薬剤（アスピリン）による急性胃病変症例

Acute Gastric Changes Following Ingestion of Medicaments (Aspirin) Reports of Cases

　サリチル酸が臨床的に用いられるようになった1年後の1877年にはすでに，その胃腸障害が注目されるところとなった．そして1938年Douthwaite ＆ Lintott¹⁾²⁾はAspirinによる胃傷害の内視鏡について始めて記した，以来，いわゆる“Aspirin Gastritis”としてサリチル酸剤による胃病変に関する多数の報告がある．著者らも，サリチル酸剤が関与すると考えられる胃病変37症例を経験し，一部に既に発表し³⁾⁴⁾，また現在検討をすすめているが，Aspirinによる2症例を示し，多少の臨床的検討を加えて記す．

　Tow cases of acute gastric changes are illustrated probably induced by anagesic and anti-inflammatory agents such as aspirin. We have also made endoscopic examinations of the stomach on 52 patients following their ingestion of these agents. Some comments are added regarding the clinical pictures and the literature.

　Of 23 patients taking aspirin, erosion was seen in 11 and ulcer in 5 (2 were multiple ulcers). Of the remaining 29 patients ingesting both aspirin and nonsteroid anti-in-flammatory analgesics, erosion was seen in 12 and ulcer in 9 (3 of them multiple). The incidence of erosion and ulcer in our series was thus as high as 70 per cent.

　Erosion or ulcer would crop up in a relatively short time, mostly within one month after medication. Lesions were chiefly localized in the antrum; erosion was more often seen in the greater curvature side, while ulcer favored the lesser curvature. These changes were demonstated even in patients who had no subjective complaints referrable to the abdomen, a finding consistent with that made by researchers who studied endoscopically the human stomach.

　Measurements of the blood level of acetylsalicylic acid value in the gastric juice has been correlated between a group endoscopically harboring lesions and another that had no gastric lesions. As for salicylic acid level no great difference was found between the two, but after histamin stimulation 4 out of 11 with gastric lesions showed higher acid value, while none of 6 patients with endoscopically intact stomach displayed any change in the secretion of free acid.