臨牀消化器内科 Vol.16 No.11(3)


特集名 Helicobacter pylori感染の内視鏡診断
題名 H.pylori除菌後の胃粘膜内視鏡像の推移
発刊年月 2001年 10月
著者 榊 信廣 東京都立駒込病院内科
【 要旨 】 正常胃粘膜にH.pyloriが感染すると,炎症性変化が起こり萎縮性変化に移行する.一方,発赤やびらんといった表層性変化が一過性に発生する.ここでは,この三つの病態がどのように内視鏡所見に反映されるか,現在まで得られたH.pylori除菌後の変化の観察から推測した.炎症性変化は,粗大粘膜ひだや結節性変化だけでなく体部小弯の顆粒状粘膜として観察されるが,除菌直後の炎症細胞浸潤の軽快とともに消退した.除菌後長期経過観察で組織学的萎縮は約40%の症例で改善したが,内視鏡的な萎縮性変化の改善は乏しかった.表層性変化として,びらんはH.pylori感染と関係なく除菌成功直後に発生した.発赤に関してはさまざまな結果が報告され,正確な診断が必要と思われた.
Theme Endoscopic Diagnosis of Helicobater pylori Infection
Title Changes of Endoscopic Findings of Gastric Mucosa After Eradication of Helicobacter pylori
Author Nobuhiro Sakaki Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital
[ Summary ] After infection by H.pylori of normal gastric mucosa, infammatory change occurs first, and then atrophic change develops. On the other hand, superficial changes including reddening and erosion occur temporarily. In this paper, we will discuss preliminary data concerning changes in endoscopic findings for gastric mucosa after eradication of H.pylori, from the view point of endoscopic diagnosis of gastritis. The endoscopic inflammatory changes, which included not only giant folds and nodularity but also granular mucosa which was observed on the lesser curvature of the gastric body, and were reduced after eradication of H.pylori. In spite of recovering from histological atrophy, the endoscopic atrophic changes did not show any remarkable degree of change, in many cases, after eradication. Concerning endoscopic superficial change, erosion showed no relation to eradication. There is a great deal of controversial data concerning reddening, for which a diagnostic criteria has not been established.
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