胃と腸50巻9号

2015年08月発行

今月の主題 食道胃接合部腺癌 主題研究

食道胃接合部腺癌の発生メカニズム

著者： 向所賢一¹ 仲山貴永¹ 荒木克夫¹ 萩原恭史¹ 九嶋亮治² 服部隆則¹ 杉原洋行¹

所属機関： ¹滋賀医科大学病理学講座分子診断病理学部門 ²滋賀医科大学臨床検査医学講座（附属病院病理診断科）

ページ範囲：P.1168 - P.1175

要旨●食道胃接合部腺癌は，2種類の異なる腫瘍の混在であると報告されている．ひとつは，H. pylori陰性の場合が多いが，胃食道逆流症（GERD）に関連したBarrett腺癌と同様の特徴を持つものである．胆汁を含む十二指腸液の逆流が関与し，特に夜間の臥位の状態では，身体の背側に位置する食道胃接合部（EGJ）にて，ニトロソ胆汁酸の発生と安定化が起こり，発癌に関与していると考えられる．もうひとつは幽門側の胃癌のようにH. pylori関連の萎縮性胃炎を背景に発生するものである．胃酸分泌の低下に伴い，胃内に溶解している胆汁酸の割合が増加する．胆汁酸はH. pyloriに対して殺菌的もしくは静菌的に働くために，萎縮が高度になるとともに，H. pyloriは胆汁酸の逆流が多い幽門側から口側へと移動し，噴門部炎を起こし発癌に関与すると考えられる．本稿では，食道胃接合部腺癌を2種類に分類し，それぞれの発癌過程において，胆汁酸，胃内pH，H. pylori感染の3要素間にみられる相互作用を考慮しながら，食道胃接合部腺癌発生のメカニズムについて考察する．

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