H2ブロッカー投与中に巨大な結節隆起を認めた難治性胃潰瘍の1例

Massive Granulation Occurred in a Patient with Refractory Ulcers during H2-blgcker Therapy, Report of a Case

要旨　患者は58歳，女性．1975年から高位潰瘍で再発・再燃を繰り返していた．1982年2月からH₂ブロッカーを初回投与された．本剤投与22か月後の内視鏡では胃体上部前後壁に活動性の潰瘍を認めた．更に同一治療を続けた4か月後の内視鏡検査では潰瘍底および周辺部に巨大な隆起を認め，生検組織では悪性像は認められなかったが，悪性リンパ腫を完全に否定できず手術を施行した．病理組織学的診断では，隆起性病変は肉芽組織であった．

　It has been known that the bottom of ulcers rises due to excessive granulation in the healing stage of ulcers treated with H₂-blockers. This paper describes a 58-year-old female patient with refractory ulcers in which massive granulation occurred after administration of an H₂-blocker for about two years. She has had recurrent ulcers since 1975 and received an H₂-blocker administration since 1982. Endoscopic findings obtained about 1 year and 11 months after the commencement of H₂-blocker therapy revealed a recurrent A₂ ulcer in the anterior and posterior walls of the gastric body. Endoscopic findings obtained four months later showed a large nodule at the site where an ulcer was found during the previous endoscopic procedures. The patient was operated on because the possibility of malignant gastric lymphoma could not be excluded, although biopsies gave no evidence of malignancy. The histopathological diagnosis was granulation. In general, the size of elevation of the ulcer bottom seen during the healing process is less than 1 cm, and to our knowledge, there is no report of elevations as large as that found in our patient (7 cm). The etiology and clinical significance of this finding are discussed in this paper.