Zollinger-Ellison症候群における上部消化管病変のX線および内視鏡像

Roentgenographic and Endoscopic Observations in the Zollinger-Ellison Syndrome

　Zollinger-Ellison症候群（以下ZES）は難治性潰瘍を主徴の1つとする．本症は比較的まれと考えられているため，あるいは通常の消化性潰瘍とは異なる部位の潰瘍が多いと考えられているため日常診療に際して本症が念頭に置かれることは少ないと思われる．われわれは空腸に特徴的なびらん性変化の認められたZES例を報告した¹⁾．その後十二指腸あるいは空腸のびらん性変化に着目し，難治性潰瘍例にセクレチン負荷試験を行い，計6例のZESを診断しえた．本症の早期発見のため，この6例の上部消化管病変に検討を加え，その特徴像の分析を試みた．

　Roentgenographic and endoscopic findings of the upper gastrointestinal tract in six patients with the Zollinger-Ellison syndrome were discussed.

　Five patients were diagnosed after partial gastrectomy because of recurrent ulcer. A patient was diagnosed before surgery. All six patients had hypergastrinemia and positive secretin tests and three patients were histologically proven to have endocrine tumors.

　Location of primary ulcer was as follows: three ulcerations were gasrtic, one duodenal, one postbulbar and one erosive duodenitis without ulcer crater.

　In five of six patients, pre- and postoperative examination revealed edematous or erosive change in the distal portion of the duodenum or the jejunum. These erosive changes in the upper bowel circularly occurred frequently. This finding gives the most informative evidence of the Zollinger-Ellison syndrome.