Helicobacter pylori除菌に伴う問題点―逆流性食道炎の発生と経過

Impact of Helicobacter pylori Eradication Therapy for Reflux Esophagitis

要旨　除菌治療後に下部食道を経時的に観察することのできた64例において，逆流性食道炎〔ロサンゼルス分類（改変）〕でのGradeを検討した．除菌3か月後を基点とした場合，12か月後までに，悪化群9例（14.1％），不変群52例（81.3％），改善群3例（4.7％）であった．経時的に観察すると全体として明らかにびらん・潰瘍型の逆流性食道炎が増加していた．不変群＋改善群に対し，悪化群では有意に高度食道裂孔ヘルニアを合併していた．また，悪化群はGrade N，Mから悪化し，Grade C以上に重症化する症例はなかった．観察開始時Grade A，Bの症例では不変，あるいは改善を認めた．

　We studied 64 patients who underwent upper gastrointestinal endoscopy repeatedly after the successful eradicaton of Helicobacter pylori. We chose a point of time three months after the eradication as the initial point. Endoscopic findings of the lower esophagus were evaluated according to the modified Los Angeles Classification. At the point of 6 and 12 months after eradication, in comparison with the initial point, the condition of 14.1％ of the patients had worsened, 81.3％ presented no change and 4.7％ had improved respectively. Patients with erosion and ulcer type of esophagitis increased during 9 month investigation.

　In the worsened group, prevalence of hiatal hernia was greater than that in the no-change group and the improved group.

　The patients whose condition worsened were from among Grades N and M. None of them were from Grades A and B. Patients whose condition was characterized as Grade A and B at the initial point either remonind unchanged or improved. They did not get worse than Grade B. There was no worsening in any group above Grade C.