病態生理からみた難治性胃潰瘍

Pathophysiology of Intractable Gastric Ulcer

要旨　難治性胃潰瘍と易治性胃潰瘍に対してH₂ブロッカー投与下に24時間胃内pHモニタリングを施行し，両者を比較することによって胃液酸度の面から難治性胃潰瘍の病態を検討した．pH 3 holding time rate，平均pH値，胃内pH-profile をパラメーターとして両者を比較すると，夜間には全く差はなく，食事などの酸分泌刺激のある日中には有意な差が認められた．日中のpH 3 holding time rateは難治性胃潰瘍ではすべて45％以下であり，45％以上であった易治性胃潰瘍と判別できた．したがって，日中の胃液酸度の充進が難治性胃潰瘍の病態であると考えられた．また，この日中の胃液酸度を抑制することが難治性胃潰瘍の治療に有効であった．

　Twenty four hours of continuous intragastric pH monitoring was performed on patients with tractable and intractable gastric ulcers being treated with H₂ blockers. The pathophysiology of intractable gastric ulcer was investigated in terms of intragastric acidity. Although there was no difference in the duration of maintaining pH 3, the average pH value and the intragastric pH profile in each group during the night, there was a statistically significant difference in the daytime when acid secretion stimulating factors such as meals were present. The pH 3 maintaining time of all patients with intractable ulcer was under 45%, although those with tractable ulcer was over 45%. These findings suggest that an increase in intragastric acidity in the daytime may cause intractable gastric ulcer. Suppression of high intragastric acidity in the daytime was effective in treating intractable gastric ulcer.