生活習慣病と食道・胃疾患
胃食道逆流症 (Gastro Esophageal Reflux Disease;GERD) は, 胃酸が食道内に逆流する病態からつけられた診断名であり, 内視鏡的な逆流性食道炎と内視鏡所見がなく胸やけ症状のみの症候性GERD (S-GERD) を包括した診断名である. GERDではいちじるしくQOLが低下しており治療する臨床的意義は大きい. 肥満者で多く見られるが, これは食道裂孔ヘルニア, 腹圧の上昇, 胆汁・膵酵素の分泌が多いことなどによる. また, 高齢女性に多く見られる圧迫骨折 (円背) は食道裂孔ヘルニアを助長する. 一方, S-GERDは若年女性に多く見られるがその病態には酸に対...
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| Published in | 順天堂医学 Vol. 50; no. 4; pp. 322 - 329 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
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順天堂医学会
2004
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| Online Access | Get full text |
| ISSN | 0022-6769 2188-2134 |
| DOI | 10.14789/pjmj.50.322 |
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| Abstract | 胃食道逆流症 (Gastro Esophageal Reflux Disease;GERD) は, 胃酸が食道内に逆流する病態からつけられた診断名であり, 内視鏡的な逆流性食道炎と内視鏡所見がなく胸やけ症状のみの症候性GERD (S-GERD) を包括した診断名である. GERDではいちじるしくQOLが低下しており治療する臨床的意義は大きい. 肥満者で多く見られるが, これは食道裂孔ヘルニア, 腹圧の上昇, 胆汁・膵酵素の分泌が多いことなどによる. また, 高齢女性に多く見られる圧迫骨折 (円背) は食道裂孔ヘルニアを助長する. 一方, S-GERDは若年女性に多く見られるがその病態には酸に対する食道の知覚過敏が関与している.胃癌は食塩摂取・喫煙・飲酒などが危険因子として知られている. H. pylori陽性者から多く発生し, 前癌病変 (萎縮性胃炎など) のない患者では除菌により癌の発生は抑制される. インドなど西アジアではH. pylori感染率が高いにもかかわらず胃癌発生率は極めて低く地域差がある. その理由としてH. pyloriの菌株や宿主免疫反応などの違いが報告されているが, 明確には説明されておらず, 今後の研究が待たれる. |
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| AbstractList | 胃食道逆流症 (Gastro Esophageal Reflux Disease;GERD) は, 胃酸が食道内に逆流する病態からつけられた診断名であり, 内視鏡的な逆流性食道炎と内視鏡所見がなく胸やけ症状のみの症候性GERD (S-GERD) を包括した診断名である. GERDではいちじるしくQOLが低下しており治療する臨床的意義は大きい. 肥満者で多く見られるが, これは食道裂孔ヘルニア, 腹圧の上昇, 胆汁・膵酵素の分泌が多いことなどによる. また, 高齢女性に多く見られる圧迫骨折 (円背) は食道裂孔ヘルニアを助長する. 一方, S-GERDは若年女性に多く見られるがその病態には酸に対する食道の知覚過敏が関与している.胃癌は食塩摂取・喫煙・飲酒などが危険因子として知られている. H. pylori陽性者から多く発生し, 前癌病変 (萎縮性胃炎など) のない患者では除菌により癌の発生は抑制される. インドなど西アジアではH. pylori感染率が高いにもかかわらず胃癌発生率は極めて低く地域差がある. その理由としてH. pyloriの菌株や宿主免疫反応などの違いが報告されているが, 明確には説明されておらず, 今後の研究が待たれる. |
| Author | 佐藤, 信紘 永原, 章仁 |
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| References | 21) TytgatGN: Review article: management of mild and severe gastro-oesophageal reflux disease. Aliment Pharmacol Ther, 2003; 17 (Suppl 2): 52-56. 29) WongBC, LamSK, WongWM, et al: China Gastric Cancer Study Group. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA, 2004; 291: 187-194. 9) FurukawaN, IwakiriR, KoyamaT, et al: Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J Gastroenterol, 1999 ; 34: 441-444. 1) 小山茂樹: 飽食・過食・脂肪食・高齢化と胃食道逆流症. 綜合臨床, 2001; 50: 2009-2014. 16) YamaguchiT, SugimotoT, YamadaH, et al: The presence and severity of vertebral fractures is associated with the presence of esophageal hiatal hernia in postmenopausal women. Osteoporos Int, 2002; 13: 331-336. 7) SifrimD, HollowayR, SilnyJ, et al: Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol, 2001; 96: 647- 655. 4) GliseH, HallerbackB, JohanssonB: Quality-of-life assessments in evaluation of laparoscopic Rosetti fundoplication. Surg Endosc, 1995; 9: 183-188 ; discussion 188-189. 20) VenablesTL, NewlandRD, PatelAC, et al: Omeprazole 10 milligrams once daily, omeprazole 20 milligrams once daily, or ranitidine 150 milligrams twice daily, evaluated as initial therapy for the relief of symptoms of gastro-oesophageal reflux disease in general practice. Scand J Gastroenterol, 1997; 32: 965-973. 11) RuhlCE, EverhartJE: Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First national health and nutrition examination survey. Ann Epidemiol, 1999 ; 9: 424-435. 14) MercerCD, WrenSF, DaCostaLR, et al: Lower esophageal sphincter pressure and gastroesophageal pressure gradients in excessively obese patients. J Med, 1987; 18: 135-146. 23) KurosawaA, MiwaH, HiraiS, et al: Decreased expression of tight junction protein and increased cell proliferation in the esophageal mucosa in the endoscopy negative gastroesophageal reflux disease. Gastroenterology, 2002; 122: A418. 13) SugermanHJ, DeMariaEJ, FeltonWL 3rd, et al: Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology, 1997; 49: 507-511. 26) ShimizuN, IkeharaY, InaulaK, et al: Eradication diminishes enhancing effects of Helicobacter pylori infection on glandular stomach carcinogenesis in Mongolian gerbils. Cancer Res, 2000; 60: 1512-1514. 5) GliseH, HallerbackB, WiklundI: Quality of life: a reflection of symptoms and concerns. Scand J Gastroenterol, 1996; 221 (Suppl): 14-17. 27) UemuraN, MukaiT, OkamotoS, et al: Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol Biomarkers Prev, 1997; 6: 639-642. 18) MiwaH, MinooT, HojoM, et al: Oesophageal hypersensitivity in Japanese patients with non-erosive gastro-oesophageal reflux diseases. Aliment Pharmacol Ther, 2004; 20 (Suppl 1): 112-117. 24) InoueM, TajimaK, YamamuraY, et al: Influence of habitual smoking on gastric cancer by histologic subtype. Int J Cancer, 1999; 81: 39-43. 3) 本郷道夫: GERDガイドライン. 日本臨床, 2004; 62: 1421-1426. 30) MiwaH, GoMF, SatoN: H. pylori and gastric cancer: the Asian enigma. Am J Gastroenterol, 2002; 97: 1106-1112. 28) UemuraN, OkamotoS, YamamotoS, et al: Helicobacter pylori infection and the development of gastric cancer. N Engl J Med, 2001; 345: 784-789. 31) YamaokaY, OritoE, MizokamiM, et al: Helicobacter pylori in North and South America before Columbus. FEBS Lett, 2002 ; 517: 180-184. 2) BarakN, EhrenpreisED, HarrisonJR, et al: Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev, 2002 ; 3: 9-15 10) LockeGR 3rd, TalleyNJ, FettSL, et al: Risk factors associated with symptoms of gastroesophageal reflux. Am J Med, 1999; 106: 642-649. 19) VaeziMF, RichterJE: Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease. Gastroenterology, 1996; 111: 1192-1199. 15) WisenO, RossnerS, JohanssonC: Impaired pancreatico-biliary response to vagal stimulation and to cholecystokinin in human obesity. Metabolism, 1988 ; 37: 436-441. 32) El-OmarEM, CarringtonM, ChowWH, et al: Interleukin-1 polymorphisms associated with increased risk of gastric cancer. Nature, 2000;404: 398-402. 6) 岩切勝彦, 林良紀, 琴寄誠, 他: GERDの発生機序-胃食道逆流, 食道内酸曝露時間延長のメカニズム-. 日本臨床, 2004; 62: 1427-1432. 8) DentJ, HollowayRH, ToouliJ, et al: Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut, 1988; 29: 1020-1028. 25) HondaS, FujiokaT, TokiedaM, et al: Development of Helicobacter pylori-induced gastric carcinoma in Mongolian gerbils. Cancer Res, 1998; 58: 4255-4259. 12) Stene-LarsenG, WebergR, Froyshov LarsenI, et al: Relationship of overweight to hiatus hernia and reflux oesophagitis. Scand J Gastroenterol, 1988; 23: 427-432. 22) MartinezSD, MalagonIB, GarewalHS, et al: Non-erosive reflux disease (NERD)-acid reflux and symptom patterns. Aliment Pharmacol Ther, 2003 ; 17: 537-545. 33) YeaSS, YangYI, JangWH, et al: Association between TNF-alpha promoter polymorphism and Helicobacter pylori cagA subtype infection. J Clin Pathol, 2001; 54: 703-706. 17) MittalRK: Hiatal hernia and gastrnesophageal reflux: another attempt to resolve the controversy. Gastroenterology, 1993; 105: 941-943. |
| References_xml | – reference: 19) VaeziMF, RichterJE: Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease. Gastroenterology, 1996; 111: 1192-1199. – reference: 3) 本郷道夫: GERDガイドライン. 日本臨床, 2004; 62: 1421-1426. – reference: 16) YamaguchiT, SugimotoT, YamadaH, et al: The presence and severity of vertebral fractures is associated with the presence of esophageal hiatal hernia in postmenopausal women. Osteoporos Int, 2002; 13: 331-336. – reference: 6) 岩切勝彦, 林良紀, 琴寄誠, 他: GERDの発生機序-胃食道逆流, 食道内酸曝露時間延長のメカニズム-. 日本臨床, 2004; 62: 1427-1432. – reference: 27) UemuraN, MukaiT, OkamotoS, et al: Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol Biomarkers Prev, 1997; 6: 639-642. – reference: 31) YamaokaY, OritoE, MizokamiM, et al: Helicobacter pylori in North and South America before Columbus. FEBS Lett, 2002 ; 517: 180-184. – reference: 1) 小山茂樹: 飽食・過食・脂肪食・高齢化と胃食道逆流症. 綜合臨床, 2001; 50: 2009-2014. – reference: 9) FurukawaN, IwakiriR, KoyamaT, et al: Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J Gastroenterol, 1999 ; 34: 441-444. – reference: 5) GliseH, HallerbackB, WiklundI: Quality of life: a reflection of symptoms and concerns. Scand J Gastroenterol, 1996; 221 (Suppl): 14-17. – reference: 8) DentJ, HollowayRH, ToouliJ, et al: Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut, 1988; 29: 1020-1028. – reference: 24) InoueM, TajimaK, YamamuraY, et al: Influence of habitual smoking on gastric cancer by histologic subtype. Int J Cancer, 1999; 81: 39-43. – reference: 4) GliseH, HallerbackB, JohanssonB: Quality-of-life assessments in evaluation of laparoscopic Rosetti fundoplication. Surg Endosc, 1995; 9: 183-188 ; discussion 188-189. – reference: 13) SugermanHJ, DeMariaEJ, FeltonWL 3rd, et al: Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology, 1997; 49: 507-511. – reference: 33) YeaSS, YangYI, JangWH, et al: Association between TNF-alpha promoter polymorphism and Helicobacter pylori cagA subtype infection. J Clin Pathol, 2001; 54: 703-706. – reference: 17) MittalRK: Hiatal hernia and gastrnesophageal reflux: another attempt to resolve the controversy. Gastroenterology, 1993; 105: 941-943. – reference: 22) MartinezSD, MalagonIB, GarewalHS, et al: Non-erosive reflux disease (NERD)-acid reflux and symptom patterns. Aliment Pharmacol Ther, 2003 ; 17: 537-545. – reference: 2) BarakN, EhrenpreisED, HarrisonJR, et al: Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev, 2002 ; 3: 9-15, – reference: 12) Stene-LarsenG, WebergR, Froyshov LarsenI, et al: Relationship of overweight to hiatus hernia and reflux oesophagitis. Scand J Gastroenterol, 1988; 23: 427-432. – reference: 30) MiwaH, GoMF, SatoN: H. pylori and gastric cancer: the Asian enigma. Am J Gastroenterol, 2002; 97: 1106-1112. – reference: 10) LockeGR 3rd, TalleyNJ, FettSL, et al: Risk factors associated with symptoms of gastroesophageal reflux. Am J Med, 1999; 106: 642-649. – reference: 20) VenablesTL, NewlandRD, PatelAC, et al: Omeprazole 10 milligrams once daily, omeprazole 20 milligrams once daily, or ranitidine 150 milligrams twice daily, evaluated as initial therapy for the relief of symptoms of gastro-oesophageal reflux disease in general practice. Scand J Gastroenterol, 1997; 32: 965-973. – reference: 23) KurosawaA, MiwaH, HiraiS, et al: Decreased expression of tight junction protein and increased cell proliferation in the esophageal mucosa in the endoscopy negative gastroesophageal reflux disease. Gastroenterology, 2002; 122: A418. – reference: 25) HondaS, FujiokaT, TokiedaM, et al: Development of Helicobacter pylori-induced gastric carcinoma in Mongolian gerbils. Cancer Res, 1998; 58: 4255-4259. – reference: 29) WongBC, LamSK, WongWM, et al: China Gastric Cancer Study Group. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA, 2004; 291: 187-194. – reference: 18) MiwaH, MinooT, HojoM, et al: Oesophageal hypersensitivity in Japanese patients with non-erosive gastro-oesophageal reflux diseases. Aliment Pharmacol Ther, 2004; 20 (Suppl 1): 112-117. – reference: 11) RuhlCE, EverhartJE: Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First national health and nutrition examination survey. Ann Epidemiol, 1999 ; 9: 424-435. – reference: 15) WisenO, RossnerS, JohanssonC: Impaired pancreatico-biliary response to vagal stimulation and to cholecystokinin in human obesity. Metabolism, 1988 ; 37: 436-441. – reference: 7) SifrimD, HollowayR, SilnyJ, et al: Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol, 2001; 96: 647- 655. – reference: 21) TytgatGN: Review article: management of mild and severe gastro-oesophageal reflux disease. Aliment Pharmacol Ther, 2003; 17 (Suppl 2): 52-56. – reference: 28) UemuraN, OkamotoS, YamamotoS, et al: Helicobacter pylori infection and the development of gastric cancer. N Engl J Med, 2001; 345: 784-789. – reference: 26) ShimizuN, IkeharaY, InaulaK, et al: Eradication diminishes enhancing effects of Helicobacter pylori infection on glandular stomach carcinogenesis in Mongolian gerbils. Cancer Res, 2000; 60: 1512-1514. – reference: 32) El-OmarEM, CarringtonM, ChowWH, et al: Interleukin-1 polymorphisms associated with increased risk of gastric cancer. Nature, 2000;404: 398-402. – reference: 14) MercerCD, WrenSF, DaCostaLR, et al: Lower esophageal sphincter pressure and gastroesophageal pressure gradients in excessively obese patients. J Med, 1987; 18: 135-146. |
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| Title | 生活習慣病と食道・胃疾患 |
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