難治性胃潰瘍の経過―8週以降の経過

Endoscopic Change of Intractable Gastric: Ulcer after Eight-weeks' Treatment

要旨　治療開始8週後の難治性胃潰瘍の内視鏡像は，多くは潰瘍部が周囲の健常粘膜よりわずかに陥凹し，再生上皮に広く覆われた面から成り，その中央に小さな白苔を有する像を呈した．再生上皮の形態は当初紡錘状を呈するが治療を継続することにより白苔の消失の有無にかかわらず敷石状に変化した．ステレオ式電子内視鏡による計測では，難治性潰瘍は潰瘍の収縮が悪く，8週後にも治療によっても白苔とそれをとりまく再生上皮の面積の広い例が多く認められた．また，1日における再生上皮の平均進展距離を算出すると，難治性潰瘍では有意に不良であった．しかし，プロトンポンプ阻害薬による治療では再生上皮の進展距離が有意に長く，難治性潰瘍の変貌の一因と考えられた．

　Endoscopic pictures of a typical intractable ulcer after eight-weeks' treatment showed a central shallow depression which was covered by regenerative epithelium with a central white coated area. Continuous treatment of ulcer changed the shape of regenerative epithelium from initial spindle-shape to cobblestone appearance, irrespective of existence or disappearance of a white coated area. Electrostereo-endoscopic examination revealed that the size of intractable ulcer was not reduced as fast as that of tractable one, and even after eight weeks of treatment, it still had a central white coated part with wide regenerative epithelial area. The average speed of epithelial regeneration of intractable ulcers was slower than that of tractable ones. The epithelial regeneration around ulcers being treated with proton pump inhibitor was significantly faster than that with conventional treatments, which may explain recent changes in the characteristics of intractable ulcers.