小児のH. pylori感染症の内視鏡所見―小児科医の立場から

Endoscopic Findings of Helicobacter pylori Infection in Children

要旨　小児のH. pylori胃炎の内視鏡所見では104例中98例（94％）に結節性胃炎（鳥肌胃炎）が認められた．結節性胃炎は幽門前庭部一面に特異なびまん性の小結節状の隆起が認められ，体部や十二指腸にまで及ぶこともあった．そして，結節の中心に陥凹を認めた．結節状変化は病理組織所見から，単核球浸潤と大型のリンパ濾胞の増生によるものと考えられた．結節性胃炎98症例のうち，19例は十二指腸潰瘍を合併していた．また，胃潰瘍合併3例のうち2例はH. pyloriの初感染により急性胃粘膜病変を呈した．除菌治療によって結節性変化は6か月以後には消退した．病理組織学的にリンパ濾胞数，炎症細胞浸潤の有意な改善を認めた．

　Nodular gastritis was found in 98 of 104（94％）of Helicobacter pylori-positive children. The endoscopic findings of nodular gastritis were mainly characterized by unique, diffuse small nodular elevated lesions in the entire antrum ; in some cases, extending into lower part of the corpus and into the duodenal bulb and slightly depressed spots were observed in the center of each nodularity. Histologically, nodular gastritis was characterized by an intense inflammatory cell infiltrate mainly of lymphocytes and an increased number of large lymphoid follicles with a germinal center. Among the 98 patients with nodular gastritis, 19 had duodenal ulcers. Among three patients with H. pylori-positive gastric ulcers, two patients showed acute gastric mucosal lesions caused by acute H. pylori infection. After 6 months of the eradication therapy of H. pylori, the endoscopic features of antral nodularity regressed. A marked improvement in histopathological features was seen post-therapy where the presence of lymphoid follicles, inflammation, and activity of gastritis improved significantly（p＜0.001）after therapy, as compared to before therapy.