合併疾患との関連からみた難治性胃潰瘍―薬剤の影響を含めて

Intractable Gastric Ulcer and Complications

要旨　難治性潰瘍の定義については時代的変遷もみられ，今日でも統一されたものはない．今回，われわれは，難治性潰瘍を“H₂ブロッカーあるいはPPIを主体とする薬物療法を含む適切な内科的療法を8週間以上行っても，なお治癒傾向の思わしくない潰瘍”とした．357例の胃潰瘍（瘢痕期を除く）のうち難治性胃潰瘍は42例11.8％の頻度であった．難治性潰瘍の要因の1つとして合併疾患が昔から言われており，またその合併疾患の治療薬剤が治癒に悪影響をもたらすことがある．NSAIDsを服用している慢性関節リウマチ患者の難治性胃潰瘍例と特別な合併疾患のみられない難治性胃潰瘍を呈示し，参考事項を述べた．

　Intractable gastric ulcer has been defined as the ulcer which is not healed (scarred) over 3 months after the initiation of anti-ulcer treatment. The recenta dvent of H₂ blockers or proton pump inhibitors (PPIs) has increased the 8-week healing rate up to as high as 90%. We therefore defined here intractable gastric ulcer as the one which failed to reach the healing stage within 8 weeks in spite of adequate therapy using H₂ blockers or PPIs. The incidence of intractable gastric ulcer was 42 (11.8%) of the 357 ulcer patients examined. Intractable gastric ulcer was more frequently observed in recurrent ulcer patients, and its common complications ineluded rheumatoid arthritis, liver disease and diabetes mellitus. Many patients with intractable gastric ulcer had long taken steroid hormones or nonsteroidal antiinflammatory drugs for their complications, while nearly the half of intractable ulcer patients had no history of drug-taking or complication, thereby suggesting that the pathogenesis of intractable gastric ulcer was not uniform but multiform.