X線学的所見と胃液分泌機能よりみた十二指腸潰瘍の胃粘膜―形態と機能の結びつき

Gastric Mucosa in Duodenal Ulcer Considered from the Radiologic Findings and Gastric Secretion: Relationship between form and function

　最近の早期胃癌診断の進歩は，胃微細粘膜像を描出し，その変化を読影することで，Ⅱb型早期胃癌や胃癌の浸潤範囲を診断しようという方向に向けられている．

　実際，二重造影の開発と改良，特に遮断剤を使用して撮影された“薬理学的二重造影像”は，日常診療の場においても胃の皺襞のみならず微細粘膜像をルチーンに描出している．したがって，われわれは経験的な積み重ねから胃の皺襞像や微細粘膜像から，その胃の酸分泌機能を推定し，薬剤の選択を行なったりしている．

　Roentgenologic findings of the gastric mucosa have been analyzed together with a study of the relationship between its pictures and gastric secretion in 100 ambulatory patients with duodenal ulcer, in 53 hospitalized patients in whom the amount of gastric secretion was measured and in 42 patients with gastric ulcer.

　In duodenal ulcer cases the mucosal folds of the stomach were often thicker and less distensible than those in gastric ulcer.

　We have also attempted to estimate in double contrast films the height of the borderline between the fundic and pyloric glands by presuming it to be located at a point where the mucosal folds of the body begin to disappear. In duodenal ulcer cases the presumed height of the borderline was very often lower.

　The patterns of fine mucosal pictures of the gastric body in patients with duodenal ulcer were assorted into several types. Rough reticular pattern and blurred barium flecks scattered about in the body with hardly any fine mucosal picture were seen in higher frequency in duodenal ulcer.

　Relationship between these roentgenological findings and gastric secretion has been studied with the results that x-ray findings of the gastric mucosa in duodenal ulcer seem to reflect the fact that “gastric mucosa is thicker and the area of the fundic gland is wider and the degree of gastritic changes is slighter than in gastric ulcer”, a pathophysiologic fact characteristic of duodenal ulcer.