| 特集名 | H. pylori胃炎からの発癌 ― 除菌有効性を巡っての視点 | |
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| 題名 | H. pylori除菌による胃癌発生予防 (1) H. pylori除菌による胃がん予防のこれまでと我が国の今後の胃がん対策 | |
| 発刊年月 | 2012年 03月 | |
| 著者 | 菊地 正悟 | 愛知医科大学医学部公衆衛生学講座 |
| 【 要旨 】 | H. pylori感染者は，未感染者に比べ胃がんのリスクが20倍以上高い．胃がんのリスクは，「がんの芽」が内視鏡で確認できる大きさになる前に除菌すれば低下する．しかし除菌後も未感染者に比べ高い．除菌の効果は，胃粘膜の萎縮が進むにつれて小さくなる． わが国ではH. pylori感染率の低下に伴い，胃がん死亡率，罹患率とも低下を続けている．現在は，感染者と未感染者が混在する状況であり，胃がんリスクの篩い分けが対策に不可欠である．感染診断と血清ペプシノゲン値の組み合わせは，篩い分けに有用である．除菌は予測される胃がんリスク減少効果に加え，各対象者の将来の受診状況も考慮して適用を考えるべきである． |
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| Theme | Carcinogenesis Based on H. pylori-associated Gastritis -- Is Cancer Control Possible by the Eradication ? | |
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| Title | Gastric Cancer Prevention by Helicobacter pylori Eradication until Now and Japanese Gastric Cancer Control Strategy from Now On | |
| Author | Shogo Kikuchi | Department of Public Health, Aichi Medical University School of Medicine |
| [ Summary ] | Patients with H. pylori infection are at a 21 times increased risk of developing gastric cancer than those without any history of H. pylori infection. Eradication of H. pylori may be effective for gastric cancer prevention, if it is employed before "germs" of gastric cancer grow so that it can be detected by endoscopic examination. The progression of mucosal atrophy weakens the preventive effects of eradication. In Japan, rates of both mortality and incidence of gastric cancer have decreased, so that the adult population consists of those at high and those at low risk of gastric cancer. It is inevitable to evaluate gastric cancer risk for individual subjects to provide prevention. A combination of the H. pylori infection test and the serum pepsinogen test may be useful for evaluation. Indications for eradication therapy should be decided considering behavior of each subject in addition to the expected risk reduction effect. |
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