特集名 | 慢性胃炎を再考する | |
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題名 | A型胃炎の臨床的・病理学的・内視鏡的特徴とB型胃炎との鑑別 | |
発刊年月 | 2019年 12月 | |
著者 | 寺尾 秀一 | 加古川中央市民病院消化器内科 |
著者 | 鈴木 志保 | 加古川中央市民病院消化器内科 |
著者 | 渡辺 英伸 | PCLジャパン |
【 要旨 】 | A型胃炎は,わが国においてもまれな疾患ではない.A型胃炎の臨床的特徴として,著明な酸分泌抑制,高ガストリン血症,悪性貧血,PGⅠ・PGⅠ/Ⅱ比の極端な低下,鉄欠乏性貧血の合併,自己免疫性疾患の併発などがあげられる.A型胃炎とB型胃炎には際立った病理組織学的な差異がある.A型胃炎の内視鏡所見の特徴は,「逆萎縮」と表現される胃体部優位の萎縮,残存胃底腺,散在性微小白色隆起,固着粘液であるが,前庭部の所見は多様である.一方,B型胃炎の内視鏡像は,種々の段階の萎縮境界によって認識される,非萎縮領域のびまん性発赤・粘膜腫脹,萎縮領域の血管透見を伴う褪色像が基本である.A型胃炎とB型胃炎の合併の評価は慎重に行うべきである. |
Theme | Reconsideration of Gastritis | |
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Title | Clinicopathological and Endoscopic Characteristics of Type A Gastritis and Differences Between Type A and B Gastritis | |
Author | Shuichi Terao | Kakogawa Central City Hospital |
Author | Shiho Suzuki | Kakogawa Central City Hospital |
Author | Hidenobu Watanabe | PCL Japan |
[ Summary ] | The clinical features of type A gastritis include achlorhydria, hypergastrinemia, pernicious anemia, significantly low pepsinogen (PG) I levels, a low PG I/II ratio, iron deficiency anemia, and concomitant autoimmune diseases. Prominent pathological differences between type A and type B gastritis contribute to the differences in endoscopic appearance characterizing the two entities. Type A gastritis is endoscopically characterized by pan‒atrophy of the corpus, various shapes of the remnant oxyntic mucosa, scattered minute whitish protrusions, sticky adherent dense mucus, and diversity in endoscopic appearance of the antrum. Type B gastritis is endoscopically characterized by diffuse redness and mucosal swelling in non‒atrophic areas and discolored mucosa with vascular visibility in atrophic areas; these areas are demarcated by an atrophic border showing various degrees of mucosal atrophy. Detailed examination is essential to diagnose concomitant type A and B gastritis. |