悪性貧血とその家系の胃粘膜像と胃癌合併に関する検討 STUDY OF THE GASTRIC MUCOSAL ATROPHIC PATTERN AND THE COMPLICATION OF GASTRIC CANCER IN PERNICIOUS ANEMIA PATIENS AND THEIR FAMILY MEMBERS

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Abstract

PAの,胃内視鏡肉眼所見,生検,Congo-redtestによって胃体部全域の高度な萎縮があり,これより幽門洞の萎縮が軽度であるものを逆萎縮型胃炎とし,この萎縮型に観察される幽門洞と体部との萎縮の差の境界を逆萎縮境界と名づけた.この内視鏡的な慨念による逆萎縮型胃炎と逆萎縮境界とは,わが国ではPAとその家系例中に特異的にみられ,PA胃の原型と考えられた.そこでまつPA及その家系でのIFA,PCA,血中gastrin値,粘膜G細胞密度について逆萎縮型胃炎との関連をのべた.胃癌合併は20例中5例(25%)と大へん高率で,このことからも逆萎縮型胃炎の認識は大切である.さらに家系例中の胃癌発生率も,胃癌と消化性潰瘍をprobandとした調査により,これより有意に高率であることがわかった.

We have experienced 20 patients with pernicious anemia (PA) during the last 10 years, and studied endoscopically their gastric mucosal atrophic pattern and complication of gastric cancer. Their family members were also examined when possible. 1) When the mucosa of the whole gastric body was severely atrophic, in contrast to the less severely atrophic antrum, and completely negative of discoloration by the congo-red test, it was defined as "endoscopic reversed atrophic type gastritis". In the cases of this reversed atrophic type gastritis, a border due to difference in severity of atrophy observed endoscopically between the antrum and the gastric body was defined as the reversed atrophic boder. 2) The reversed atrophic type gastritis was observed in 17 (85%) of 20 patients with PA. Reversed atrophic boder was seen in 12 (60%) of 20 PA patients. 3) In 4 of 11 members of the 7 families of patients with PA, a reversed atrophic type gastritis was found. 4) Reversed atrophic type gastritis of PA had relation to the hypergastrinemia, and no relation to the positivity of PCA and IFA. In cases of reversed atrophic gastritis of f ammly members of PA, serum gastrin was elevated as high as in PA, and was related to positivity of PCA and IFA. 5) Gastric cancer was associated in 5 of 20 patients (25%) with PA, including 1 patient with heterochronous double gastric cancer. Lesions were frequently found in the antrum, with a predominance of elevated, differentinated type of carcinomas. 6) A case of gastric cancer was seen in a higher percentage of family members of PA patient than in the families of gastric cancer or peptic ulcer patients.

Journal

  • GASTROENTEROLOGICAL ENDOSCOPY

    GASTROENTEROLOGICAL ENDOSCOPY 23(1), 66-77, 1981

    Japan Gastroenterological Endoscopy Society

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