特集名 | PPIの長期投与 | |
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題名 | PPI長期投与の問題点 (2) 胃炎の進展と胃粘膜萎縮に及ぼす影響 | |
発刊年月 | 2002年 02月 | |
著者 | 上村 直実 | 呉共済病院消化器科 |
【 要旨 】 | 1996年にH.pylori陽性患者に対するPPIの長期投与により体部胃炎が増悪し,ひいては胃粘膜萎縮が進展することがKuipersらにより報告され,H.pylori感染胃粘膜に対するPPIの長期投与前に除菌をすべきであるとの意見もあるが,一方では萎縮性変化に影響しないとする報告もあり,一定のコンセンサスが得られていない.筆者らの成績からもH.pylori感染による体部胃炎および萎縮性胃炎の進展に対して,局所の胃酸分泌能の違いが大きな影響を有していることは確かである.しかし,PPIによる体部胃炎に対する影響は個々の胃酸分泌能と薬剤の酸分泌抑制力により異なり,本邦での詳細な検討によるエビデンスの構築が必要と考えられる. |
Theme | PPI Therapy | |
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Title | Effect of Proton Pump Inhibitors on Helicobacter pylori Related Gastritis | |
Author | Naomi Uemura | Department of Gastroenterology, Kure Kyosai Hospital |
[ Summary ] | Several studies in western countries have shown that long-term use of proton pump inhibitors (PPI) aggravates corpus gastritis in patients with Helicobacter pylori infection, promoting the development of atrophic gastritis. We studied the effects of long-term use of antisecretory agents on the H. pylori-positive gastric mucosa in Japan. The long-term use of famotidine, after 8 weeks of treatment with PPIs, distinctly decreased H. pylori density and neutrophil infiltration in the antrum, but did not change H. pylori density in the corpus. The gastritis score increased in patients who had no, or mild, corpus gastritis before treatment and significantly decreased, in those who had moderate or severe gastritis before treatment. In 11 patients who received long-term treatment with PPIs alone, neutrophil infiltration and H. pylori density decreased, not only in the antrum but, also in the corpus. There was no increase in intestinal metaplasia or mucosal atrophy as assessed endoscopically during follow-ups. Changes in corpus gastritis, in response to acid-suppressive therapy, may depend on the severity of gastritis before treatment. Long-term use of PPIs apparently does not accelerate the development of atrophy or intestinal metaplasia in Japanese patients. We must examine the relationship between long-termuse of PPIs and changes in histologic gastritis patterns in the future. |