十二指腸炎の病態

A Pathogenesis of Chronic Duodenitis

要旨　慢性十二指腸炎は，過去，現在ともに潰瘍所見がみられないにもかかわらず，十二指腸に発生する原因不明の炎症である．この病態が存在することは，2世紀前から知られている．初期の文献では，この病態の存在は外科的切除標本により，続いてX線的に指摘されている．この病態に対する理解は経口十二指腸生検の導入から進展した．続いて内視鏡の導入は十二指腸の直視あるいは目的部分からの生検診断を可能にした．慢性十二指腸炎の臨床的意義については意見が対立している．Ostrow and Resnickは本病態が過酸，十二指腸炎，十二指腸潰瘍へと進展する潰瘍体質に含まれると主張し，これに対してCheliは，本症には低酸，無酸が多いことから異論を唱えている．したがって長期の多数例によるprospective studyが必要である．

　Chronic duodenitis (primary) is a condition of unknown cause characterized by inflammation involving the mucosa of the duodenum (especially first part) with no signs of past or present ulceration.

　This condition has been recognized for more than 2 centuries.

　The early literature on this condition was based on findings obtained at surgery and later by radiology. The major advances in our understanding of this disease started with the introduction of peroral duodenal biopsy. Subsequently, the introduction of fiberoptic endoscopy allowed direct visualization of the duodenum, and target biopsies of suspicious areas of mucosa can be easily obtained.

　The clinical importance of duodenitis in the absence of chronic ulceration remains controversial.

　Ostrow and Resnick (1959) developed a hypothesis which proposed a pathological sequence of hyperchlorhydria, duodenitis and duodenal ulcer as steps in the peptic ulcer diathesis. On the contrary, Cheli observed that the majority of patients with duodenitis had hypochlorhydria or achlorhydria. Therefore, this study does not support the theory of “peptic duodenits”.

　Prospective studies should be required including long-term clinical follow-up of a large number of patients with duodenitis, accurately and specifically diagnosed by endoscopy and histopathology.