臨牀消化器内科 Vol.16 No.11(6)


特集名 Helicobacter pylori感染の内視鏡診断
題名 H.pylori胃炎除菌前後の拡大観察
発刊年月 2001年 10月
著者 八木 一芳 新潟県立吉田病院内科
著者 中村 厚夫 新潟県立吉田病院内科
著者 関根 厚雄 新潟県立吉田病院内科
【 要旨 】 H.pylori(HP)非感染胃粘膜およびHP胃炎粘膜の拡大内視鏡像と組織像の対比検討した後,HP胃炎の除菌前後の拡大像の変化を組織学的変化とともに検討した.非萎縮粘膜での除菌後の特徴はpits間の発赤・隆起の消失,白濁したpitsのピンホール状pitsへの改善,集合細静脈の可視化であった.これらはHP非感染粘膜の拡大像の構成要素でもあった.萎縮粘膜の除菌後観察例では,ピンホール状pitsとその周囲を取り囲むネットワークを形成した毛細血管が観察できる症例では胃底固有腺の再生を認める一方,腺溝模様症例は固有腺の再生は乏しかった.以上より,拡大像は炎症および萎縮の改善など胃粘膜の状態を反映していると考えられた.
Theme Endoscopic Diagnosis of Helicobater pylori Infection
Title Magnified Observation of Gastric Mucosa Before and After Eradication of Helicobacter pylori
Author Kazuyoshi Yagi Niigata-prefectural Yoshida Hospital, Department of Intennal Medicine
Author Atsuo Nakamura Niigata-prefectural Yoshida Hospital, Department of Intennal Medicine
Author Atsuo Sekine Niigata-prefectural Yoshida Hospital, Department of Intennal Medicine
[ Summary ] A magnified view of corpus of H.pylori-negative normal stomach tissue showed collecting venules, true capillaries forming networks, and gastric pits, with a pinhole-like appearance. This view termed type Z-O. H.pylori induced gastritis, showed various views, and these views were termed as the following ways; 1) true capillaries were observed, but not collecting venules (Z-1), 2) neither collecting venules nor true capillaries were observed and white pits were observed (Z-2), 3) redness was observed around white dilated pits (Z-3). Greater curvature of the body in 42 cases with H.pylori induced gastritis was observed by magnifying endoscope before and 2 months after eradication. The following three details of magnifying findings were assessed; (A) whether redness and elevation of the intervals between pits improved or not, (B) whether white pits improved to pinhole-like appearance or not, (C) whether collecting venules became visible or not. 39 cases of H.pylori infection were cured. 86% (30/35)* of cases showed improvements in elevation and redness intervals between pits. 72% (28/39) of cases showed changes from white pits to a pinhole-like appearance. In 28% cases, collecting venules became visible. Furthermore, we observed a decreased curvature of low bodies before and after eradication evaluated by magnifying endoscopy and biopsy specimens to assess regeneration of oxyntic glands after eradication. The appearance of pinhole-pits and capillaries forming a network was indicated by a magnified view of the regeneration of oxyntic glands.
*: 4 cases showed true capillary pattern and neither redness nor elevation before eradication.
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