噴門部領域の急性病変―Mallory-Weiss症候群，特発性食道破裂，食道粘膜下血腫

Acute Lesion at the Esophagogastric Junction (Mallory-Weiss Syndrome, Spontaneous Esophageal Rupture, Esophageal Submucosal Hematoma)

要旨　噴門部領域の急性病変の発生には，急激な腹圧の上昇による噴門部周辺粘膜の過伸展が要因とされる．つまり，悪心・嘔吐などを契機として発症することから，機械的・物理的機序が関与する．このような機序で発症する類縁疾患には，Mallory-Weiss症候群，特発性食道破裂および食道粘膜下血腫の3疾患がある．しかし，この3疾患は機序は同様でも個体側の条件も関与して，全く異なった病態となり，おのずと治療・予後も異なる．つまり，Mallory-Weiss症候群と食道粘膜下血腫は，ほとんどの症例が保存的治療で軽快するが，特発性食道破裂は全身管理が必要となり外科的治療を必要とする症例も多い．特に，特発性食道破裂は初診時の正診率が治療成績を左右するため，内視鏡検査をはじめ総合的に診断することが必要である．

　Vomiting consists of a complex series of movements controlled by the complicated regulation. If the cardia fails to open when the abdominal muscles vigorously contract, tear is a likely result. The severity of emetogenic injury varies from a relatively minor mucosal laceration to complete rupture of the wall of the esophagus. Between the two extremes, emetogenic injury infrequently causes an intermediate laceration with bleeding into the wall of the esophagus. Regardness of etiology most esophageal hematomas were associated with benign course.

　Mallory-Weiss syndrome is characterized by upper gastrointestinal bleeding due to superficial mucosal lacerations or fissures near the esophagogastric junction that are caused by an increase in intraluminal and intramural pressure gradients. Most lacerations occur in the gastric mucosa and may extend to the esophagogastric junction. Mallory-Weiss syndrome generally has a benign course.

　In contrast, esophageal rupture is a serious complication necessiating immediate intervention. Delay in treatment ends up with an enormous increase in mortality rates. Early endoscopic visualization of an esophageal tear and its site would be quite important for its treatment.