胃底腺領域における慢性胃炎の診断と評価

Diagnosis and Evaluation of Chronic Gastritis at the Fundic Gland Area

要旨　慢性萎縮性胃炎は幽門腺領域と胃底腺領域別に生じる粘膜変化で，単なる生理的加齢現象ではない．胃底腺領域の萎縮性胃炎には中間帯が関与する通常の萎縮性胃炎と悪性貧血を典型とするいわゆるA型胃炎に大別されるが，胃小区像や腸上皮化性の分布などに種々の差がみられた．また萎縮性胃炎は局在性胃病変の背景胃粘膜としての意義を有し，Ⅱa-subtypeと過形成性ポリープ後者では，ポリープの存在部位（前庭部と胃体部）により，萎縮の程度，腸上皮化生の分布などに種々の相違がみられるが，胃体部に存在する過形成性ポリープの症例で高ガストリン血症を伴い，粘膜萎縮の主座が胃体部に存在すると思われる例を認めた．

　Chronic atrophic gastrit is not a physiological or aging phenomenon but a mucosal lesion which occurs independently at the pyloric gland area and the fundic gland area. Atrophic gastritis at the fundic gland area is deviled into the following two types: one is usual atrophic change related to intermediate zone and another is so-called type A gastritis, its representative case is pernicious anemia, and there were various differences in features of their areae gastricae etc. The atrophic gastritis also has a role of background gastric mucosa in localized gastric lesions. Various differences such as degree of atrophy and distribution of intestinal metaplasia were recognized between Ⅱa-subtype and hyperplastic polyp, in the latter according to the location of polyps (antrum or body).