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要旨●患者は70歳代,女性.心窩部痛の精査目的で行ったEGDで萎縮性胃炎を認め,尿素呼気試験でH. pylori感染陽性と診断した.2次除菌で除菌成功を確認した.除菌成功1年後のEGDで,胃前庭部の萎縮性変化が乏しいのに対して,胃体部から胃穹窿部にかけて萎縮性変化の進展が認められ,明らかな内視鏡的逆萎縮の所見を示した.この時点でAIGを疑った.空腹時血清ガストリンは673pg/ml,PCA陽性,胃体部粘膜の生検でECMを確認し,AIGと診断した.
A 70-year-old female underwent upper gastrointestinal endoscopy because of epigastric pain. H. pylori-positive atrophic gastritis was diagnosed and the patient underwent eradication therapy. Successful eradication was verified using the urea breath test after the second eradication therapy. One-year after successful eradication, upper gastrointestinal endoscopy revealed severe atrophic gastritis of the corpus and mild gastritis of the antrum(i.e. inverse atrophy was shown on endoscopy). We diagnosed the patient with autoimmune gastritis with hypergastrinemia, low pepsinogenemia, positive parietal cell antibody, and endocrine cell micronesting on biopsy.
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