食道潰瘍

Esophageal Ulcer

　食道潰瘍は食道疾患のなかでも比較的稀なもので，X線上，下部食道に食道癌類似の狭窄，壁不整を示すものとして，従来癌との鑑別疾患として注意されてきた．しかし，最近になり一般の生活様式の変遷のためか，日常の外来診療でも患者数は増加しており，いろいろと消化器症状を有し，内視鏡検査の進歩で診断がそれ程困難でなくなってきている現在，鑑別疾患というだけでなく一つの疾患として，診断，治療の面であらためて注目されるようになってきた．

頻度

　食道潰瘍の頻度は，はじめ剖検例を中心に報告され，Berthold（1883）の9,633例中0.16％，Gruber（1911）の4,208例中0.6％とされ，臨床例ではJackson（1929）¹⁾が食道鏡検査例4,000例中88例2.2％と述べている．われわれも，過去10年間の食道鏡検査回数9,726回で2.3％とJacksonとほぼ同じような頻度である．しかし，10年前の千葉大学第2外科での統計では，食道鏡検査回数5,005回中0.8％と少なく²⁾，最近になり診断技術面の進歩もあるが，食生活の変化で，肥満，特に老人の肥満者の多いことなど，疾患の実数も確かにふえてきていると思う．

　Clinical study has been made of esophageal ulcer. Of its various possible cases, the most common one is of peptic nature associated with esophageal hiatus hernia or the short esophagus. Clinical symptoms include heart burn, dysphagia, retrosternal pain and epigastric distress. But they somewhat vary according to the type and site of ulcer. For instance, ulcer in the lowermost esophagus near the esophagogastric junction often causes dysphagia, while ulcers extending widely in the lower esophagus is responsible for heart burn and epigastric distress due to erosive esophagitis, and ulcer restricted only in the midesophagus causes pain at swallowing. Diagnosis by X-ray depends not so much on demonstration of a niche as on indirect signs. Endoscopy reveals less rugged changes as compared with those of cancer, and ulcer is characterized by the absence of any proliferative changes around the lesion. Internal management has priority over other therapeutic measures, but when ulcer is complicated with bleeding, stricture, etc, or when the clinical course is prolonged with severe signs and symptoms, surgical intervention is in order. Of our experiences cases, we have described here an ulcer of the esophagus which was later diagnosed as cancer. The relationship of ulcer with cancer still remains a topic of further discussions and investigations.