Helicobacter pylori陰性・正常胃粘膜内視鏡像の検討  [in Japanese] Endoscopic features of the noramal gastric mucosa without Helicobacter pylori infection.  [in Japanese]

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Abstract

近年高解像力の内視鏡が開発され,胃体部全体に微細発赤点が整然と配列している症例をしばしば経験し,近接観察にてこれらは粘膜を貫く集合細静脈と推定した.この所見をregular arrangement of colleting venules(以下RAC)とし,胃粘膜の萎縮パターンがClosedの症例242例を用い,前庭部と胃体部より生検し,ウレアーゼ・テストまたは培養および組織学的に検討しRACとH.pylori(以下HP)との相関を検討した.RAC(+)は92例,その内,HP(-)は88例(95.7%)であり,RAC(-)は150例でその内,HP(+)は141例(94%)であった.さらに,RACの微細発赤点が集合細静脈であることを確認するためRAC症例の29例を拡大内視鏡にて観察し,それらが集合細静脈の透見像であること,さらに集合細静脈の周囲には真性毛細血管がネットワークを形成し,その中心にgastricpitsを認める像を観察しえた.以上の結果よりRACはHP陰性正常胃における胃底腺粘膜の・典型的内視鏡像と考えられた.

Since the development of the high-resolution electric endoscope, minute points with rednesscan be observed throughout the gastric body, and close observation suggests that these pointsare blood vessels which penetrate the non-atrophic gastric mucosa. The minute points withredness are considered to be collecting venules of Helicobacter pylori(HP)-negative normalmucosa, and accordingly have been termed RAC(regular arrangement of collecting venules).We studied 242 cases of closed-type atropy to clarify the correlation between RAC(+)and HP-negative. In C-0, 67 cases were diagnosed as RAC(+)and all were HPnegative(100%). InC-1, 20cases were diagnosed as RAC(+)and 180f them were HP-negative(90%). In C-2, 4cases were diagnosed as RAC(+)and 30f them were HPnegative(75%). In C-3, 1cases wasdiagnosed as RAC(+)and was not HP-negative(0%). Among the total of C-o, C-1, C-2 andG3, 95.7%(88/92)of cases diagnosed as RAC(+)were HP-negative. These results show thatRAC can be evaluated as endoscopically as non-HP normal gastric mucosa. To clarify theseminute points with redness, RAC were observed by magnifing endoscopy. These pointscorresponded to collecting venules and true capillaries showing reticulation were observed.This shows a magnified view of an HP-negative normal gastric body. Neither collectingvenules nor true capillaries were observed in RAC-negative cases with HP infection. Histological study suggested that in the magnified view, the HP-negative normal fundic gland iscomposed of normal gastric pits, a regular arrangement of surface mucosal epithelia and asurface venular mesh. In conclusion, minute points with redness are collecting venules, and theregular arrangement of collecting venules(RAC)is a finding peculiar to the corpus in the HP-negative normal stomach.

Journal

  • Gastroenterological Endoscopy

    Gastroenterological Endoscopy 42(10), 1977-1987, 2000

    Japan Gastroenterological Endoscopy Society

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