@article{oai:ir.kagoshima-u.ac.jp:00015628,
 author = {小吉, 尚裕 and 前田, 英仁 and 福迫, 哲史 and 石田, 紀久 and 猪狩, 洋介 and 佐々木, 文郷 and 藤田, 浩 and 菰原, 義弘 and 井戸, 章雄},
 journal = {鹿児島大学医学雑誌, Medical journal of Kagoshima University},
 month = {},
 note = {An 86-year-old man presented to our hospital with a 1-week history of undifferentiated dizziness. He was hospitalized for intensive evaluation as hematological tests showed severe anemia (Hb5.3g/dL), along with giant erythroblastic anemia.
Based on the results of hematological analysis and esophagogastroduodenoscopy findings, we diagnosed the patient with pernicious anemia caused by type A gastritis. His pernicious anemia was treated by intramuscular injections of vitamin B12, which improved the anemia.
Esophagogastroduodenoscopy also showed a 25-mm sized polypoid lesion in the upper-posterior wall of the stomach. Therefore, he underwent further evaluation with esophagogastroduodenoscopy, endoscopic ultrasonography, contrast-enhanced CT, and biopsy. Based on the results, we diagnosed the patient with early gastric well-differentiated tubular adenocarcinoma for which a curative endoscopic submucosal dissection (ESD) was performed.Furthermore, another 10-mm sized elevated-type lesion with no continuity was observed, which was also a well-differentiated tubular adenocarcinoma.
As the number of patients with Helicobacter pylori infection is decreasing, physicians need to be aware of type A gastritis., 症例は86歳男性. 1週間前よりふらつきが出現するようになったため当院を受診した. 血液検査でHb5.3g/dLと重度の貧血を認めたため精査目的に入院となった. 巨赤芽球性貧血であり,　血液検査, 内視鏡所見からA型胃炎に伴う悪性貧血と診断した. ビタミンB12を筋肉内投与することで貧血は改善した.また胃体上部後壁に25mm大の0 -Ⅰ病変を認め, 生検で高分化管状腺癌の診断であった. 内視鏡検査, 超音波内視鏡検査, 造影CT検査を施行し, 早期胃癌と診断した. 内視鏡的粘膜下層剥離術を施行し, 最終病理診断では深達度は粘膜にとどまり内視鏡的根治度Aであった. またその近傍に連続性を持たない10mm大の0-Ⅱa病変を認め, 同病変も高分化管状腺癌であった.
日常診療の際には，貧血の原因として A 型胃炎を念頭に置く必要があり，悪性貧血，胃癌の合併に注意を要する. H. pylori感染とそれに伴う疾患が減少する中で, 今後A型胃炎の特徴について熟知する必要があると考える.},
 pages = {17--21},
 title = {A型胃炎に悪性貧血, 早期胃癌を合併した1例},
 volume = {72},
 year = {2020}
}