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<title>自己免疫性胃炎 診療の手引き | 株式会社文光堂</title>


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<meta name="description" content="自己免疫性胃炎はかつて稀な疾患とされたが，いまや日常診療で頻繁に遭遇する疾患となっている．胃癌や胃神経内分泌腫瘍の合併，自己免疫疾患との関連，ビタミンB12欠乏による神経障害など，多様な課題をはらむ疾患である．診断の進め方，患者への説明，長期フォローアップのあり方など，迷いやすいポイントも多い．本書は，自己免疫性胃炎診療の実際をわかりやすく整理した本邦初の実践的手引き書．これまでになかった視点を提">

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		<h1 class="catchCopy">内視鏡医へ向けた自己免疫性胃炎診療の羅針盤</h1>
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					編集：春間　賢（淳風会医療診療セクター長／川崎医科大学名誉教授， 日本消化器内視鏡学会関連研究会「自己免疫性胃炎の診断基準確立とその臨床病理学的意義に関する研究会」メンバー）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3><h3 class="review">書評</h3></div><section class="current content">自己免疫性胃炎はかつて稀な疾患とされたが，いまや日常診療で頻繁に遭遇する疾患となっている．胃癌や胃神経内分泌腫瘍の合併，自己免疫疾患との関連，ビタミンB12欠乏による神経障害など，多様な課題をはらむ疾患である．診断の進め方，患者への説明，長期フォローアップのあり方など，迷いやすいポイントも多い．本書は，自己免疫性胃炎診療の実際をわかりやすく整理した本邦初の実践的手引き書．これまでになかった視点を提供し，明日からの診療に直結する解説や症例を収載．実地現場で内視鏡検査を行っている臨床医にとって必携の一冊．</section><section class="preface">序文<br><br>　自己免疫性胃炎autoimmune gastritis（AIG）は，以前は悪性貧血と診断された患者の精査の内視鏡検査で診断されていました．悪性貧血が日本ではまれな疾患であることから，AIG も日本ではまれな胃疾患と考えられていました．しかしながら，最近，AIG は日々の上部消化管内視鏡でよく遭遇する疾患であることが明らかになりました．その背景にはAIG の認知度が高まったことが大きく関与していると思われますが，ピロリ除菌の普及によりピロリ感染に隠されていたAIG が顔を現したことや，自己免疫性疾患そのものが増加していることも関係している可能性もあります．AIG の診断基準は日本消化器内視鏡学会の附置研究会により作成されましたが，実際にAIG と診断した場合にどのような対応をすればよいのでしょうか．AIG と診断すれば胃癌だけでなく，胃神経内分泌腫瘍neuroendocrine tumor（NET）の合併や，将来悪性貧血を発症するのか，甲状腺をはじめとした他部位の自己免疫性疾患の合併，ビタミンB12 欠乏による亜急性連合性脊髄変性症の発症など多くの問題が出てまいります．そのような状況を患者にどのように，どこまで説明すればよいでしょうか．あまり恐れさせてはいけないので，「大丈夫です．安心してください」といった言葉はかけますが，患者に定期的に受診し内視鏡検査を受けてもらう必要がありますので，安心しすぎて医療機関離れになってもいけません．AIG は非常に臨床的対応が難しい疾患です．そこで，実地診療で内視鏡検査を行っておられる医師や，AIG の患者を診ておられる医師を対象に，AIG を疑った場合，あるいはAIG と診断した場合，どのように考えて対応すればよいかを解説した手引書として本書を作成いたしました．AIG は古くからある疾患ではあるものの日本での歴史は浅く，エビデンスが少ないという現状ではありますが，本書を購入いただき，熟読していただければ安心してAIG の診療に臨むことができると考えております．しかしながら，本書の作成過程で多くの課題も出てまいりました．AIG 初期病変の診断とその意義，ピロリ感染との関わり，胃自己抗体の判定法，生検診断の問題などです．購読後ご意見を頂き，次のステップとして読者の方々と一緒に「AIG 診療のガイドライン」を作成できればと考えております．<br><br>2025 年10 月<br>淳風会医療診療セクター長 / 川崎医科大学名誉教授<br>春間　　賢</section><section class="indexes">序論<br>　1．日本のAIGの診断基準<br>　2．最初にAIGを診断するコツ<br>　3．本書を読むにあたって<br>　4．AIG を疑ったときの胃生検について<br>Ⅰ 総論<br>　Q1　AIGを診断する意義は？<br>　Q2　AIG とStrickland らのA 型胃炎は同じ疾患か？<br>Ⅱ 疫学<br>　Q3　本邦でAIGは増えているのか？<br>　　　　―AIG の頻度は，男女差，発症年齢，家族集積性について―<br>Ⅲ 病因・病態<br>　Q4　AIGの原因は？ その病態は？<br>　　　　－H. pyloriとの関連<br>　Q5　AIG の自然史と病期の概要は？<br>　Q6　多腺性自己免疫症候群とは？　AIGとの関連は？<br>　Q7　日本と海外でAIGの特徴は違うのか？<br>Ⅳ 診断<br>　Q8　検診からAIGの拾い上げは可能か？　　<br>　Q9　AIGを疑うべき臨床的な状況は？<br>　Q10　AIG を疑った場合，確定診断と積極的診断に必要な検査は何か？<br>　Q11　よりよいAIGの病理診断に内視鏡医が注意すべきことは？<br>　　　　－病理医から内視鏡医へのアドバイス－<br>　Q12　AIGの病理診断で注意すべき点は何か？　<br>　　　　－内視鏡医が知っておくべきAIGの病理所見－<br>　Q13　AIGの内視鏡診断はどのように行うか?<br>　　　　－病期分類について－<br>　Q14　内視鏡的にAIG の病期診断は可能か？<br>　Q15　AIGの血清診断にはどのようなものがあるか？<br>　Q16　胃X線検査はAIGの診断に有用か？<br>　Q17　H. pyloriの除菌失敗を繰り返すときにAIGを疑うべきか？<br>　Q18　AIG診断にIEEは有用か？<br>　Q19　AIGと鑑別困難なH.pylori除菌後症例とは？<br>Ⅴ 合併症<br>　Q20　AIGで注意すべき合併症は何か？（総論）<br>　Q21　AIGでの胃癌の特徴・合併頻度はどの程度か？<br>　Q22　H. pylori未感染AIGに胃癌は合併するのか？<br>　Q23　AIGのNETの合併頻度はどの程度か？<br>　Q24　AIGでの貧血にどのように対応するか？<br>　Q25　AIGでの神経学的合併症にはどのようなものがあるか？<br>　Q26　AIG の胃内合併症（病変）にはどのようなものがあるか？<br>　Q27　AIG の膵癌，大腸癌など他部位の胃外悪性腫瘍の合併率は高いか？<br>Ⅵ 治療と経過<br>　Q28　AIGの治療目標は何か？　AIG症例の経過観察の仕方とは？<br>　Q29　H. pylori陽性のAIGに対して除菌治療は行うべきか？<br>　Q30　AIGでNSAIDsやDOAC を投与する際にPPI/P-CABを併用する必要はあるか？<br>Ⅶ 予後<br>　Q31　AIG の生命予後は？<br>Ⅷ 症例<br>　症例1　AIGに合併したGAVEの１例<br>　症例2　AIG に発症した亜鉛製剤による胃粘膜傷害の2例<br>　症例3　AIGの経過中に発症した１型糖尿病の１例<br>　症例4　AIG中に発見された好酸球性食道炎の１例<br>　症例5　AIG 診断後，再受診せず約3 年後より急速に進行したSCD を診断し治療により改善した１例</section><section class="review">◆書評1◆<br>評者：鈴木秀和（一般社団法人日本ヘリコバクター学会理事長，東海大学医学部内科学系消化器内科学教授）<br><br>　『自己免疫性胃炎 診療の手引き』は，長年にわたり胃炎研究と消化器内視鏡学の最前線を牽引されてきた春間　賢先生（川崎医科大学名誉教授）が編集された，臨床知の集大成である．今や本領域で知らぬ者はいない名著『胃炎の京都分類』は，春間先生が胃炎診療の世界標準化を目指し，胃の炎症・萎縮・発癌リスク評価を体系化された成果であり，その真価はすでに確立している．その金字塔に続くものとして，本書は自己免疫性胃炎（AIG）という新たな臨床課題に真正面から挑む，力強い試みの結晶である．<br>　かつて悪性貧血の背景疾患として稀とされたAIGは，近年，H.pylori除菌後に顕在化する症例が増え，日常診療で遭遇する機会が確実に増加している．本書は，その診断・説明・経過観察について，最新知見に基づき具体的かつ実践的に整理されている．とりわけ注目すべきは，H.pylori感染胃炎とAIGにおける胃粘膜萎縮の共通点と相違点に対する鋭い視座である．両者はいずれも萎縮性変化を呈するが，前者では幽門腺領域から体部へ進展する一方，後者では体部・噴門部優位となり，逆萎縮を呈する点が特徴的である．この形態的対比は，免疫環境の差異，自己抗体の関与，さらには発癌経路の多様性を理解する上で極めて重要である．また，両病態の合併例においては，炎症像や萎縮の進展が複雑化し，自己抗体の影響や除菌効果の評価が難しくなるため，診療方針決定が一層困難となる．本書はその点についても具体例を示し，臨床家が直面する課題に的確に応えている．<br>　さらに，AIGに随伴する胃癌・胃神経内分泌腫瘍，ビタミンB12欠乏や神経障害，自己免疫疾患の併存（多腺性自己免疫症候群等）といった全身的課題にも丁寧に言及し，胃疾患を超えた視野で病態理解を深める構成となっている．本書がAIG診療の標準化を推進し，H.pylori関連疾患を含む胃炎学の統合的発展を牽引することを強く期待する．<br>　大先輩の貴重な業績に対し，私のような若輩が書評を記す僭越をお許しいただきたい．心より敬意を表して，本書の刊行を寿ぐ．<br><br>（「Medical Practice」2025年12月号（42巻12号）掲載）</section></article>
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