幽門洞胃炎を中心にした慢性胃炎の診断と評価

Evaluation of Antral Gastritis in Relation to Fundal Gastritis

要旨　中村のf-lineより幽門側にみられる萎縮性胃炎を“幽門洞胃炎”(antral gastritis)と定義し，加齢による幽門洞胃炎の進行と胃潰瘍，胃癌の発生との関連を検討した．幽門洞胃炎は体部胃炎に比し，高頻度かつ短時間の間に進行し，体部胃炎の拡大を引き起こすことを明らかにした．また幽門洞胃炎は胃潰瘍の発生と胃癌，特にその組織型に密接な関連を有することを示した．

　The grade of antral gastritis and the extent of fundal gastritis in patients with gastro-duodenal disease were examined by the endoscopic congo red test combined with gastric biopsy.

　There were significant differences between the extent of fundal gastritis and the grade of antral gastritis in patients with gastroduodenal diseases. Gastric cancers and ulcers were associated with severe antral and fundal gastritis. In patients with gastric polyp, although fundal gastritis was about the same as that of gastric cancers and ulcers, antral gastritis was usually moderate. In contrast, there was little or no atrophic gastritis both in the pyloric and fundic gland areas in patients with duodenal ulcer.

　Follow-up studies showed that antral gastritis progressed significantly more frequently and more rapidly than fundal gastritis. Atrophic gastritis extended more frequently from the antrum to the gastric body than from the gastric body to the antrum. Moreover, there were close correlations between the deterioration of the antral gastritis and gastric ulcers and cancers. Gastric ulcers occurred more frequently when the antral gastritis progressed, and gastric cancers of well-differentiated type developed more frequently when intestinal metaplasia progressed in the antral portion.