NHPH感染胃炎のX線・内視鏡所見の特徴

Characteristics of X-ray and Endoscopic Findings in NHPH-infected Gastritis

要旨●NHPH感染胃炎の内視鏡所見として，ひび割れ状粘膜・霜降り状所見・鳥肌胃炎・点状発赤の既報がある．当院でH. suisを同定した36例でその頻度，胃粘膜萎縮との関係，好発部位を検討し，さらに5例で胃X線造影所見を検討した．霜降り状所見は胃角部から前庭部小彎に早期に出現し，炎症の進行に伴い，胃角部から前庭部大彎のひび割れ状粘膜に移行すると推定された．鳥肌胃炎はH. pylori感染と鑑別困難だが，胃角部大彎の腺境界付近の限局性の点状発赤はH. suis感染胃炎における特徴的所見の可能性がある．ひび割れ状粘膜症例の胃X線造影所見はH. pylori感染胃炎の早期，つまり軽度萎縮にて観察される前庭部胃炎の所見と酷似していた．

　Regarding EGD（esophagogastroduodenoscopic）findings of NHPH（Non-Helicobacter pylori Helicobacter）-infected gastritis, four findings have already been reported：crack-like mucosa, white marbled appearance, nodular gastritis, and spotty redness. The frequency, gastric mucosa relation with atrophy, and gastric region of frequent occurrence of each finding were investigated in 36 cases in which the NHPH species were identified as H. suis（Helicobacter suis）in our facility. The characteristics of X-ray findings of five cases near the time of diagnosis were examined. It was presumed that the white marbled appearance appears relatively early from the gastric angle to the lesser curvature of the antrum. However, it changes to crack-like mucosa from the gastric angle to the greater curvature of the antrum as inflammation progresses. Nodular gastritis cannot be distinguished from H. pylori（Helicobacter pylori）-infected gastritis based on EGD findings. Spotty redness localized near the glandular border of the greater curvature of the gastric angle might be a characteristic of H. suis-infected gastritis. The gastric X-ray findings of the cases with crack-like mucosa are similar to those of early H. pylori-infected gastritis, particularly the slight atrophy of the antral gastritis.