臨牀消化器内科 Vol.31 No.2(5-3)


特集名 有効性評価に基づく胃がん検診ガイドライン―内視鏡検診時代の新たなる幕開け
題名 検診対象集約への戦略―現状と課題 (3) ペプシノゲン検査とHelicobacter pylori抗体併用法(ABC分類)による胃がんリスク評価
発刊年月 2016年 02月
著者 吉田 岳市 和歌山県立医科大学第二内科
著者 榎本 祥太郎 NSメディカル和歌山診療所
著者 渡邊 実香 NSメディカル和歌山診療所
著者 玉井 秀幸 和歌山県立医科大学第二内科
著者 加藤 順 和歌山県立医科大学第二内科
著者 一瀬 雅夫 和歌山県立医科大学第二内科
【 要旨 】 高度萎縮性胃炎の指標である血清ペプシノゲン(PG)検査およびHelicobacter pylor(HP)感染を診断する特異抗体を併用するABC分類は,HP感染胃炎進行(HP未感染→HP感染成立軽度萎縮→高度萎縮)に伴い胃がん発生リスクが上昇するという知見に基づいている.しかし,高度萎縮に匹敵する胃がん高リスクである高度活動性胃炎を欠くなど,ABC分類は現時点では胃がん検診に応用するには未完成な段階にあり,運用上の課題も山積している.胃がん検診受診者保護のうえから,長期にわたり安定的な制度を構築するためにも,安易な導入を避け,一つずつ課題を丁寧に解決する努力が必要である.
Theme Evidence-based Guidelines Version 2 for Gastric Cancer Screening ; The Beginning of a New Era of Endoscopic Cancer Screening
Title Gastric Cancer Risk Evaluated with Serum Levels of Pepsinogen and Helicobacter pylori Antibody
Author Takeichi Yoshida Department of Gastroenterology, Wakayama Medical University
Author Shotaro Enomoto NS Medical & Healthcare Service
Author Mika Watanabe NS Medical & Healthcare Service
Author Hideyuki Tamai Department of Gastroenterology, Wakayama Medical University
Author Jun Kato Department of Gastroenterology, Wakayama Medical University
Author Masao Ichinose Department of Gastroenterology, Wakayama Medical University
[ Summary ] We have recently revealed that both highly active gastritis and severe atrophic gastritis are high risk of gastric cancer in Helicobacter pylor (H. pylori)‒associated gastritis in the follow‒up study of 4,655 healthy asymptomatic subjects, in whom serum pepsinogen (PG) and H. pylori antibody titer had been measured. As supported by several reports, these serum markers would be promising for assessing gastric cancer risk in subjects with H. pylori infection, and are expected to provide a future basis for a more efficient screening program, wherein target settings are based on individual cancer risk. Although a screening method utilizing serum risk markers seems like an ideal framework, its feasibility has to be validated for many crucial points. In particular, this requires much more administrative work than the present method, and the managerial burden might be too great to maintain efficacy. Additionally, the false negative rate of the H. pylori antibody test, which is currently widely used, is high at a non‒negligible level. Until these problems are resolved, incomplete methods, including the so‒called "ABC‒method", should not be adopted for screening. More importantly, to protect the public's health, a reliable and sustainable program for gastric cancer screening should be developed.
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