逆流性食道炎の内視鏡診断

Diagnosis of Postoperative Reflux Esophagitis: Chiefly Its Endoscopic Findings

　非特異性食道炎については種々の病因が考えられているが，胃液をはじめ消化液の食道内への逆流によってひきおこされる逆流性食道炎が最も屡屡経験される．下部食道から噴門にかけて，様々の食道内への逆流防止機構が考えれている．例えば食道下端における輪状筋の収縮が括約筋様作用をもつとか，噴門部の斜走筋の収縮で胃が吊り上げられ，噴門が閉鎖されるとか，His角，噴門の胃粘膜ひだによる弁作用とか，横隔膜のPinchcock様作用であるとかである．

　このような生理機構が不全であったり破壊されたとき，逆流性食道炎がおこりやすいのであるが，われわれは外科的立場より，手術操作のためにこれらの機構がこわされておこる食道再建術後の逆流性食道炎について，主に内視鏡的な面より検討を加えてみる．食道炎の診断基準についてはまちまちであり，その方法論からも問題のあるところであるが，内視鏡所見について一つの診断基準を考えてのべてみるつもりである．

　From the standpoint of surgery, we have studied reflux esophagitis after the operation of esophageal reconstruction, evaluating its diagnostic criteria with emphasis laid on the endoscopic findings. Although there have been many reports of reflux esophagitis due to regurgitation of gastric juice, opinion is somewhat divided on this question.

　Of 426 cases, totalling to 1,171 examinations, that have been postoperatively studied by esophagoscopy, 150 cases (35%) were diagnosed as reflux esophagitis. Its incidence differed according to the methods of operation, ranging from about 10 per cent to as many as 48 per cent.

　Reflux esophagitis can be divided into three groups as determined by endoscopy. The first is seen as reddening of the mucosal surface, hardly different in height from the surrounding mucosa. The reddening is pale, and its area is ill-defined. The second group is characterized by erosion. It is sharply circumscribed against the neighboring area with difference in height. Not only ulcer formation but also constriction is included in this group. In the third group are seen clusters of small protrusions, some with rough surface and others looking like multiple leucoplakia. Biopsy shows that the first group can not always be diagnosed as esophagitis, but in the second group almost all cases can be confirmed as such.

　We have also attempted to establish biopsic criteria of esophagitis, correlating them with esophagoscopic findings. Correlation was found in about half of cases between biopsic and endoscopic findings regarding the grade of severity in esophagitis.