小児の胃潰瘍

Gastric Ulcer in Children

要旨●小児の消化性潰瘍は比較的まれな疾患であり，胃潰瘍に対して十二指腸潰瘍は1.5〜10倍多いとされる．H. pylori感染症以外の胃潰瘍の原因は二次性潰瘍が多く，感染症，Zollinger-Ellison症候群などの酸分泌亢進性，好酸球性胃腸炎などのアレルギー性，NSAIDsなどの薬剤性，ストレス性などがある．急性胃粘膜病変は，頻回の嘔吐と消化管出血を伴う急性腹症として発症し，年少児においてはH. pylori初感染のことがある．小児においても上部消化管内視鏡検査は胃潰瘍の診断に有用であり，特に粘膜生検による病理組織学的な原因精査が重要である．

　The rate of occurrence of peptic ulcer disease is low in childhood, with a predominance of duodenal ulcers over gastric ulcers（1.5〜10：1）. Apart from the gastric ulcers caused by Helicobacter pylori, most gastric ulcers in children are secondary to and associated with underlying disorders such as infections ; hypersecretory state, as in Zollinger-Ellison syndrome ; eosinophilic gastroenteritis with allergy ; use of medications such as NSAIDs ; or extreme physiologic stress.

　Patients with AGML（acute gastric mucosal lesion）present with acute abdomen, frequent vomiting, and hematemesis. AGML appears in young children as an acute infection of H. pylori.

　The role of endoscopy in the diagnosis of gastric ulcer is crucial to visualize the gastric mucosal abnormalities, and more importantly, to obtain tissue biopsies for the diagnosis of etiology.