薬剤性・腐食性食道炎の画像診断

Endoscopic Diagnosis of Drug-induced Esophagitis and Corrosive Esophagitis

要旨●薬剤性食道炎・腐食性食道炎は，経口摂取された薬剤や酸性またはアルカリ性物質，重金属などによる化学的食道粘膜傷害である．腐食性食道炎は成人では自殺企図による飲用が主であり，一般に原因物質が明確で炎症の領域が広範である．一方で薬剤性食道炎は，内服薬が食道の生理的狭窄部に長時間滞留することによる粘膜傷害であるため，内服から発症までに一定の時間経過を要する．一般に炎症の領域は狭く患者自身の認識も乏しいため，特徴的な内視鏡所見が診断の契機となることも多い．非心原性胸痛を主訴とする症例においては本症を疑い，病歴や内服歴，生活歴を十分に確認する必要がある．

　Drug-induced esophagitis and corrosive esophagitis are chemical injuries to the esophageal mucosa caused by orally ingested drugs, acids, alkalis, heavy metals, and other toxic agents. In corrosive esophagitis, which is usually associated with suicide attempts, the causative agent is typically evident and the affected area with inflammation is extensive. Conversely, drug-induced esophagitis is characterized by mucosal injury secondary to prolonged drug retention within the natural esophageal constrictions and there is a delay between drug ingestion and symptomatic onset. The inflamed area is typically narrow and may not be readily apparent to the patient ; therefore, characteristic endoscopic findings are a critical diagnostic indicator. Drug-induced esophagitis should be considered in patients presenting with noncardiogenic chest pain as the primary complaint, and comprehensive reevaluation of the patient's medical history, including a detailed account of their medical and lifestyle factors, is essential.