十二指腸炎の内視鏡所見と生検所見の対比

Duodenitis: An Endoscopic and Histologic Study

要旨　十二指腸炎の内視鏡的分類の見直しを行った．今回，新たに分類したそれぞれのグループごとに光顕組織像の特徴を検討し，以下の成績を得た．①発赤型：絨毛は中等度萎縮．細胞浸潤は軽度．胃上皮化生は軽度．②びらん型：粘膜表層部は壊死杯細胞なし．細胞浸潤は高度．胃上皮化生なし．③粘膜粗糙型―(a)発赤粗大隆起：絨毛は高度萎縮，細胞浸潤は軽度．Brunner腺が増殖．胃上皮化生は中等度．(b)胃上皮化生による顆粒状隆起：胃上皮化生は高度．細胞浸潤は軽度．(c)平皿状陥凹：絨毛は軽度萎縮，細胞浸潤は軽度．胃上皮化生は軽度．各グループ相互の関係，各グループと臨床像との関係などについて今後検索を進める必要がある．

　Duodenitis was classified endoscopically. Biopsy from each type of duodenitis, and the normal duodenum was performed (Table 1). Quantitative histological study of the biopsy specimens was done. Many histological variables were correlated to the endoscopic classification of duodenitis (Table 2).

　1. Hyperemic type (Fig. 2): The height of villus decreases. The degree of cellural infiltration of lamina propria is normal (Fig. 3).

　2. Erosive type (Fig. 4): Necrosis of the superficial part of the mucosa is present. Cellular infiltration including numerous neutrophils increases. Goblet cell and gastric epitherial metaplasia are not found (Fig. 5).

　3. Rough-surfaced type with thickened fold and/or nodular mucosa (Fig. 6): Hyperplasia of Brunner's gland is present. The height of villi heighly decreases. The degree of cellular infiltration of the lamina propria is normal. Gastric epithelial metaplasia is found frequently (Fig. 7).

　4. Rough surfaced type with granulation due to gastric epithelial metaplasia (Fig. 8): Gastric epithelial metaplasia is present in all cases. No increase of cellular infiltration of lamina propria is recognized. The mucosa is thick due to the elongated villus-crypt unit (Fig. 9).

　5. Rough-surfaced type with flat-bottomed dish-like depression (Fig. 10): The height of villi decreases. No increase of cellular infiltration of lamina propria recognized (Fig. 11).