難治の経過をたどった胃潰瘍の1例

Intractable Gastric Ulcer, Report of a Case

要旨　患者は44歳の男性で，1983年から当科で十二指腸潰瘍のため治療を受けていた．1987年より2年間，通院が途絶えていたが，約1年間に及ぶ頑固な心窩部痛を主訴に再受診した．内視鏡では胃角小轡に活動性潰瘍がありH₂ブロッカー療法では治癒までに14週を要し，難治性であった．その後の再発時にも難治性であったが，プロトンポンプ阻害薬（PPI）療法では速やかに治癒した．胃内pHモニタリングでは，H₂ブロッカー投与時には日中の胃液酸度はまったく抑制されていなかったのに対し，PPI投与時には昼夜を問わず十分な抑制が得られた．すなわち，PPI療法の治癒促進効果はこの胃液酸度抑制力によるものと考えられた．しかし，PPI療法を中止すると再発を繰り返したことから，再発防止のためにPPI療法を含めた新しい療法の検討が必要である．

　A 44-year-old male patient, who had been under treatment for duodenal ulcer at our clinic since 1983, complained in 1989 of a stubborn epigastric pain of one year duration, after a two-year absence from treatment (1987-1988). Endoscopic examination revealed an active ulcer in the lesser curvature of the gastric angle.

　H₂-blocker treatment was carried out for as long as 14 weeks, with favorable results. The disease subsequently recurred, however, and was treated with proton pump inhibitor (PPI), which took effect promptly. Intragastric pH monitoring showed that the gastric juice acidity was fully controlled by PPI all day long, whereas it was not reduced by H₂-blocker in the daytime. The higher therapeutic effect of PPI seems to be due to its action in reducing gastric acidity. Unfortunately, the cessation of PPI administration resulted in relapse of the disease. A new concurrent therapy is therefore needed, to prevent recurrence.