日本総合健診医学会 第53回大会・特別講演6 胃がん検診の今昔・未来：内視鏡？ピロリ
胃がんは日本における主要ながんの一つであり、その予防と早期発見のための検診が重要視されている。従来、バリウムX線造影検査が胃がん検診の主流であったが、近年では内視鏡検査の有用性が広く認識されつつある。日本では2015年に対策型検診として、漸く内視鏡検査が導入されたが、その普及率は自治体ごとに異なる。お隣の韓国と比較すると、日本における内視鏡検診の普及は遅れているのが現状である。本総説では、胃がん検診の今昔を概観し、ピロリ菌感染率の低下に伴う胃がん発生率の推移、内視鏡検査の有用性、および人工知能（AI）を用いた画像診断技術の進歩について論じる。さらに、胃がんの一次予防としてのピロリ菌除菌の意義に...
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| Published in | 総合健診 Vol. 52; no. 3; pp. 486 - 492 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本総合健診医学会
10.05.2025
|
| Online Access | Get full text |
| ISSN | 1347-0086 1884-4103 |
| DOI | 10.7143/jhep.52.486 |
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| Abstract | 胃がんは日本における主要ながんの一つであり、その予防と早期発見のための検診が重要視されている。従来、バリウムX線造影検査が胃がん検診の主流であったが、近年では内視鏡検査の有用性が広く認識されつつある。日本では2015年に対策型検診として、漸く内視鏡検査が導入されたが、その普及率は自治体ごとに異なる。お隣の韓国と比較すると、日本における内視鏡検診の普及は遅れているのが現状である。本総説では、胃がん検診の今昔を概観し、ピロリ菌感染率の低下に伴う胃がん発生率の推移、内視鏡検査の有用性、および人工知能（AI）を用いた画像診断技術の進歩について論じる。さらに、胃がんの一次予防としてのピロリ菌除菌の意義についても議論する。今後の展望（未来）として、内視鏡診断技術、特にAI内視鏡のさらなる進化が期待される。 |
|---|---|
| AbstractList | 胃がんは日本における主要ながんの一つであり、その予防と早期発見のための検診が重要視されている。従来、バリウムX線造影検査が胃がん検診の主流であったが、近年では内視鏡検査の有用性が広く認識されつつある。日本では2015年に対策型検診として、漸く内視鏡検査が導入されたが、その普及率は自治体ごとに異なる。お隣の韓国と比較すると、日本における内視鏡検診の普及は遅れているのが現状である。本総説では、胃がん検診の今昔を概観し、ピロリ菌感染率の低下に伴う胃がん発生率の推移、内視鏡検査の有用性、および人工知能（AI）を用いた画像診断技術の進歩について論じる。さらに、胃がんの一次予防としてのピロリ菌除菌の意義についても議論する。今後の展望（未来）として、内視鏡診断技術、特にAI内視鏡のさらなる進化が期待される。 |
| Author | 鈴木 秀和 |
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| References | 10) Ford AC, Yuan Y, Moayyedi P: Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis. Gut 2020; 69(12): 2113-21. 19) Fu XY, Mao XL, Chen YH, et al: The Feasibility of Applying Artificial Intelligence to Gastrointestinal Endoscopy to Improve the Detection Rate of Early Gastric Cancer Screening. Front Med (Lausanne) 2022; 9: 886853. 13) Haruma K, Kato M, Inoue K, et al: Kyoto classification of gastritis. 1st ed. Tokyo: Nihon Medical Center, 2014. 17) Ochiai K, Ozawa T, Shibata J, Ishihara S, Tada T: Current Status of Artificial Intelligence-Based Computer-Assisted Diagnosis Systems for Gastric Cancer in Endoscopy. Diagnostics (Basel) 2022; 12 (12). 12) Suzuki H, Matsuzaki J: Gastric cancer: evidence boosts Helicobacter pylori eradication. Nat Rev Gastroenterol Hepatol 2018; 15(8): 458-60. 15) Toyoshima O, Nishizawa T, Yoshida S, et al: Consistency between the endoscopic Kyoto classification and pathological updated Sydney system for gastritis: A cross-sectional study. J Gastroenterol Hepatol 2022; 37(2): 291-300. 16) Dixon MF, Genta RM, Yardley JH, Correa P: Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20(10): 1161-81. 18) Xiao Z, Ji D, Li F, Li Z, Bao Z: Application of Artificial Intelligence in Early Gastric Cancer Diagnosis. Digestion 2022; 103(1): 69-75. 20) Suzuki H, Yoshitaka T, Yoshio T, Tada T: Artificial intelligence for cancer detection of the upper gastrointestinal tract. Dig Endosc 2021; 33(2): 254-62. 14) Suzuki H, Sano M, Nishizawa T, Toyoshima O: Endoscopic diagnosis of early gastric cancer and high-risk gastritis. Korean J Helicobacter Up Gastrointest Res 2024; 24(4): 311-8. 2) Huang RJ, Laszkowska M, In H, Hwang JH, Epplein M: Controlling Gastric Cancer in a World of Heterogeneous Risk. Gastroenterology 2023; 164(5): 736-51. 11) Choi IJ, Kim YI, Park B: Helicobacter pylori and Prevention of Gastric Cancer. N Engl J Med 2018; 378(23): 2244-5. 6) Tan Y, Matsuzaki J, Saito Y, Suzuki H: Environmental factors in gastric carcinogenesis and preventive intervention strategies. Genes Environ 2025; 47(1): 5. 5) Kato M, Ota H, Okuda M, et al: Guidelines for the management of Helicobacter pylori infection in Japan: 2016 Revised Edition. Helicobacter 2019; 24(4): e12597. 9) Tsugawa H, Suzuki H, Saya H, et al: Reactive oxygen species-induced autophagic degradation of Helicobacter pylori CagA is specifically suppressed in cancer stem-like cells. Cell Host Microbe 2012; 12(6): 764-77. 4) Marshall BJ, Warren JR: Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1(8390): 1311-5. 8) Tsugawa H, Mori H, Matsuzaki J, et al: CAPZA1 determines the risk of gastric carcinogenesis by inhibiting Helicobacter pylori CagA-degraded autophagy. Autophagy 2019; 15(2): 242-58. 3) Sun D, Mulder DT, Li Y, et al: The Effect of Nationwide Organized Cancer Screening Programs on Gastric Cancer Mortality: A Synthetic Control Study. Gastroenterology 2024; 166(3): 503-14. 7) Tsugawa H, Kato C, Mori H, et al: Cancer Stem-Cell Marker CD44v9-Positive Cells Arise From Helicobacter pylori-Infected CAPZA1-Overexpressing Cells. Cell Mol Gastroenterol Hepatol 2019; 8(3): 319-34. 1) Hamashima C, Shabana M, Okada K, Okamoto M, Osaki Y: Mortality reduction from gastric cancer by endoscopic and radiographic screening. Cancer Sci 2015; 106(12): 1744-9. |
| References_xml | – reference: 7) Tsugawa H, Kato C, Mori H, et al: Cancer Stem-Cell Marker CD44v9-Positive Cells Arise From Helicobacter pylori-Infected CAPZA1-Overexpressing Cells. Cell Mol Gastroenterol Hepatol 2019; 8(3): 319-34. – reference: 20) Suzuki H, Yoshitaka T, Yoshio T, Tada T: Artificial intelligence for cancer detection of the upper gastrointestinal tract. Dig Endosc 2021; 33(2): 254-62. – reference: 19) Fu XY, Mao XL, Chen YH, et al: The Feasibility of Applying Artificial Intelligence to Gastrointestinal Endoscopy to Improve the Detection Rate of Early Gastric Cancer Screening. Front Med (Lausanne) 2022; 9: 886853. – reference: 16) Dixon MF, Genta RM, Yardley JH, Correa P: Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20(10): 1161-81. – reference: 4) Marshall BJ, Warren JR: Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1(8390): 1311-5. – reference: 11) Choi IJ, Kim YI, Park B: Helicobacter pylori and Prevention of Gastric Cancer. N Engl J Med 2018; 378(23): 2244-5. – reference: 14) Suzuki H, Sano M, Nishizawa T, Toyoshima O: Endoscopic diagnosis of early gastric cancer and high-risk gastritis. Korean J Helicobacter Up Gastrointest Res 2024; 24(4): 311-8. – reference: 12) Suzuki H, Matsuzaki J: Gastric cancer: evidence boosts Helicobacter pylori eradication. Nat Rev Gastroenterol Hepatol 2018; 15(8): 458-60. – reference: 10) Ford AC, Yuan Y, Moayyedi P: Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis. Gut 2020; 69(12): 2113-21. – reference: 6) Tan Y, Matsuzaki J, Saito Y, Suzuki H: Environmental factors in gastric carcinogenesis and preventive intervention strategies. Genes Environ 2025; 47(1): 5. – reference: 2) Huang RJ, Laszkowska M, In H, Hwang JH, Epplein M: Controlling Gastric Cancer in a World of Heterogeneous Risk. Gastroenterology 2023; 164(5): 736-51. – reference: 9) Tsugawa H, Suzuki H, Saya H, et al: Reactive oxygen species-induced autophagic degradation of Helicobacter pylori CagA is specifically suppressed in cancer stem-like cells. Cell Host Microbe 2012; 12(6): 764-77. – reference: 13) Haruma K, Kato M, Inoue K, et al: Kyoto classification of gastritis. 1st ed. Tokyo: Nihon Medical Center, 2014. – reference: 3) Sun D, Mulder DT, Li Y, et al: The Effect of Nationwide Organized Cancer Screening Programs on Gastric Cancer Mortality: A Synthetic Control Study. Gastroenterology 2024; 166(3): 503-14. – reference: 8) Tsugawa H, Mori H, Matsuzaki J, et al: CAPZA1 determines the risk of gastric carcinogenesis by inhibiting Helicobacter pylori CagA-degraded autophagy. Autophagy 2019; 15(2): 242-58. – reference: 5) Kato M, Ota H, Okuda M, et al: Guidelines for the management of Helicobacter pylori infection in Japan: 2016 Revised Edition. Helicobacter 2019; 24(4): e12597. – reference: 17) Ochiai K, Ozawa T, Shibata J, Ishihara S, Tada T: Current Status of Artificial Intelligence-Based Computer-Assisted Diagnosis Systems for Gastric Cancer in Endoscopy. Diagnostics (Basel) 2022; 12 (12). – reference: 15) Toyoshima O, Nishizawa T, Yoshida S, et al: Consistency between the endoscopic Kyoto classification and pathological updated Sydney system for gastritis: A cross-sectional study. J Gastroenterol Hepatol 2022; 37(2): 291-300. – reference: 1) Hamashima C, Shabana M, Okada K, Okamoto M, Osaki Y: Mortality reduction from gastric cancer by endoscopic and radiographic screening. Cancer Sci 2015; 106(12): 1744-9. – reference: 18) Xiao Z, Ji D, Li F, Li Z, Bao Z: Application of Artificial Intelligence in Early Gastric Cancer Diagnosis. Digestion 2022; 103(1): 69-75. |
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| Title | 日本総合健診医学会 第53回大会・特別講演6 胃がん検診の今昔・未来：内視鏡？ピロリ |
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