特集名 | 薬物治療をめぐるControversy --上部消化管 | |
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題名 | 胃炎にHelicobactor pylori除菌を (2) しない | |
発刊年月 | 1999年 11月 | |
著者 | 谷中 昭典 | 筑波大学臨床医学系消化器内科 |
【 要旨 】 | Helicobactor pylori(H.pylori)は,感染者全例にH.pylori胃炎を惹起するが,胃癌,リンパ腫などの悪性疾患に罹患する症例はごく一部にすぎない.数多くのH.pylori胃炎のなかで,どのような症例が胃癌などの悪性疾患に罹患するのか事前に予測できないことから,予防のために,H.pylori胃炎全例に除菌治療を行うべきであるという考え方がある.しかしながら,この考え方には,以下のごとき問題点が残されている. 第一に,胃癌については,definite carcinogenとしてのH.pyloriの位置づけが確立されつつあるものの,H.pyloriが胃癌のmost important carcinogenであると結論するに十分な証拠がまだ存在しない.第二に,小児期より長期間H.pyloriに曝露された成人のH.pylori胃炎に除菌を行っても,どの程度,胃癌発症のリスクを低下させられるか,ヒトにおいてまだ客観的な成績が出されていない.第三に,H.pylori除菌により胃癌発症のリスクが低下するとしても,逆に除菌後に発症,増悪する逆流性食道炎が食道腺癌のリスクをどの程度,増大させるか不明である.第四に膨大な数のH.pylori胃炎に一網打尽の除菌を行うことは,除菌のコストにより医療経済を圧迫するとともに,抗生物質耐性菌を飛躍的に増大させる危険性がある. 以上の理由により,筆者は,現状においては,H.pylori胃炎全例に対する除菌は行うべきではないと考える. |
Theme | Controversies in the Drug Therapy of Upper Gastrointestinal Tract Disorders | |
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Title | Should All H.pylori be Eradicated in Patients with Gastritis Alone? --Answer : No at Present | |
Author | Akinori Yanaka | Department of Gastroenterology Institute of Clinical Medicine University of Tsukuba |
[ Summary ] | It has been suggested that infection with Helicobacter pylori (H.pylori) causes gastritis in almost all the patients, but usually does not cause malignant diseases, such as gastric carcinoma or malignant lymphoma. Several recent studies, however, have demonstrated that gastric carcinoma is strongly associated with H.pylori infection. Therefore, one would expect that all kinds of H.pylori, including those in gastritis patients, should be eradicated to prevent subsequent development of gastric carcinoma. There remains, however, several unsolved issues before starting complete eradication of H.pylori from all the H.pylori-infected human being in the world. First, we do not know whether H.pylori is the most important carcinogen with regard to gastric cancer. In addition, we do not know how much we can reduce the risk of gastric carcinoma through eradication of H.pylori in adult patients, who have already been infected with H.pylori presumably for more than 20 years. Second, it seems possible that H.pylori eradication raises the risk of adenocarcinoma of the esophagus, in contrast to its beneficial effects on lowering risk of the gastric carcinoma. Third, it seems highly likely that H.pylori eradication in large number of the population increases the number of H.pylori strains, which show resistance to almost all antibiotics. Increase in such antibiotic-resistant H.pylori strains may provoke more harmful effects on our gastric mucosae. Based on these standpoints, it seems too early to conclude that all the H.pylori should be eradicated merely for the prevention of gastric carcinoma. |