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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

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掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1219

印刷版ISSN:0536-2180

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