| 特集名 | H. pylori胃炎からの発癌 ― 除菌有効性を巡っての視点 | |
|---|---|---|
| 題名 | 胃切除後残胃に対する除菌の異時性多発癌発生予防効果 | |
| 発刊年月 | 2012年 03月 | |
| 著者 | 安藤 貴文 | 名古屋大学大学院医学系研究科消化器内科学 |
| 著者 | 榊原 真肇 | 愛知県がんセンター愛知病院消化器内科 |
| 著者 | 石黒 和博 | 名古屋大学大学院医学系研究科消化器内科学 |
| 著者 | 前田 修 | 名古屋大学大学院医学系研究科消化器内科学 |
| 著者 | 渡辺 修 | 名古屋大学大学院医学系研究科消化器内科学 |
| 著者 | 後藤 秀実 | 名古屋大学大学院医学系研究科消化器内科学 |
| 【 要旨 】 | 残胃癌のリスクファクターとして，Helicobacter pylori (H. pylori) 感染による残胃炎と，膵液，胆汁を含む十二指腸液の逆流が重要である．消化性潰瘍の手術はほとんど行われなくなり，胃切除後の残胃の多くは胃癌術後であることから，H. pylori感染の関与がより重要である．残胃9症例に対してH. pylori除菌治療を施行して，除菌後の胃粘膜の組織学的変化を体部の小弯と大弯でシドニー分類に準じて評価した．残胃においても，H. pylori除菌により，炎症，萎縮ともに改善したが，とくに萎縮の改善が顕著であった．異時性多発癌の発生予防に繫がる可能性があり，胃癌術後症例も積極的にH. pylori除菌治療をすべきである． | |
| Theme | Carcinogenesis Based on H. pylori-associated Gastritis -- Is Cancer Control Possible by the Eradication ? | |
|---|---|---|
| Title | Usefulness of Prophylactic Helicobacter pylori Eradication in Gastric Remnants in Preventing Metachronous Gastric Carcinoma | |
| Author | Takafumi Ando | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author | Masatoshi Sakakibara | Department of Gastroenterology, Aichi Cancer Center Aichi Hospital |
| Author | Kazuhiro Ishiguro | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author | Osamu Maeda | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author | Osamu Watanabe | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author | Hidemi Goto | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| [ Summary ] | Objective : Secondary stomach cancer in remnant stomach lesions occurs relatively soon after distal gastrectomy using the Billroth I reconstruction procedure. Prophylactic eradication of Helicobacter pylori (H. pylori) after endoscopic resection of early gastric cancer should be used to prevent the development of metachronous gastric carcinoma. However, the effects of H. pylori eradication on the gastric remnant has not been clearly determined. We investigated the association of H. pylori infection with histological changes in the gastric remnant. Methods : Nine patients who were H. pylori-positive after distal gastrectomy (eight for gastric cancer, one for gastric ulcer) underwent H. pylori eradication therapy and were followed by endoscopy for 9 years. Upper gastroenteroscopy series were done before and at 1, 3, 5, 7 and 9 years after eradication. Biopsy specimens were taken from the lesser and greater curvatures, respectively. Histological changes, including chronic inflammation, activity, atrophy, and intestinal metaplasia, were evaluated using the updated Sydney system. Results : Successful eradication was confirmed using the urea breath test in all nine patients. Chronic inflammation scores improved after eradication at both the lesser (mean scores: before eradication, 2.9; 1y after, 2.3; 3y, 1.8; 5y, 1.5; 7y, 1.3; and 9y, 1.0) and greater curvatures (before, 2.9; 1y after, 1.9; 3y, 1.4; 5y, 1.3; 7y, 1.1; and 9y, 0.6). Atrophy scores improved more quickly after eradication than chronic inflammation scores at both the lesser (before, 2.4; 1y after, 1.8; 3y, 0.8; 5y, 0.3; 7y, 0.0; and 9y, 0.0) and greater curvatures (before, 2.2; 1y after, 1.3; 3y, 0.5; 5y, 0.0; 7y, 0.0; and 9y, 0.0). No secondary stomach cancers were found with endoscopy. Conclusion: H. pylori eradication improved pre-cancerous lesions in gastric remnants in patients who had undergone distal gastrectomies. Prophylactic H. pylori eradication in the gastric remnants may be useful in preventing the development of metachronous gastric carcinoma. |
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