若年女性にみられたcollagenous gastritisの1例

Collagenous Gastritis in a Young Japanese Woman, Report of a Case

要旨　患者は23歳，女性．心窩部痛を主訴に当科を受診した．胃X線造影検査で，胃体上部から胃角部の前後壁に広範な不整形陥凹面を認めた．陥凹面の内部には淡いバリウム斑を伴う平皿状の透亮像を多発性に認めた．内視鏡検査で同陥凹面は褪色調であり，その内部には大小不同で円形から楕円形を呈する取り残し様の島状粘膜が敷石状に多発していた．陥凹面をNBIで観察すると萎縮性胃炎のパターンを認めた．陥凹面からの生検で，粘膜上皮下にcollagen bandの肥厚を認め，粘膜固有層内に慢性炎症細胞浸潤を認めたことから，collagenous gastritisと確診した．本症は極めてまれな疾患であり，その病態病因は依然不明であるが，過去の本邦報告例と同様に本例もH. pylori陰性であり，原因不明の胃粘膜萎縮による陥凹面の形成がその本態と考えられた．

　We reported the case of a young Japanese woman with collagenous gastritis. A 23-year-old female was refered to our institution with a complaint of epigastric pain. Endoscopic examination disclosed a depressed area without erosion in the gastric body. High-resolution magnification endoscopy with narrow-band imaging demonstrated loss of normal subepithelial capillary network and round pits, with irregular arrangement of collecting venules, whose findings corresponded to those of gastric atrophy, in the depression. Biopsy specimens revealed a thickened eosinophilic band-like structure, which was positive on Azan staining but negative on amyloid staining, beneath the surface epithelium. It was accompanied by infiltration of inflammatory cells in the lamina propria. Little is known about the natural history and pathogenesis and further case studies are warranted to clarify the nature of this rare entity.