逆流性食道炎の重症度分類―病態生理学的観点から

A Grading of Reflux Esophagitis: in View of Pathophysiological Findings

要旨　逆流性食道炎の内視鏡的重症度と病態生理学的重症度との関連性について比較検討した．胃食道逆流現象（GER）は食道内24時間pHモニターにより，その回数と停滞時間を測定した．食道運動機能はinfused catheter法にて，第一次蠕動波高とLESPを測定し，acid clearing testも実施した．Savary ＆ Miller（S & M）分類のstage ⅠからⅢについては病態生理学的重症度とよく合致していたが，ⅣはⅢに比し病態生理学的にはむしろ軽症であった．色調変化型食道炎はS & M分類のⅠに近い病態であったが，両者を比較すると前者はGERの頻度が高く，後者はGERの停滞時間が延長していた．以上の結果をもとに機能面からみた逆流性食道炎の重症度分類を呈示した．

　This paper reports a comparative study on endoscopical grading and pathophysiological grading of reflux esophagitis. The episodes and duration of gastroesophageal reflux (GER) were estimated by 24-hour pH monitoring in distal esophagus. Esophageal motor function was evaluated by the amplitude of primary peristalsis in the esophageal body and the lower esophageal sphincter pressure (LES) under the infused catheter method. At the same time, acid clearing tests were performed. The endoscopical grading by Savary & Miller (S & M) classification corresponds to the grading of pathophysiological findings in stage Ⅰ, Ⅱ and Ⅲ respectively. However, the pathophysiological findings of stage Ⅳ was milder than that of stage Ⅲ. The pathophysiological findings of discoloring type esophagitis were similar to that of stage Ⅰ. There were correlations between discoloring type esophagitis and episodes of GER, and between stage Ⅰ esophagitis and duration of GER. Based on these results, we proposed a grading scale of reflux esophagitis in view of pathophyBiological findings. According to our grading, Grade Ⅰ may be composed of discoloring type esophagitis and stage Ⅰ (S & M). Grade Ⅱ and Ⅲ may correspond to stage Ⅱ and Ⅲ (S & M) respectively. But stricture and Barrett's esophagus (stage Ⅳ of S&M) may be considered additional factors in view of pathophysiological findings.