers with Neither Helicobacter pylori Infection nor Non-steroidal Anti-inflammatory Drugs

要旨●非Helicobacter pylori（H. pylori）・非薬剤性潰瘍（特発性潰瘍）はわが国でも潰瘍全体の12%を占めると考えられ，患者背景や好発部位に注目し診療する必要がある．除外診断にガストリノーマ，Crohn病，感染などを確認する．また外傷や熱傷など身体的ストレスに加え，災害時ストレスも独立して潰瘍をひき起こすことが明らかとなった．災害時特殊環境下の出血性胃潰瘍は多発・胃体部発生も多いが，平常時の特発性潰瘍は胃前庭部〜十二指腸球部に多くみられ，動脈硬化性疾患を複数持つ患者がリスクとなり，難治・易再発を呈することもしばしばある．H. pylori除菌後（または自然除菌後）と，H. pylori未感染胃に発生する特発性潰瘍の違いに関しては報告が少なく，より大規模な検証が求められる．

　Peptic ulcers caused neither by Helicobacter pylori infection nor by nonsteroidal anti-inflammatory drugs are termed as IPU（idiopathic peptic ulcers）and show a 12% prevalence rate among Japanese patients with peptic ulcers. Based on the research after the 2011 Great East Japan earthquake, psychological stress during large-scale disasters is newly recognized as an independent risk factor for peptic ulcers.

　When not experiencing a disaster, IPUs are ordinary clinical situations, possibly having the following features：1）underlying comorbid arteriosclerosis, particularly in the antrum of the stomach, often showing refractoriness and 2）a high recurrence rate. Differences between H. pylori-unrelated IPUs and IPUs after eradication therapy of H. pylori are still unclear, and additional large-scale studies are needed for clarification.