胃と腸58巻1号

2023年01月発行

今月の主題 Non-H. pylori Helicobacter胃炎と周辺疾患

主題

NHPH関連の胃MALTリンパ腫

著者： 瀧川英彦¹ 弓削亮¹ 清水大輔² 宮本亮² 大谷里奈² 門田紘樹² 北台靖彦³ 岡志郎² 田中信治¹

所属機関： ¹広島大学病院内視鏡診療科 ²広島大学病院消化器・代謝内科 ³県立広島大学健康科学科

ページ範囲：P.61 - P.70

文献概要

要旨●胃MALTリンパ腫の病因として，API2-MALT1融合遺伝子，H. pylori感染症が知られているが，近年NHPH誘導性の胃MALTリンパ腫の存在が明らかになっている．本稿では，胃MALTリンパ腫におけるNHPH感染状況，除菌治療反応性，内視鏡的特徴などについて解説する．当科の検討において，NHPH感染はAPI2-MALT1遺伝子陰性H. pylori陰性症例の55%（16/29）に認められ，H. pylori陰性胃MALTリンパ腫の主要な病因の一つであると考えられた．また，従来除菌治療による寛解率が低いと考えられてきたH. pylori陰性の胃MALTリンパ腫においても，NHPH陽性例では，高率（75%，12/16）に除菌治療による寛解が得られた．NHPH陽性胃MALTリンパ腫に特徴的にみられる内視鏡所見として，鳥肌様の変化やMLP（multiple lymphomatous polyposis）様の顆粒状の変化が観察されることが多く，背景粘膜にもNHPH感染に特徴的な所見がみられた．特徴的な内視鏡所見を念頭に置いたうえで，NHPH感染の可能性を考慮した胃MALTリンパ腫の診療を行うことが大切である．

参考文献

1）Heilmann KL, Nowottny U. Histological demonstration of Campylobacter-like organisms in stomach biopsy. Dtsch Med Wochenschr　112：861-862, 1987

2）Nakamura M, Murayama SY, Serizawa H, et al.“Candidatus Helicobacter heilmannii”from a cynomolgus monkey induces gastric mucosa-associated lymphoid tissue lymphomas in C57BL/6 mice. Infect Immun　75：1214-1222, 2007

3）Kobayashi M, Yamamoto K, Ogiwara N, et al. Helicobacter heilmannii-like organism in parietal cells：A diagnostic pitfall. Pathol Int　66：120-122, 2016

4）Goji S, Tamura Y, Sasaki M, et al. Helicobacter suis-infected nodular gastritis and a review of diagnostic sensitivity for Helicobacter heilmannii-like organisms. Case Rep Gastroenterol　9：179-187, 2015

5）Debongnie JC, Donnay M, Mairesse J. Gastrospirillum hominis（“Helicobacter heilmanii”）：a cause of gastritis, sometimes transient, better diagnosed by touch cytology? Am J Gastroenterol　90：411-416, 1995

6）Holck S, Ingeholm P, Blom J, et al. The histopathology of human gastric mucosa inhabited by Helicobacter heilmannii-like（Gastrospirillum hominis）organisms, including the first culturable case. APMIS　105：746-756, 1997

7）Ierardi E, Monno RA, Gentile A, et al. Helicobacter heilmannii gastritis：a histological and immunohistochemical trait. J Clin Pathol　54：774-777, 2001

8）Joo M, Kwak JE, Chang SH, et al. Helicobacter heilmannii-associated gastritis：clinicopathologic findings and comparison with Helicobacter pylori-associated gastritis. J Korean Med Sci　22：63-69, 2007

9）鈴木志保，村山琮明，中村正彦，他．当院で経験したnon-Helicobacter pylori Helicobacter感染胃炎4例の検討．日ヘリコバクター会誌　20：77-83, 2019

10）Mimura T, Yoshida M, Nishiumi S, et al. IFN-γ plays an essential role in the pathogenesis of gastric lymphoid follicles formation caused by Helicobacter suis infection. FEMS Immunol Med Microbiol　63：25-34, 2011

11）Stolte M, Kroher G, Meining A, et al. A comparison of Helicobacter pylori and H. heilmannii gastritis. A matched control study involving 404 patients. Scand J Gastroenterol　32：28-33, 1997

12）Zhang G, Ducatelle R, Mihi B, et al. Helicobacter suis affects the health and function of porcine gastric parietal cells. Vet Res　47：101, 2016

13）Flahou B, Haesebrouck F, Pasmans F, et al. Helicobacter suis causes severe gastric pathology in mouse and mongolian gerbil models of human gastric disease. PLoS One　5：e14083, 2010

14）Carragher DM, Rangel-Moreno J, Randall TD. Ectopic lymphoid tissues and local immunity. Semin Immunol　20：26-42, 2008

15）Aloisi F, Pujol-Borrell R. Lymphoid neogenesis in chronic inflammatory diseases. Nat Rev Immunol　6：205-217, 2006

16）Morgner A, Lehn N, Andersen LP, et al. Helicobacter heilmannii-associated primary gastric low-grade MALT lymphoma：complete remission after curing the infection. Gastroenterology　118：821-828, 2000

17）O'Rourke JL, Dixon MF, Jack A, et al. Gastric B-cell mucosa-associated lymphoid tissue（MALT）lymphoma in an animal model of‘Helicobacter heilmannii'infection. J Pathol　203：896-903, 2004

18）Heilmann KL, Borchard F. Gastritis due to spiral shaped bacteria other than Helicobacter pylori：clinical, histological, and ultrastructural findings. Gut　32：137-140, 1991

19）Okiyama Y, Matsuzawa K, Hidaka E, et al. Helicobacter heilmannii infection：clinical, endoscopic and histopathological features in Japanese patients. Pathol Int　55：398-404, 2005

20）De Groote D, Van Doorn LJ, Van den Bulck K, et al. Detection of non-pylori Helicobacter species in“Helicobacter heilmannii”-infected humans. Helicobacter　10：398-406, 2005

21）Van den Bulck K, Decostere A, Baele M, et al. Identification of non-Helicobacter pylori spiral organisms in gastric samples from humans, dogs, and cats. J Clin Microbiol　43：2256-2260, 2005

22）Nakamura M, Øverby A, Michimae H, et al. PCR analysis and specific immunohistochemistry revealing a high prevalence of non-Helicobacter pylori Helicobacters in Helicobacter pylori-negative gastric disease patients in Japan：High susceptibility to an Hp eradication regimen. Helicobacter　25：e12700, 2020

23）Liu J, He L, Haesebrouck F, et al. Prevalence of coinfection with gastric non-Helicobacter pylori Helicobacter（NHPH）species in Helicobacter pylori-infected patients suffering from gastric disease in Beijing, China. Helicobacter　20：284-290, 2015

24）Takigawa H, Yuge R, Masaki S, et al. Involvement of non-Helicobacter pylori Helicobacter infections in Helicobacter pylori-negative gastric MALT lymphoma pathogenesis and efficacy of eradication therapy. Gastric Cancer　24：937-945, 2021

25）Zelenetz AD, Gordon LI, Chang JE, et al. NCCN Guidelines®insights：B-cell lymphomas, Version 5.2021.J Natl Compr Canc Netw　19：1218-1230, 2021

26）Asano N, Iijima K, Koike T, Imatani A, et al. Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphomas：A review. World J Gastroenterol　21：8014-8020, 2015

27）Asano N, Iijima K, Terai S, et al. Eradication therapy is effective for Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma. Tohoku J Exp Med　228：223-227, 2012

28）Jung K, Kim DH, Seo HI, et al. Efficacy of eradication therapy in Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma：A meta-analysis. Helicobacter　26：e12774, 2021

29）Kadota H, Yuge R, Miyamoto R, et al. Investigation of endoscopic findings in nine cases of Helicobacter suis-infected gastritis complicated by gastric mucosa-associated lymphoid tissue lymphoma. Helicobacter　27：e12887, 2022

30）Takigawa H, Masaki S, Naito T, et al. Helicobacter suis infection is associated with nodular gastritis-like appearance of gastric mucosa-associated lymphoid tissue lymphoma. Cancer Med　8：4370-4379, 2019

31）Naito T, Yuge R, Tanaka S, et al. Gastric mucosa-associated lymphoid tissue lymphoma in conjunction with multiple lymphomatous polyposis in the context of Helicobacter pylori and Helicobacter suis superinfection. Clin J Gastroenterol　14：478-483, 2021

32）Tsukadaira T, Hayashi S, Ota H, et al. Prevalence, clinical features, and esophagogastroduodenoscopy（EGD）findings of non-Helicobacter pylori Helicobacter infection：A study of 50 cases at a single facility in Japan. Helicobacter　26：e12811, 2021

33）Shiratori S, Mabe K, Yoshii S, et al. Two cases of chronic gastritis with non-Helicobacter pylori Helicobacter infection. Intern Med　55：1865-1869, 2016

34）Kadota H, Yuge R, Miyamoto R, et al. Investigation of endoscopic findings in nine cases of Helicobacter suis-infected gastritis complicated by gastric mucosa-associated lymphoid tissue lymphoma. Helicobacter　27：e12887, 2022

35）Rimbara E, Suzuki M, Matsui H, et al. Isolation and characterization of Helicobacter suis from human stomach. Proc Natl Acad Sci U S A　118：e2026337118, 2021