長期間経過をみた十二指腸炎の1例

A Long-term Follow-up Patient with Duodenitis, Report of a Case

要旨　患者は51歳，男性．健診の胃X線検査で十二指腸球部から下行脚にかけて粘膜ひだの腫大と結節状隆起を指摘され来院した．内視鏡検査では同部位に山田Ⅰ～Ⅱ型の隆起が多発し，表面に発赤・びらんを伴い，十二指腸炎と診断された．生検組織所見では表面上皮の欠損，腸絨毛の減少ならびに消失，炎症性細胞浸潤，更にBrunner腺の過形成が認められた．無症状であったが年1回のX線検査を定期的に受けていた．6年4か月後の内視鏡検査でも球部から下行脚に発赤・びらんを伴った低い隆起が多発して認められた．本症例は長期間の経過において上皮のびらん・再生が繰り返し起きていたと推測されるが，基本的な形態像は不変であった．

　A 51-year-old man, whose x-rays revealed abnormalities in the duodenum during mass screening examination, visited our hospital. The x-ray findings showed thickening of the duodenal folds and mucosal nodules throughout the first and second portions of the duodenum. He was diagnosed endoscopically as having duodenitis with findings such as mucosal nodules with multiple erosions in the duodenal bulb and in the second portion of the duodenum.

　Histologically, the biopsy specimen showed erosion, loss of the villous pattern, increasing cellularity of the lamina propria and hyperplastic changes of Brunner's glands. He recieved annual follow-up x-ray examinations for a period of time. After 6 years and 4 months, endoscopic findings demonstrated multiple erosions in the duodenal bulb and swollen folds with erosions in the second portion of the duodenum. It seems that erosions and regenerative epithelium of the surface remained for a long period of time in the duodenum.

　However, the x-ray and endoscopic findings showed almost no change. There are several problems with the diagnosis and physiological aspects of the duodenitis. Thus, it is important that cases, followed up as duodenitis for a long time, should be collected and studied.