胃と腸41巻7号

2006年06月発行

今月の主題 Helicobacter pyloriに起因しないとされる良性胃粘膜病変 主題

Helicobacter pylori陽性と陰性の胃粘膜所見の特徴―拡大内視鏡による診断

著者： 八木一芳¹ 坪井清孝¹ 中村厚夫¹ 関根厚雄¹

所属機関： ¹新潟県立吉田病院内科

ページ範囲：P.1017 - P.1024

要旨　H. pylori非感染胃粘膜と感染粘膜の拡大像の違いは次のようにまとめられる．体部ではH. pylori非感染粘膜は集合細静脈，真性毛細血管のネットワーク，ピンホール状のpitから形成されている．感染粘膜では集合細静脈は見えず，pitも白濁・開大している．幽門部では非感染粘膜は整然とした粘膜模様に沿って微細血管が走行しているが，感染粘膜では大小不同・不整な粘膜模様に不整な微細血管が観察される．噴門部では非感染粘膜では集合細静脈を伴う胃底腺が食道・胃接合部直下まで存在し，噴門部粘膜は極めて狭い．感染粘膜では噴門部粘膜が長くなっており食道扁平上皮下端に黄色隆起を呈する食道噴門腺を認めることが多い．酢酸撒布による拡大内視鏡では食道噴門腺の露出が観察される．

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