胃潰瘍の総合医学的治療研究(2) : 精神神経要因の治癒経過への影響について

抄録

In connection with a series of studies on the comprehensive medical treatment of peptic ulcers, the authors have previously reported a clinical study on the inpatient treatment with placebo and on the basic mechanisms of ulcer healing. This second report deals with the influence of psychoneurotic factors on the healing process of gastric ulcers.The study was undertaken on a total of 50 inpatients, each of whom was afflicted with an active single ulcer. Relations among seven factors influencing the rate of ulcer healing (age, sex, size of ulcer, gastric acid secretion, anxiety levels, types of mecholyl response on admission and emotional stress) and the time required for healing were analysed. The results obtained were as follows : 1) Of the 13 patients whose ulcers were less than 10mm in diameter, 11(84.3%) were healed at the end of 8th week, whereas out of the 37 patients whose ulcers were larger than 10mm in diameter, 15 cases (40.5%) were healed within 8 weeks. The differences between these two groups statistically significant (P<0.02).2) The patients with ulcers larger than 10mm in diameter were tentatively classified into two types, that is, i) the mental, physical stable type and ii) the psychosomatic type according to the presence or absence of emotional stress and the types of mecholyl response. Of the 15 cases belonging to the former type, 9 (60.0%) were healed at the end of the 8th week and 14 (93.3%) at the end of the 12th week. When the same period of examination was applied to the 22 cases of the latter type, the numbers were 6 (27.2%) and 15 (68.2%) respectively. The differences in the time required for the healing of the two types were statistically significant. Ages were the same for the two types.3) In the present study, it was not established whether or not psychoneurotic factors affected the rate of ulcer healing in the patients whose ulcers were less than 10mm in diameter.The above results suggested that emotional stress and an imbalance in the autonomic nervous functions influenced the healing process of relatively large gastric ulcers by delaying it.