青森県におけるさまざまなNHPH胃炎の3例

Three Cases of Non-Helicobacter pylori Helicobacter Infection in the Aomori Prefecture

要旨●本邦におけるNHPH感染例は，弘前大学の田中正則氏によるGastrospirillum hominis関連胃炎が最初の報告である．その後も青森県内ではいくつかの症例があるが，さまざまな内視鏡所見を呈している．本稿では急性胃炎と考えられた1例，胃体部に主座を置く発赤調陥凹性病変を呈した1例，鳥肌胃炎の1例を紹介した．NHPH感染診断にはWarthin-Starry染色，Giemsa染色が有用であることが多いが，これらの検査で感染を証明できない場合には免疫組織化学染色，遺伝子的な検査が有用であった．NHPHの除菌をH. pyloriに準じて行ったが，H. suisはH. pyloriよりも酸性条件下で発育するので抗菌薬の感受性の至適pHが異なることも考えられる．

　The first case of NHPH（Non-Helicobacter pylori Helicobacter）infection in Japan was reported as Gastrospirillum hominis-associated gastritis from Hirosaki University in 1994. NHPH infection has been associated with nodular gastritis and mucosa-associated lymphoid tissue lymphoma. However, clinical management of NHPH infection has not been established. Herein, we report three cases of NHPH infection in the Aomori Prefecture in the north end of Japanese mainland. Case 1 is a 50-year-old woman with acute gastritis living with six cats. EGD（esophagogastroduodenoscopy）for epigastric pain revealed acute gastritis in the antrum. Gastric mucosal biopsy detected NHPH（Gastrospirillum hominis）. Her symptoms were disappeared by H2RA without any antibiotics. NHPH was negative at the follow-up EGD. Case 2 is a 56-year-old man presenting with a specific mucosal appearance in the corpus of the stomach. EGD revealed a reddish depressed mucosa in the corpus, but 13C-urea breath test and H. pylori（Helicobacter pylori）stool antigen were negative. H. suis（Helicobacter suis）was identified by PCR（polymerase chain reaction）using gastric biopsy specimens. After the triple therapy of PPI（proton pump inhibitor）＋AMOX（amoxicillin）＋MNZ（metronidazole）, PCR for H. suis was negative, and the lesion improved. Case 3 is a 30-year-old woman with gastritis living with a chicken since the age of 10 years. EGD to screen gastric cancer revealed nodular gastritis in the antrum. PCR for H. suis was positive, and the triple therapy of PPI＋AMOX＋MNZ was performed. After the treatment, PCR was negative and nodular gastritis improved.