胃診断学20年の歩みと展望―胃潰瘍（急性潰瘍を含む）を中心に

Progress in the Diagnosis of Gastric UIcer in the Last Twenty Years

要旨　胃潰瘍の診断はより質的診断（機能的診断）へと目が向けられ，胃生検の幅広い普及により鑑別診断－主として早期胃癌，胃悪性リンパ腫一にも一層重点が置かれてきている．一方，典型的な胃の線状潰瘍が少なくなっており，外科的治療を要する胃潰瘍も減少傾向を示している．すなわち，診断の進歩による早期治療や生活環境の向上にも起因していると思われる．薬物療法としてのH₂受容体拮抗剤の登場は，潰瘍治癒の向上をもたらしている反面，依然として再発には今後の検討課題が残されている．胃粘膜防御機構の解明がなされつつある現在，防御因子と攻撃因子の両面を考慮した治療モデルの確立が望まれる．急性胃潰瘍と慢性胃潰瘍の関連性についても，今後，成因あるいは病態生理面での検討がなされるものと思われる．

　The diagnosis of gastric ulcer has made great progress along with the advances in the development of endoscopic instruments. In particular, diagnosis based on gastric biopsy has become indispensable for differential diagnosis. It is especially important to distinguish gastric ulcer from early gastric cancer and malignant lymphoma of the stomach.

　Recently, the incidence of gastric linear ulcers having typical deformity has decreased. There has also been a tendency towards a reduction, year after year, in the number of cases requiring surgical treatment. These may be attributable to early treatment based on the advanced diagnosis of gastric ulcer as well as on the general improvement in life environment. In addition, the remarkable contribution of drug therapy must not be overlooked. For example, histamine H₂-receptor antagonists have come into widespread clinical use, with consequent improvement in the healing of gastric ulcers.

　However, satisfactory and effective means against the recurrence of gastric ulcer remain to be studied. Furthermore, clarification of the gastric mucosal defensive mechanism is still under investigation. It is desirable to establish an effective therapeutic model, taking both aggressive and defensive factors into consideration.

　The relationship between acute and chronic gastric ulcers still remains to be a topic for current and future research.