Helicobacter pylori除菌療法で軽快した特発性肉芽腫性胃炎の1例

Idiopathic Granulomatous Gastritis Improved by Helicobacter pylori Eradication, Report of a Case

要旨　症例は49歳，女性．主訴は心窩部痛と体重減少．胃X線検査および上部消化管内視鏡検査で，胃体部小彎の多発びらんと広範囲の胃壁伸展異常がみられた．びらんからの生検組織には非乾酪性類上皮細胞肉芽腫が認められた．腹部CTでは胃所属リンパ節の腫大所見がみられたが，眼や肺野，肺門リンパ節にはサルコイドーシスを思わせる所見はなく，結核，梅毒，Crohn病の所見も認めなかった．特発性肉芽腫性胃炎と診断した．Helicobacter pylori IgG抗体が陽性を示したため，除菌治療を行った．除菌後に胃体部のびらんは消失し，それと同時に生検組織で類上皮細胞肉芽腫も消褪した．治療前後の画像所見と生検組織の検討から，類上皮細胞肉芽腫が胃のびらん形成に影響していることが示唆された．

　A 49-year-old female visited our hospital because of epigastralgia and loss of weight. Barium meal examination and upper gastrointestinal endoscopy examination revealed multiple erosions and narrowing of the stomach.

　Non-caseous epithelioid cell granulomas were revealed with biopsy tissue from the gastric erosion. But there were no findings evident of sarcoidosis, which as an eye lesion, shows hilar lymphadenopathy and an abnormal value on blood examination. Furthermore, we did not have any findings of tuberculosis, lues or Crohn's disease. We finally diagnosed it as Idiopathic Granulomatous Gastritis.

　Because a Helicobacter pylori IgG antibody was positive, we eradicated Helicobacter pylori. After eradication, gastric erosion disappeared, and epithelioid cell granulomas were found to be reduced in biopsy tissue.

　It was suggested that granulomatous inflammation was related to the gastric erosion.