難治性胃潰瘍の内視鏡的検討―難治要因と長期経過

Study on Endoscopic Findings of Intractable Gastric Ulcer: Factors Influencing Healing Rateand Long-term Prognosis

要旨　難治性胃潰瘍の形態学的特徴を明らかにするため，H₂ブロッカー治療例で定期的に内視鏡検査が施行された581例（活動期より治療456例）の背景因子を検討した．12週未治癒例46例を難治，4週治癒例142例を易治と定義し，その背景因子を比較検討したところ，胃角部潰瘍，不整形ならびに線状潰瘍，十二指腸潰瘍の合併，再発例，長い病悩期間，喫煙者に難治例が多かった．内視鏡所見では深掘れ型，治癒期の周辺隆起が最も難治に重要な因子であった．更に，手術例を中心に難治性潰瘍の形態学的特徴を明らかにした．

　The aim of this study was to evaluate the characteristics of intractable gastric ulcers under treatment with H₂-receptor antagonist. Background factors and endoscopic findings of tractable (healed within 4 weeks) and intractable (not healed after 12 weeks of treatment) gastric ulcers were compared with chisquare test.

　Background factors were as follows: age, sex, location and shape of ulcer, ulcer history, duration of symtoms, concurrent duodenal ulcer, smoking, and alcohol consumption.

　Endoscopic findings in the active and healing stage were also used for evaluation of intractable factors.

　Cumulative healing rate with H₂-receptor antagonist was 39.3% at 4 weeks, 79.6% at 8 weeks and 90.0% at 12 weeks in 581 patients of gastric ulcers.

　In 456 patients treated from the active stage, cumulative healing rate was 38.0% at 4 weeks, 75.9% at 8 weeks and 87.6% at 12 weeks respectively. Most intractable gastric ulcers were deep excavated ulcers surrounding amarked elevation located in the angle.

　Other factors involved in intractable ulcer were recurrent cases, long duration of symptoms and smoking habit.