腸上皮化生のレ線診断

Intestinal Metaplasiaz its Radiological Diagnosis

　腸上皮化生は古くから組織学的にみとめられている．また，この診断は組織学的につけられるべきであって，レ線，内視鏡，摘出胃肉眼所見でつけられるべきでないことは当然である．しかし，早期胃癌の肉眼的単位での診断は，一応重要であり，肉眼的単位の診断をまったく無視するわけにはいかない．一方，近年胃生検による診断が普及してきて，両方が相俟ってより精密になってきた．したがって，より微細な肉眼的単位の各所見の読みが要求されてくるようになってきた．

　これらの意味で胃炎を読むときに，「レリーフ」単位から「胃小区」単位へと読みを深めてゆかなくてはならない．反面，胃小区を読んだとしても，細胞単位の診断がすべてわかるとはおもわない．このあたりの的中率が今後の問題になってくるようにおもわれる．

　The diagnosis of intestinal metaplasia in the gastric mucosa should be done only through histological study. The present report is an attempt to arrive at its diagnosis as closely as possible by findings obtained by x-ray, endoscopy and the resected stomach. Observation of the mucosal surface on the macroscopic level must be concentrated on the size of the areae gastricae, the degree of its unevenness, their shapes, marginal appearances around them, the width of marginal furrows and their color.

　These observations can only be made strictly in metaplasia of higher degree and more diffuse type. No gross study of the mucosal surface can unveil intestinal metaplasia of a slighter degree, such as seen around an “erosion” or ulcer and its scar, nor its macroscopic diagnosis possible in areas where the mucosal surface is flat because of anadenia.

　Diagnosis of intestinal metaplasia shall become more accurate if biopsy is combined with the following x-ray procedures. In the first place, a Levine tube is introduced into the stomach, then gastric juice is aspirated as much as possible. After appropriate amount of air is sent in and contrast medium of good quality (e. g. Bestobar) is swallowed, the anterior and posterior walls are independently delineated by double contrast method. Overdistention of the gastric wall should by all means avoided. It should be remembered as well that the anterior wall can best be depicted in the head-low position (Trendelenburg's position). A strong suspicion of intestinal metaplasia is entertained when the areae gastricae are either uneven in size, of irregular shape, polygonal, zigzag in their margins, in disorderly arrangement, or have wide furrows between the areas.