胃と腸57巻9号

2022年08月発行

今月の主題 胃癌スクリーニングの課題と将来展望 主題

日本人の胃粘膜の時代的変遷—胃癌発生との関連

著者： 春間賢¹² 鎌田智有³ 村尾高久³ 角直樹³ 末廣満彦¹ 河本博文¹ 眞部紀明⁴ 藤田穣⁴ 綾木麻紀⁴ 間部克裕² 吉原正治² 井上和彦² 山辻知樹⁵ 伊藤公訓⁶

所属機関： ¹川崎医科大学総合医療センター総合内科学2 ²淳風会健康管理センター ³川崎医科大学健康管理学 ⁴川崎医科大学検査診断学（内視鏡・超音波） ⁵川崎医科大学総合医療センター外科 ⁶広島大学病院総合内科・総合診療科

ページ範囲：P.1114 - P.1125

要旨●胃粘膜に炎症（胃炎）が発生すると，その炎症が固有胃腺を破壊し萎縮性胃炎となり，その過程で腸上皮化生が発生する．そのような胃粘膜の変化は胃の加齢現象で，避けることのできない人類の宿命であると考えられていた．しかしながら，なぜ胃炎が起こるのか，なぜ腸上皮化生が発生するのか，根本的な原因は明らかでなかった．1983年に，胃炎の原因がH. pyloriであることが，さらに，胃粘膜萎縮や腸上皮化生のほとんどはH. pylori感染者だけに認められる現象であることがわかった．社会環境，特に衛生環境の改善とともにH. pylori感染率は，本邦も含め世界中で低下しつつある．さらに本邦では，除菌療法の普及により萎縮性胃炎や腸上皮化生が減少し，その結果，日本人の上部消化管には大きな変化が起こっている．本稿の総説では，約半世紀に及ぶ日本人の胃粘膜の形態と機能の変化について，H. pylori以外の，胃粘膜に影響を及ぼす因子も取り上げて概説した．

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