胃と腸46巻8号

2011年07月発行

今月の主題 食道の炎症性疾患 主題

Helicobacter pylori感染と逆流性食道炎

著者： 春間賢¹ 眞部紀明² 鎌田智有¹ 村尾高久¹ 塩谷昭子¹ 井上和彦³ 草加勝康⁴

所属機関： ¹川崎医科大学消化管内科 ²川崎医科大学内視鏡・超音波センター ³川崎医科大学総合診療科 ⁴草加病院

ページ範囲：P.1247 - P.1252

要旨　H. pylori（Helicobacter pylori）感染は胃炎や消化性潰瘍，胃癌などの疾患の重要な病原因子である．H. pylori感染と逆流性食道炎の関係については，地域別にその関係をみた報告では，東アジアでは逆流性食道炎のH. pylori感染率が対照群と比べ低く，西ヨーロッパや北アメリカでは関連がないとする報告が多い．日本では，H. pylori感染は胃粘膜萎縮を起こすことが多く，胃酸分泌が低下するため，H. pylori感染者では逆流性食道炎が発生しにくい可能性がある．一方，H. pylori除菌後の逆流性食道炎の発生については，除菌により逆流性食道炎の発生は認めるものの，頻度は高いものではなく，また軽症のものが多く，除菌療法の妨げとはならない．

参考文献

1）Labenz J, Blum AL, Bayerdörffer E, et al. Curing Helicobacter pylori infection in patients with duodenal ulcer may provoke reflux esophagitis. Gastroenterology 112 : 1442-1447, 1997

2）Raghunath A, Hungin AP, Wooff D, et al. Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease : systematic review. BMJ 326 : 737, 2003

3）Haruma K, Hamada H, Mihara M, et al. Negative association between Helicobacter pylori infection and reflux esophagitis in older patients : case-control study in Japan. Helicobacter 5 : 24-29, 2000

4）大原秀一，関根仁，飯島克則，他．老年者逆流性食道炎における胃粘膜萎縮とHelicobacter pylori感染の検討．日消誌 93 : 235-239, 1996

5）Labenz J, Malfertheiner P. Helicobacter pylori in gastro-oesophageal reflux disease : causal agent, independent or protective factor ? Gut 41 : 277-280, 1997

6）Haruma K, Kamada T, Kawaguchi H, et al. Effect of age and Helicobacter pylori infection on gastric acid secretion. J Gastroenterol Hepatol 15 : 277-283, 2000

7）Fallone CA, Barkun AN, Friedman G, et al. Is Helicobacter pylori eradication associated with gastroesophageal reflux disease ? Am J Gastroenterol 95 : 914-920, 2000

8）Hamada H, Haruma K, Mihara M, et al. High incidence of reflux oesophagitis after eradication therapy for Helicobacter pylori : impacts of hiatal hernia and corpus gastritis. Aliment Pharmacol Ther 14 : 729-735, 2000

9）Iijima K, Ohara S, Sekine H, et al. Changes in gastric acid secretion assayed by endoscopic gastrin test before and after Helicobacter pylori eradication. Gut 46 : 20-26, 2000

10）Sasaki A, Haruma K, Manabe N, et al. Long-term observation of reflux oesophagitis developing after Helicobacter pylori eradication therapy. Aliment Phamacol Ther 17 : 1529-1534, 2003

11）Ott EA, Mazzoleni LE, Edelweiss MI, et al. Helicobacter pylori eradication does not cause reflux oesophagitis in functional dyspeptic patients : a randomized, investigator-blinded, placebo-controlled trial. Aliment Pharmacol Ther 21 : 1231-1239, 2005

12）Vakil N, Talley NJ, Stolte M, et al. Patterns of gastritis and the effect of eradicating Helicobacter pylori on gastro-oesophageal reflux disease in Western patients with non-ulcer dyspepsia. Aliment Pharmacol Ther 24 : 55-63, 2006

13）Take S, Mizuno M, Ishiki K, et al. Helicobacter pylori eradication may induce de novo, but transient and mild, reflux esophagitis : Prospective endoscopic evaluation. J Gastroenterol Hepatol 24 : 107-113, 2009

14）Yagi S, Okada H, Takenaka R, et al. Influence of Helicobacter pylori eradication on reflux esophagitis in Japanese patients. Dis Esophagus 22 : 361-367, 2009

15）Yaghoobi M, Farrokhyar F, Yuan Y, et al. Is there an increased risk of GERD after Helicobacter pylori eradication? : A meta-analysis. Am J Gastroenterol 105 : 1007-1013, 2010

16）Moayyeddi P, Bardhan C, Young L, et al. Helicobacter pylori eradication does not exacerbate reflux symptoms in gastroesophageal reflux disease. Gastroenterology 121 : 1120-1126, 2001

17）水野元夫，石木邦治．治療をめぐる最近の進歩─GERD合併消化性潰瘍の除菌治療 : 除菌後にGERDはどうなるか．医のあゆみ 210 : 480-484, 2004