Helicobacter pyloriに起因しないとされる胃粘膜病変の形態―gastric antral vascular ectasia（GAVE）とdiffuse antral vascular ectasia（DAVE）

Gastric Antral Vascular Ectasia (GAVE) and Diffuse Antral Vascular Ectasia (DAVE)

要旨　GAVEの内視鏡的特徴は，幽門輪より放射状に縦走する数条の鮮やかな発赤帯である．発赤帯は小さい斑状ないしは点状の発赤が集簇している．そして，個々の発赤点は拡張しコイル状に蛇行した毛細血管から成っている．また，前庭部の蠕動運動が亢進していることが多い．DAVEでも拡張しコイル状に蛇行した毛細血管から成る斑状ないしは点状の発赤が観察できるが，前庭部にほぼ均一に分布している．両疾患ともに，内視鏡検査時に出血しているところを観察したり，また胃内に血液が貯留しているのを見ることはまれである．GAVEと鑑別しなければいけないのは表層性胃炎でみられる櫛状発赤であり，DAVEと鑑別すべき疾患には出血性胃炎，出血傾向のため生じた粘膜内出血，portal hypertensive gastropathy，多発するangiodysplasiaなどがある．治療は内視鏡的熱凝固法が第一選択となる．予後は基礎疾患の重症度が大きく影響する．

　Characteristic of endoscopic findings in GAVE is the appearance of several brightly red stripes radiating longitudinally from the pyloric ring. Each column consists of multiple patchy reddening or red spots, and each red lesion contains dilated and convoluted capillaries. Antral peristalsis in GAVE frequently accentuates this. In DAVE, multiple patchy reddening and red spots containing dilated and convoluted capillaries are scattered diffusely throughout the antrum. Active bleeding or stigmata of bleeding could seldom be observed during endoscopic examination in either GAVE and DAVE. Red stripes in GAVE must be differentiated from comb like redness in so-called superficial gastritis. Gastric diseases for which differential diagnosis from DAVE must be made, include hemorrhagic gastritis, intramucosal or submucosal bleeding due to systemic hemorrhagic tendency, portal hypertensive gastropathy and multiple angiodysplasia. Endoscopic heat coagulation therapy is recommended to ablate dilated capillaries. Prognosis of GAVE and DAVE differs according to the severity of associated conditions.