出血性びらんの内視鏡的ならびに文献的考察

Endoscopic Study of Hemorrhagic Erosions of the Stomach and Review of Literature

　従来，出血性びらんという用語は，びらんまたは，びらん性胃炎の用語と混用されてきた．Table 1に示すように，既に1897年，Lainé¹⁾によるÉrosions Hémorrhagiquesが初めでその後著者により，その命名はまちまちで統一されておらず，ほとんどが肉眼所見に基づくもので，現在用いられているものは，この内わずか3～4に過ぎない．この混乱に対しKatz²⁾（1968年）がAcute erosive gastritis，Hemorrhagic gastritis，Acute gastric ulcerをAcute gastric mucosal lesions（以下AGMLと略）と総称することを提唱したが，本邦でも，川井ら³⁾の急性胃病変の呼称がある．

　出血性びらんの内視鏡的観察については，1939年Schindler⁴⁾がこれを詳細に記述している．即ち出血性びらんは，新しいかつ重要な疾患であることを強調し，Mucosal Hemorrhage，Hemorrhagic erosion，およびPigment spotに分類しその症例を述べているが，この業績が35年前に発表されたこと，およびその卓越した内容は，今日なお我々に感動大きなものを与える，同様に，Fodden⁵⁾も胃・十二指腸潰瘍に合併する出血性びらんについて述べている．このほか，AGMLとアルコール，種々な薬剤，または中枢神経系疾患との関連を論じた報告は，まさに枚挙にいとまがない．

　1) 130 cases of hemorrhagic erosions were analysed in regard to its endoscopic appearances. In addition, an extensive review of literature was made concerning hemorrhagic erosions and simulating conditions which were appropriately named by Katz et al. as acute gastric mucosal lesions (AGML).

　2) The cases were divided into two groups; the acute epigastralgia group and the chronic symptom group. The cases associated with the other illnesses were separately discussed. All cases with acute epigastralgia were detected in front clinics only, and mostly among younger generations but not rarely in the ages over 50. Male predominancy was apparent. Occasionally the condition persisted for some time, but required no operative treatment. The chronic symptom group tended to be found in older ages over 40 and also predominantly in male.

　3) In the acute epigastralgia group, the erosions were linear, or wide and irregular in shape and were mainly distributed in the antrum and angulus, whereas the chronic symptom group showed spotty erosions and wider distribution but mostly at the angular portion.

　4) Hemorrhagic erosions seemed to occur in the endoscopically nonatrophic mucosa.

　5) There was a case in which an apparent polyp developed at the site of hemorrhagic erosion.

　6) Recurrence was encountered in only one case of each group in our series.

　7) Coexistence of diseases of the other organs should be carefully ruled out. In addition, differenciation from the other gastric diseases such as advanced or early gastric carcinoma or sarcoma should be done with great care.

　8) It was surprising to find that endoscopic descriptions of similar conditions dated back to 1939 by Rudolf Schindler.